Kjærstad Hanne Lie, de Siqueira Rotenberg Luisa, Macoveanu Julian, Coello Klara, Faurholt-Jepsen Maria, Bjertrup Anne Juul, Knudsen Gitte M, Fisher Patrick M, Vinberg Maj, Kessing Lars Vedel, Lafer Beny, Miskowiak Kamilla Woznica
Neurocognition and Emotion in Affective Disorders (NEAD) Centre, Psychiatric Centre Copenhagen, Mental Health Services, Capital Region of Denmark, and Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
Copenhagen Affective Disorder Research Centre (CADIC), Psychiatric Centre Copenhagen, Frederiksberg Hospital, Frederiksberg, Denmark.
Bipolar Disord. 2024 Sep;26(6):556-569. doi: 10.1111/bdi.13444. Epub 2024 May 2.
This study aimed to investigate the neural underpinnings of emotional cognition subgroups in recently diagnosed patients with bipolar disorder (BD) and change over time over a 15-month follow-up period.
Patients and healthy controls (HC) underwent emotional and nonemotional cognitive assessments and functional magnetic resonance imaging (fMRI) at the baseline (BD n = 87; HC n = 65) and at 15-month follow-up (BD n = 44; HC n = 38). Neural activity during emotion reactivity and regulation in response to aversive pictures was assessed during fMRI. Patients were clustered into subgroups based on their emotional cognition and, with HC, were compared longitudinally on cognition and neural activity during emotion reactivity and regulation.
Patients were optimally clustered into two subgroups: Subgroup 1 (n = 40, 46%) was characterized by heightened emotional reactivity in negative social scenarios, which persisted over time, but were otherwise cognitively intact. This subgroup exhibited stable left amygdala hyper-activity over time during emotion reactivity compared to subgroup 2. Subgroup 2 (n = 47, 54%) was characterized by global emotional cognitive impairments, including stable difficulties with emotion regulation over time. During emotion regulation across both time points, this group exhibited hypo-activity in the left dorsolateral prefrontal cortex. Additionally, patients in subgroup 2 had poorer nonemotional cognition, had more psychiatric hospital admissions and history of psychotic episodes than those in subgroup 1.
Broad impairments in emotional cognition in approximately half of BD patients and associated nonemotional cognitive deficits may originate from insufficient recruitment of prefrontal resources, contributing to poorer clinical outcomes.
本研究旨在调查近期诊断为双相情感障碍（BD）的患者情绪认知亚组的神经基础，并在15个月的随访期内观察其随时间的变化。
患者和健康对照者（HC）在基线时（BD组n = 87；HC组n = 65）以及15个月随访时（BD组n = 44；HC组n = 38）接受了情绪和非情绪认知评估以及功能磁共振成像（fMRI）。在fMRI期间评估对厌恶图片的情绪反应和调节过程中的神经活动。根据患者的情绪认知将其聚类为亚组，并与HC组一起纵向比较情绪反应和调节过程中的认知和神经活动。
患者最佳地聚类为两个亚组：亚组1（n = 40，46%）的特征是在负面社交场景中情绪反应增强，这种情况随时间持续存在，但在其他方面认知完好。与亚组2相比，该亚组在情绪反应过程中随时间表现出稳定的左侧杏仁核过度活跃。亚组2（n = 47，54%）的特征是整体情绪认知受损，包括随时间持续存在的情绪调节困难。在两个时间点的情绪调节过程中，该组左侧背外侧前额叶皮层表现为活动减退。此外，亚组2的患者非情绪认知较差，精神病住院次数和精神病发作史比亚组1的患者更多。
约一半的BD患者存在广泛的情绪认知障碍及相关的非情绪认知缺陷，可能源于前额叶资源募集不足，导致临床结局较差。
