Psychiatry Research: Neural Markers of Mania That Distinguish Inpatient Adolescents with Bipolar Disorder from Those with Other Psychopathology
Adolescents with manic or hypomanic episodes—key features of bipolar disorder (BD)—may experience delayed correct diagnosis or inappropriate treatment because some symptoms of BD are also seen in other disorders (such as unipolar depressive disorders and attention deficit/hyperactive disorder).
A team of scientists from the University of Pittsburgh including Michele Bertocci, PhD (Assistant Professor of Psychiatry); Renata Rozovsky, PhD (postdoctoral associate); Amelia Versace, PhD (Associate Professor of Psychiatry); Henry Chase, PhD (Research Assistant Professor of Psychiatry); Boris Birmaher, MD (Distinguished Professor of Psychiatry and Endowed Chair in Early Onset Bipolar Disease); Mary Phillips, MD, MD, (CANTAB) (Distinguished Professor of Psychiatry, Clinical and Translational Science, and Bioengineering, and Pittsburgh Foundation-Emmerling Endowed Chair in Psychotic Disorders); and Rasim Diler, MD (Professor of Psychiatry), studied inpatient adolescents included in the Inpatient Child and Adolescent Bipolar Spectrum Imaging Study with the goal of differentiating BD from other disorders by identifying objective biological markers specific to the manic features of bipolar disorder.
Participants included 92 adolescents diagnosed with either well-characterized bipolar I/II disorder, or with other psychopathology without any threshold/subthreshold mania or hypomania, and an unaffected comparison group.
“All inpatient adolescents were assessed with multi-day diagnostic processes including semi-structured interviews (with parents and adolescents), self-reported mood and energy ratings, and sleep/activity monitoring (at Inpatient Child and Adolescent Bipolar Services, or In-CABS, the nation’s first inpatient bipolar program for adolescents). These assessments ensure diagnostic accuracy of the presence or absence of manic/hypomanic episodes in inpatient adolescents, who overall represent severe form of illnesses and may enable identification of biological markers specific to bipolar disorder,” said Dr. Diler, multiple principal investigator (MPI) and senior author of the study, recently published in Psychiatric Research.
The team used functional magnetic resonance imaging (fMRI) during a monetary reward task, hypothesizing that reduced subcortical and elevated cortical activation would be observed in bipolar disorder relative to other groups, and that these markers would be related to self-reported mania scores. Analysis of the neuroimaging data revealed reduced activity in the reward network in bipolar disorder, relative to both the group with other pathology and to an unaffected comparison group.
“It is compelling that the reduced neural activity is related to mania symptoms and not to other clinical measures,” said Dr. Bertocci, the study’s MPI and corresponding author. “We hope that with replication, these findings can contribute to risk calculation and ultimately to improved diagnosis.”
Neural markers of mania that distinguish inpatient adolescents with bipolar disorder from those with other psychopathology
Bertocci MA, Rozovsky R, Wolfe M, Abdul-waalee H, Chobany M, Malgireddy G, Hart JA, Skeba A, Brady T, Lepore B, Versace A, Chase HW, Birmaher B, Phillips ML, Diler RS.
Psychiatry Research, Volume 333, 2024, 115747, ISSN 0165-1781, https://doi.org/10.1016/j.psychres.2024.115747.