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Parsing Dimensional vs Diagnostic Category: Related Patterns of Reward Circuitry Function in Behaviorally and Emotionally Dysregulated Youth in the Longitudinal Assessment of Manic Symptoms Study
Bebko G, Bertocci MA, Fournier JC, Hinze AK, Bonar L, Almeida JRC, Perlman SB, Versace A, Schirda C, Travis M, Gill MK, Demeter C, Diwadkar VA, Ciuffetelli G, Rodriguez E, Olino T, Forbes E, Sunshine JL, Holland SK, Kowatch RA, Birmaher B, Axelson A, Horwitz SM, Arnold LE, Fristad MA, Youngstrom EA, Findling RL, and Phillips ML.
JAMA Psychiatry 71:71-80, 2014

Pediatric disorders characterized by behavioral and emotional dysregulation pose diagnostic and treatment challenges because of high comorbidity, suggesting that they may be better conceptualized dimensionally rather than categorically. Identifying neuroimaging measures associated with behavioral and emotional dysregulation in youth may inform understanding of underlying dimensional vs disorder-specific pathophysiologic features.

Dr. Genna Bebko and her colleagues set out to identify, in a large cohort of behaviorally and emotionally dysregulated youth, neuroimaging measures that are either associated with behavioral and emotional dysregulation pathologic dimensions (behavioral and emotional dysregulation measured with the Parent General Behavior Inventory 10-Item Mania Scale [PGBI-10M], mania, depression, and anxiety) or measures that differentiate diagnostic categories (bipolar spectrum disorders, attention-deficit/hyperactivity disorder, anxiety, and disruptive behavior disorders).  

In collaboration with investigators from three academic medical centers, Dr. Bebko conducted a multisite neuroimaging study focusing on a referred sample of behaviorally and emotionally dysregulated youth from the Longitudinal Assessment of Manic Symptoms (LAMS) study (n = 85) and healthy youth (n = 20). Using a region-of-interest analyses, the investigators examined relationships among prefrontal-ventral striatal reward circuitry during a reward paradigm (win, loss, and control conditions), symptom dimensions, and diagnostic categories. They found that, regardless of diagnosis, higher PGBI-10M scores were associated with greater left middle prefrontal cortical activity (r = 0.28) and anxiety with greater right dorsal anterior cingulate cortical (r = 0.27) activity to win. The 20 highest (t = 2.75) and 20 lowest (t = 2.42) PGBI-10M, scoring youth showed significantly greater left middle prefrontal cortical activity to win compared with 20 healthy youth.  Disruptive behavior disorders were associated with lower left ventrolateral prefrontal cortex activity to win (t = 2.68) (allP < .05, corrected).  

Dr. Bebko and her team concluded that despite a distinct reward-related neurophysiologic feature in disruptive behavior disorders, the findings from this project support a dimensional approach to studying neural mechanisms in behaviorally and emotionally dysregulated youth.

Contributors
Genna Bebko, PhD; Michele A. Bertocci, PhD; Jay C. Fournier, PhD; Amanda K. Hinze, MS; Lisa Bonar, BS; Jorge R. C. Almeida, MD, PhD; Susan B. Perlman, PhD; Amelia Versace, MD; Claudiu Schirda, PhD; Michael Travis, MD; Mary Kay Gill, RN, MSN; Gary Ciuffetelli, BA; Eric Rodriguez, BS; Thomas Olino, PhD; Erika Forbes, PhD; Boris Birmaher, MD; David Axelson, MD; and Mary L. Phillips, MD, MD (Cantab) (Department of Psychiatry, University of Pittsburgh Department of Psychiatry)

Vaibhav A. Diwadkar, PhD (Department of Psychiatry and Behavioral Neuroscience, Wayne State University)

Christine Demeter, MA; Jeffrey L. Sunshine, MD, PhD; and Robert L. Findling, MD, MBA (Division of Child and Adolescent Psychiatry, Case Western Reserve University)

Scott K. Holland, PhD (Division of Pediatric Radiology, University of Cincinnati)

Robert A. Kowatch, MD, PhD (Research Institute, Nationwide Children?s Hospital)

Sarah M. Horwitz, PhD (Department of Psychiatry, New York University)  

L. Eugene Arnold, MD, MEd and Mary A. Fristad, PhD, ABPP (Department of Psychiatry, The Ohio State University)

Eric A. Youngstrom, PhD (Department of Psychology, University of North Carolina)

The results of this study were published in JAMA Psychiatry. Click here for a link to the abstract.