FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain.
Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.
Bipolar Disord. 2019 Aug;21(5):449-457. doi: 10.1111/bdi.12767. Epub 2019 Apr 25.
While widespread cortical and subcortical brain functional abnormalities have been found in bipolar disorder, the changes that take place between illness phases and recovery are less clearly documented. Only a small number of longitudinal studies of manic patients, in particular, have been carried out.
Twenty-six bipolar patients underwent fMRI during performance of the n-back working memory task when manic and again after recovery. Twenty-six matched healthy controls were also scanned on two occasions. Task-related activations and de-activations were examined.
When manic, the patients showed clusters of significantly reduced activation in the left dorsolateral prefrontal cortex (DLPFC)/precentral cortex and the parietal cortex/superior precuneus bilaterally. They also showed failure of de-activation in the ventromedial frontal cortex (vmPFC). After recovery, activation in the left DLPFC/precentral cortex and in the bilateral parietal cortex/superior precuneus clusters increased significantly. However, failure of de-activation remained present in the vmPFC.
Recovery from mania is associated with normalization of DLPFC and parietal hypoactivation, but not with vmPFC failure of de-activation, which accordingly appears to represent a trait abnormality in the disorder.
尽管双相情感障碍存在广泛的皮质和皮质下脑功能异常，但疾病发作和缓解期之间的变化却鲜为人知。特别是针对躁狂症患者的纵向研究数量较少。
26 名双相情感障碍患者在躁狂发作期间和恢复后进行了 n-back 工作记忆任务的 fMRI 扫描。26 名匹配的健康对照者也在两次扫描中接受了扫描。研究人员观察了与任务相关的激活和去激活情况。
当患者处于躁狂状态时，他们的左侧背外侧前额叶皮层（DLPFC）/前额叶皮层和双侧顶叶皮层/上楔前叶簇中显著减少了激活。他们的腹内侧前额叶皮层（vmPFC）也存在去激活失败的情况。恢复后，左侧 DLPFC/前额叶皮层和双侧顶叶皮层/上楔前叶簇的激活显著增加。但是，vmPFC 中的去激活失败仍然存在。
从躁狂症中恢复与 DLPFC 和顶叶激活不足的正常化有关，但与 vmPFC 的去激活失败无关，这表明 vmPFC 的去激活失败可能是该疾病的一种特质异常。
