White matter hyperintensities and their associations with suicidality in patients with major affective disorders

Pompili, Maurizio; Ehrlich, Stefan; Pisa, Eleonora De; Mann, J. John; Innamorati, Marco; Cittadini, Andrea; Montagna, Benedetta; Iliceto, Paolo; Romano, Andrea; Amore, Mario; Tatarelli, Roberto; Girardi, Paolo

doi:10.1007/s00406-007-0755-x

Cited by 72 publications

(47 citation statements)

References 36 publications

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“…79 As might be expected from the wide range of associated symptoms illustrated above, imaging studies have revealed very heterogeneous brain structural and functional changes related to suicide attempt; comprising the frontal, temporal, and the parietal cortices, and the subcortical structures. [36][37][38]80,81 Concordant with the suggestion that a broad array of mental impairments and neural abnormalities would be implicated in suicide, we observed that the occurrence of suicide in geriatric depression was associated with widespread, in contrast to circumscribed, reduction in GM and WM, when compared with patients with nonsuicidal depression. Significant decreases in the GM volume were seen in the frontal, medial frontal, parietal and temporal cortices, and the insula, midbrain, cerebellum, and lentiform nucleus of patients in the DS group.…”

Section: Suicidal Versus Nonsuicidal Geriatric Depressionsupporting

confidence: 84%

Cortical and Subcortical Abnormalities in Late-Onset Depression With History of Suicide Attempts Investigated With MRI and Voxel-Based Morphometry

Hwang

Lee

Tsai

et al. 2010

J Geriatr Psychiatry Neurol

191

104

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Late-onset major depression is thought to have a biological (vascular) basis, which could be a result of brain structure change. Vascular lesions can affect both the gray matter (GM) and white matter (WM), while most previous studies addressed WM abnormality. This study explored the disease- and symptom (history of suicide attempt) -related GM morphometry in elderly male patients with late-onset depression. A total of 70 patients with depression admitted to our geriatric psychiatric ward were investigated, and 26 age-matched males were recruited as controls. We used T1-weighted magnetic resonance imaging (MRI) to obtain cerebral structural information and adopted voxel-based morphometry (VBM) to investigate brain volume change related to disease (depression vs control) and symptom (depression with history of suicide attempt vs depression without history of suicide attempt). Late-onset depression was associated with smaller volumes in several regions of GM (insula and the posterior cingulate region) and WM (subcallosal cingulate cortex, floor of lateral ventricles, parahippocampal region, insula, and the cerebellum). Compared with nonsuicidal counterpart, suicidal depression was associated with decreased GM and WM volume in the frontal, parietal, and temporal regions, and the insula, lentiform nucleus, midbrain, and the cerebellum. Marked regional volume reduction was noticed at dorsal medial prefrontal cortex. Our results demonstrate that the development of suicidal behaviors in major depression is related to widespread but discrete volume reduction in several cortical and subcortical structures, fitting with the hypothesis that decreased cerebral volume in certain regions renders biological susceptibility to attempt suicide during depressive states.

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Section: Suicidal Versus Nonsuicidal Geriatric Depressionsupporting

confidence: 84%

Cortical and Subcortical Abnormalities in Late-Onset Depression With History of Suicide Attempts Investigated With MRI and Voxel-Based Morphometry

Hwang

Lee

Tsai

et al. 2010

J Geriatr Psychiatry Neurol

191

104

View full text Add to dashboard Cite

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“…Thirty-five of these studies evaluated the presence of hyperintensities in bipolar patients. Applying the five a priori criteria to these studies, eight studies were excluded: four (Breeze et al, 2003; Deicken et al, 1991; Hickie et al, 1995; Pompili et al, 2007) were excluded because the hyperintensity data reported was not differentiated by the specific psychiatric diagnosis; three (Botteron et al, 1992; Böhm et al, 2006; Zanetti et al, 2007) were individual case reports; and one (Kato et al, 2000) did not include a control group. Finally, of the 27 studies meeting criteria for meta-analysis, six of these were excluded (see Table II).…”

Section: Resultsmentioning

confidence: 99%

“…Dupont et al (1987, 1990) noted a trend toward increased depressive symptoms in subjects with greater hyperintensities, but Gulseren et al (2006) did not. Pompili et al (2007) reported that WMH were associated with history of suicide attempts.…”

