Abstract
Psychotic bipolar disorder (P-BD) is a specific subset that presents greater risk of relapse and worse outcomes than nonpsychotic bipolar disorder (NP-BD). To explore the neuroanatomical bases of psychotic dimension in bipolar disorder (BD), a systematic review was carried out based on the gray matter volume (GMV) among P-BD and NP-BD patients and healthy controls (HC). Further, we conducted a meta-analysis of GMV differences between P-BD patients and HC using a whole-brain imaging approach. Our review revealed that P-BD patients exhibited smaller GMVs mainly in the prefronto-temporal and cingulate cortices, the precentral gyrus, and insula relative to HC both qualitatively and quantitatively. Qualitatively the comparison between P-BD and NP-BD patients suggested inconsistent GMV alterations mainly involving the prefrontal cortex, while NP-BD patients showed GMV deficits in local regions compared with HC. The higher proportions of female patients and patients taking psychotropic medication in P-BD and P-BD type I were associated with smaller GMV in the right precentral gyrus, and the right insula, respectively. In conclusions, psychosis in BD might be associated with specific cortical GMV deficits. Gender and psychotropic medication might have effects on the regional GMVs in P-BD patients. It is necessary to distinguish psychotic dimension in neuroimaging studies of BD.
Highlights
Bipolar disorder (BD) is a prevalent condition, affecting approximately 1% of the population, that is associated with high disability if not promptly treated (Altamura, Buoli, & Serati, 2011)
In attempt to clarify the neuroanatomical alterations associated with the psychotic dimension of BD, we reviewed magnetic resonance imaging (MRI) studies that investigated gray matter volume (GMV) among psychotic bipolar disorder (P-BD) and NPBD patients and healthy controls (HC)
The studies showed smaller GMVs in the bilateral temporal and left occipital clusters using a whole-brain analysis (Chen et al, 2007), as well as in the bilateral caudate and globus pallidus (Mamah et al, 2016; Womer et al, 2014), and no GMV differences in the right middle frontal gyrus, left inferior frontal gyrus (Ekman et al, 2017), anterior cingulate cortex (ACC) (Javadapour et al, 2007), fusiform gyrus (Ekman et al, 2017), amygdala (Haukvik et al, 2014), or hippocampus (Haukvik et al, 2014; Javadapour et al, 2010) using an region of interest (ROI)-based method in nonpsychotic bipolar disorder (NP-BD) patients compared with HC
Summary
Bipolar disorder (BD) is a prevalent condition, affecting approximately 1% of the population, that is associated with high disability if not promptly treated (Altamura, Buoli, & Serati, 2011). A relatively new quantitative coordinate-based metaanalytic approach, that is, the anisotropic effect size version of seedbased d mapping (AES-SDM), allows the results of individual studies to be weighted and controlled for several moderating variables, including demographic, clinical, and imaging factors and medication effects at the time of scanning (Moser et al, 2018). In attempt to clarify the neuroanatomical alterations associated with the psychotic dimension of BD, we reviewed magnetic resonance imaging (MRI) studies that investigated GMVs among P-BD and NPBD patients and HC. Using AES-SDM, we conducted a coordinatebased meta-analysis of voxel-based morphometry (VBM) studies to identify the regional GMV differences between P-BD patients and HC. We explored the possible demographic and clinical variables that may affect GMV, paying special attention to the effects of psychotropic medications
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