Department of Psychiatry and Behavioral Sciences, Dell Medical School, University of Texas, Austin, TX, USA.
Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA.
Bipolar Disord. 2021 Aug;23(5):500-508. doi: 10.1111/bdi.13025. Epub 2020 Nov 18.
Altered activity in the ventrolateral prefrontal and anterior cingulate cortices, as well as subcortical and amygdala projection sites, was previously reported during a first manic episode in youth with bipolar disorder and observed to be associated with treatment response. To extend these findings, we investigated functional connectivity among these regions in first-episode manic participants who remitted after 8 weeks of treatment compared to those who did not.
Forty-two participants with bipolar disorder (60% female) during their first manic episode were recruited and received 8 weeks of treatment. Twenty-one remitted following treatment. Participants completed fMRI scans, at baseline and following 8 weeks of treatment, while performing a continuous performance task with emotional and neutral distractors. A healthy comparison group (n = 41) received fMRI evaluations at the same intervals. Differences in functional connectivity of the amygdala and caudate with the rostral anterior cingulate and ventrolateral prefrontal cortices at baseline (and changes in functional connectivity following treatment) were modeled between groups.
At baseline, non-remitters showed an increase in positive connectivity between right anterior cingulate and caudate and a loss of negative connectivity between right anterior cingulate and amygdala, compared to healthy participants. Individuals who remitted following treatment showed an increase in negative connectivity between amygdala and left anterior cingulate 8 weeks following treatment.
Results provide evidence of alterations in anterior cingulate amygdala and caudate functional connectivity in bipolar disorder non-remitters during a first manic episode and changes in anterior cingulate functional connectivity associated with remission suggesting targets to predict treatment response. Registered at ClinicalTrials.Gov; Functional and Neurochemical Brain Changes in First-episode Bipolar Mania. NCT00609193. URL: https://clinicaltrials.gov/ct2/show/NCT00609193?term=strakowskirank=1.
在双相情感障碍青年首次躁狂发作期间，先前报道了腹外侧前额叶和前扣带回皮质以及皮质下和杏仁核投射部位的活动改变，并观察到与治疗反应相关。为了扩展这些发现，我们研究了在接受 8 周治疗后缓解的首发躁狂患者与未缓解的患者这些区域之间的功能连接。
招募了 42 名处于首次躁狂发作期间的双相情感障碍患者（60%为女性），并接受了 8 周的治疗。21 名患者在治疗后缓解。参与者在基线和 8 周治疗后完成了 fMRI 扫描，同时进行带有情绪和中性分心物的连续表现任务。41 名健康对照组在相同时间间隔接受 fMRI 评估。在基线时（以及治疗后功能连接的变化），在组间对杏仁核和尾状核与额前扣带回和腹外侧前额叶皮质之间的功能连接差异进行建模。
在基线时，与健康参与者相比，非缓解者表现出右侧前扣带回和尾状核之间正连接增加，以及右侧前扣带回和杏仁核之间负连接丧失。在治疗后缓解的个体在治疗后 8 周时显示出杏仁核和左前扣带回之间负连接增加。
结果提供了证据表明，在首次躁狂发作期间，双相情感障碍非缓解者的前扣带回-杏仁核和尾状核功能连接存在改变，以及与缓解相关的前扣带回功能连接的改变，这表明可以预测治疗反应的靶点。在 ClinicalTrials.Gov 注册；首发双相躁狂的功能和神经化学脑变化。NCT00609193。网址：https://clinicaltrials.gov/ct2/show/NCT00609193？term=strakowskirank=1。
