Department of Child Psychology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, China.
Department of Radiology, Shandong First Medical University & Shandong Academy of Medical Sciences, Tai'an, Shandong, China.
J Affect Disord. 2021 May 1;286:87-93. doi: 10.1016/j.jad.2021.02.077. Epub 2021 Mar 4.
Bipolar disorder (BD) with psychotic symptoms is a specific phenotype that presents greater risk of relapse and worse outcomes than nonpsychotic BD, however, the underlying mechanisms remain unknown and are less revealed in youth. Thus, the aims of the present study were to investigate brain structural alterations in pediatric bipolar disorder (PBD) patients with and without psychotic symptoms, and specifically to evaluate the impact of psychotic features on gray matter volume (GMV) in PBD patients.
A total of 73 individuals were recruited into three groups, n = 28, psychotic PBD, P-PBD; n = 26, nonpsychotic PBD, NP-PBD; and n = 19, healthy controls, HC. All participants underwent high-resolution structural magnetic resonance scans. Voxel-based morphometry was used to investigate GMV alterations. Analyses of variance (ANOVA) were performed to obtain brain regions with significant differences among three groups and then post hoc tests were calculated for inter-group comparisons.
The ANOVA revealed significant GMV differences among three groups in the bilateral amygdala-hippocampus-parahippocampal complex (AMY-HIS-ParaHIS complex), left superior temporal gyrus (STG), left inferior frontal gyrus (IFG), bilateral putamen (PUT), left precentral gyrus (PG), left supramarginal gyrus (SMG), and right inferior parietal lobule (IPL). Compared with HCs, P-PBD patients showed decreased GMV in the bilateral AMY-HIS-ParaHIS complex, left STG, left IFG, bilateral PUT, and left PG; while NP-PBD patients exhibited decreased GMV in the left IFG, left PG, left SMG, and right IPL. Furthermore, P-PBD patients showed increased GMV in the right IPL when comparing to NP-PBD patients.
The present findings require replication in larger samples and verification in medication free subjects.
The present findings suggested that psychotic features in PBD were associated with extensive brain structural lesions mainly located in the prefrontal-limbic-striatum circuit, which might represent the pathological basis of more sever symptoms in patients with psychotic PBD.
伴精神病性症状的双相障碍（BD）是一种特定的表型，其复发风险和结局较非精神病性 BD 更差，但其潜在机制尚不清楚，在青少年中表现得较少。因此，本研究旨在探讨伴和不伴精神病性症状的儿科双相障碍（PBD）患者的脑结构改变，并特别评估精神病性特征对 PBD 患者灰质体积（GMV）的影响。
共纳入 73 名个体，分为三组：28 名伴精神病性 PBD 患者（P-PBD），26 名不伴精神病性 PBD 患者（NP-PBD），19 名健康对照者（HC）。所有参与者均接受高分辨率结构磁共振扫描。基于体素的形态测量学用于研究 GMV 改变。方差分析（ANOVA）用于获得三组间存在显著差异的脑区，然后进行事后检验以进行组间比较。
方差分析显示三组间在双侧杏仁核-海马体-旁海马复合体（AMY-HIS-ParaHIS 复合体）、左侧颞上回（STG）、左侧额下回（IFG）、双侧壳核（PUT）、左侧中央前回（PG）、左侧缘上回（SMG）和右侧顶下小叶（IPL）存在显著的 GMV 差异。与 HC 相比，P-PBD 患者双侧 AMY-HIS-ParaHIS 复合体、左侧 STG、左侧 IFG、双侧 PUT 和左侧 PG 的 GMV 减少；NP-PBD 患者左侧 IFG、左侧 PG、左侧 SMG 和右侧 IPL 的 GMV 减少。此外，与 NP-PBD 患者相比，P-PBD 患者右侧 IPL 的 GMV 增加。
本研究结果需要在更大的样本中复制，并在未用药的受试者中验证。
本研究结果表明，PBD 中的精神病性特征与广泛的脑结构损伤有关，主要位于前额叶-边缘-纹状体回路，这可能代表精神病性 PBD 患者症状更严重的病理基础。
