Neural markers of mania that distinguish inpatient adolescents with bipolar disorder from those with other psychopathology

• Published in: Psychiatry research 2024-03, Vol.333, p.115747-115747, Article 115747
• Main Authors: Bertocci, Michele A., Rozovsky, Renata, Wolfe, Maria, Abdul-waalee, Halimah, Chobany, Mariah, Malgireddy, Greeshma, Hart, Jonathan A., Skeba, Alex, Brady, Tyler, Lepore, Brianna, Versace, