Structural and metabolic differentiation between bipolar disorder with psychosis and substance-induced psychosis: An integrated MRI/PET study

Abstract

Keywords:Bipolar disorder Substance-induced psychosis Magnetic resonance imaging (MRI) Positron emission tomography (PET) Gray matter Cerebral metabolism A B S T R A C TBackground: Bipolar disorder (BD) may be characterized by the presence of psychotic symptoms and comorbid substance abuse. In this context, structural and metabolic dysfunctions have been reported in both BD with psychosis and addiction, separately. In this study, we aimed at identifying neural substrates differentiating psychotic BD, with or without substance abuse, versus substance-induced psychosis (SIP) by coupling, for the first time, magnetic resonance imaging (MRI) and positron emission tomography (PET). Methods: Twenty-seven BD type I psychotic patients with (n = 10) or without (n = 17) substance abuse, 16 SIP patients and 54 healthy controls were enrolled in this study. 3T MRI and 18-FDG-PET scanning were acquired. Results: Gray matter (GM) volume and cerebral metabolism reductions in temporal cortices were observed in all patients compared to healthy controls. Moreover, a distinct pattern of fronto-limbic alterations were found in patients with substance abuse. Specifically, BD patients with substance abuse showed volume reductions in ventrolateral prefrontal cortex, anterior cingulate, insula and thalamus, whereas SIP patients in dorsolateral prefrontal cortex and posterior cingulate. Common alterations in cerebellum and parahippocampus were found in both BD with substance abuse and SIP. Finally, a unique pattern of GM volumes reduction, with concomitant increased of striatal metabolism, were observed in SIP patients. Conclusions: These findings contribute to shed light on the identification of common and distinct neural markers associated with bipolar psychosis and substance abuse. Future longitudinal studies should explore the effect of single substances of abuse in patients at the first-episode of BD and substanceinduced psychosis.ß 2016 Elsevier Masson SAS. All rights reserved.

The metabolic basis of psychosis in bipolar disorder: A positron emission tomography study

“…Specifically, our results showed that our groups of BD patients had extensive FDG uptake alterations in occipital regions, partially in line with our previous MRI/PET study . These regions have been found to be altered in several psychiatric disorders and in high‐risk individuals .…”

“…In conclusion, this is the first study assessing the FDG uptake brain differences between BD patients with and without lifetime psychotic symptoms by means of a PET approach. Metabolic investigations are of great interest in psychiatric diseases, because metabolic modification arises before gross morphological alteration and subtend functional networks . Our findings suggest that FDG uptake alterations in brain networks involved in emotions are a key feature of BD, despite the presence of past psychotic symptoms.…”

“…Exclusion criteria consisted of: a diagnosis of mental retardation, any current major medical or neurological illness, a history of traumatic head injury with loss of consciousness and any other Axis‐I disorders, including alcohol abuse. The healthy controls (HC) were recruited based on the absence of a personal or family lifetime history of any psychiatric disorder, and they have been previously employed in our previous MRI/PET study . The study was approved by the local Ethical Committee.…”

“…The healthy controls (HC) were recruited based on the absence of a personal or family lifetime history of any psychiatric disorder, and they have been previously employed in our previous MRI/PET study. 16 The study was approved by the local Ethical Committee. Informed consent was obtained for all participants.…”

Gray matter bases of psychotic features in adult bipolar disorder: A systematic review and voxel‐based meta‐analysis of neuroimaging studies

“…Using the whole-brain method, with the exception of one study (Cui et al, 2011) that revealed greater GMVs in the right putamen and cerebellum, an overwhelming number of studies showed smaller GMVs in the bilateral prefrontal cortex (PFC), involving the superior, middle and inferior frontal gyri (Altamura, Delvecchio, et al, 2017;Cui et al, 2011;Ivleva et al, 2013;Song et al, 2015;Tost et al, 2010); the medial frontal gyrus et al, 2010). Using the whole-brain method, with the exception of one study (Cui et al, 2011) that revealed greater GMVs in the right putamen and cerebellum, an overwhelming number of studies showed smaller GMVs in the bilateral prefrontal cortex (PFC), involving the superior, middle and inferior frontal gyri (Altamura, Delvecchio, et al, 2017;Cui et al, 2011;Ivleva et al, 2013;Song et al, 2015;Tost et al, 2010); the medial frontal gyrus et al, 2010).…”