Neuroimaging Markers of Bipolar Disorder Risk for At-Risk Youth

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Children of parents with bipolar disorder are at a higher risk of developing bipolar disorder along with other mood and anxiety disorders.
Children of parents with bipolar disorder are at a higher risk of developing bipolar disorder along with other mood and anxiety disorders.

Higher activity and functional connectivity of the anterior cingulate cortex during emotion regulation tasks may serve as a specific marker of bipolar disorder (BD) risk, according to a study published in JAMA Psychiatry.

Researchers examined evidence from neuroimaging studies, specifically the measures of emotion processing and regulation neural circuitries and their association to symptoms present in youth at risk for BD. The study compared the offspring of parents with bipolar disorder, the offspring of healthy parents, and the offspring of comparable parents without bipolar disorder using data from cross-sectional and longitudinal neuroimaging studies. The study included 80 participants with a mean age of 14.2 ± 2.1 years.

The comparison showed that offspring of parents with bipolar disorder had greater right rostral anterior cingulate cortex activity than offspring of comparable parents without bipolar disorder when regulating attention to happy expressions (mean difference 0.744 ± 0.249; 95% CI, 0.134-1.354; P =.01). These findings positively correlate with affective lability severity (ρ = 0.304; P =.01). Greater amygdala to left caudal anterior cingulate cortex functional connectivity when regulating attention to fearful faces in comparison with offspring of comparable parents without bipolar disorder was also found in offspring of parents with bipolar disorder (mean difference 0.493 ± 0.169; 95% CI, 0.079-0.908; P =.01). These findings correlate with increases in affective lability over follow-up (r = 0.541; P =.003). Affective lability is a precursor to BD. 

The study is limited by the small sample size as well as the scarce amount of follow-up data. Furthermore, some of the patients in the study were receiving medications that could have affected study outcomes. 

The investigators conclude that greater right rostral anterior cingulate cortex activity and greater amygdala to left caudal anterior cingulate cortex functional connectivity during emotional regulation have great potential for use as markers of BD risk in youth. These markers could aid in the early identification for treatment of young patients at risk of developing BD. 

Disclosures: Multiple authors declare affiliations with the pharmaceutical industry. Please refer to original reference for a full list of authors' disclosures.

Reference

Acuff HE, Versace A, Bertocci MA, et al; for the Longitudinal Assessment of Manic Symptoms (LAMS) Consortium.Association of neuroimaging measures of emotion processing and regulation neural circuitries with symptoms of bipolar disorder in offspring at risk for bipolar disorder [published online September 5, 2018]. JAMA Psychiatry. doi: 10.1001/jamapsychiatry.2018.2318

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