Section: Discussion and Reviewmentioning

confidence: 99%

Hyperintense MRI lesions in bipolar disorder: A meta-analysis and review

Beyer

Young

Kuchibhatla

et al. 2009

International Review of Psychiatry

121

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Background Cortical and subcortical hyperintensities in magnetic resonance imaging (MRI) scans are thought to represent areas of ischemic damage to brain tissue. Researchers have focused on the possible role these lesions may have in psychiatric disorders, including bipolar disorder. In 1997, the proposed ‘vascular mania’ diagnosis suggested utilizing not only the presence of strokes, but also confluent hyperintensities in its diagnostic criteria. This study was conducted to use meta-analytic techniques to investigate the association of hyperintensities and bipolar illness and to evaluate the current state of the literature. Methods Using the PubMed and MEDLINE databases, we conducted a systematic literature search of studies investigating hyperintensities in subjects with bipolar disorder and controls or other psychiatric illnesses. We identified 44 publications from which 35 studies were included for review and 27 were selected for meta-analysis. Summary statistics of the prevalence were estimated through odds-ratios and confidence interval. Heterogeneity of the results across studies was tested using Q-statistics. Results Meta-analysis identified an odds ratio of 2.5 (95% CI 1.9, 3.3) for hyperintensities in bipolar subjects compared to controls; however, there was significant heterogeneity among the studies (Q-statistics =32; p =0.04). This finding was most prominent for adolescents and children where the odds ratio was 5.7 (95% CI 2.3, 13.7). Deep white matter hyperintensities (odd ratio 3.2; 95% CI 2.2, 4.5) and subcortical grey matter hyperintensities (odds ratio 2.7; 95% CI 1.3, 2.9) were more strongly associated with bipolar subjects. There were no differences between bipolar subjects and controls for perivascular hyperintensities (odds ratio 1.3; 95% CI 0.8, 1.9). Though hyperintensities were numerically greater in bipolar subjects, meta-analysis did not demonstrate any significant differences between bipolar subjects and unipolar depression subjects (OR 1.6; 95% CI 0.9, 2.7) nor subjects with schizophrenia (OR 1.5; 95% CI 0.9, 2.7). Conclusions This meta-analysis continues to support the association of bipolar disorder and hyperintensities, especially in the deep white matter and subcortical grey matter. It also highlights the increased incidence in children and adolescence with bipolar disorder. However, hyperintensities are not specific to bipolar disorder, but appear at similar rates in unipolar depression and schizophrenia. Thus, the role of hyperintensities in the pathogenesis, pathophysiology, and treatment of bipolar disorder remains unclear. Further studies are required that are large enough to decrease the heterogeneity of the samples and MRI techniques, assess size and location of hyperintensities, and the impact on treatment response. Coordination with newer imaging techniques, such as diffusion tensor imaging (DTI) may be especially helpful in understanding the pathology of these lesions.

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“…Although the pathogensis of these lesions is not completely understood, at least some are likely to reflect vascular ischaemia and are associated with cardiac risk factors and normal ageing (Breeze, Hesdorffer, Hong, Frazier, & Renshaw, 2003). They appear particularly significant in affective disorder, having being associated both with late-onset depressive illness (Sneed, Roose, & Sackeim, 2006) and high rates of suicidality (Pompili et al, 2007).…”

Section: White Mattermentioning

confidence: 99%

The structural neuroimaging of bipolar disorder

Emsell

McDonald

2009

International Review of Psychiatry

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There is an increasing body of literature fuelled by advances in high-resolution structural MRI acquisition and image processing techniques which implicates subtle neuroanatomical abnormalities in the aetiopathogenesis of bipolar disorder. This account reviews the main findings from structural neuroimaging research into regional brain abnormalities, the impact of genetic liability and mood stabilizing medication on brain structure in bipolar disorder, and the overlapping structural deviations found in the allied disorders of schizophrenia and depression. The manifold challenges extant within neuroimaging research are highlighted with accompanying recommendations for future studies. The most consistent findings include preservation of total cerebral volume with regional grey and white matter structural changes in prefrontal, midline and anterior limbic networks, non-contingent ventriculomegaly and increased rates of white matter hyperintensities, with more pronounced deficits in juveniles suffering from the illness. There is increasing evidence that medication has observable effects on brain structure, whereby lithium status is associated with volumetric increase in the medial temporal lobe and anterior cingulate gyrus. However, research continues to be confounded by the use of highly heterogeneous methodology and clinical populations, in studies employing small scale, low-powered, cross-sectional designs. Future work should investigate larger, clinically homogenous groups of patients and unaffected relatives, combining both categorical and dimensional approaches to illness classification in cross-sectional and longitudinal designs in order to elucidate trait versus state mechanisms, genetic effects and medication/illness progression effects over time.

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White matter hyperintensities and their associations with suicidality in patients with major affective disorders

Cited by 72 publications

References 36 publications

Cortical and Subcortical Abnormalities in Late-Onset Depression With History of Suicide Attempts Investigated With MRI and Voxel-Based Morphometry

Cortical and Subcortical Abnormalities in Late-Onset Depression With History of Suicide Attempts Investigated With MRI and Voxel-Based Morphometry

Hyperintense MRI lesions in bipolar disorder: A meta-analysis and review

The structural neuroimaging of bipolar disorder

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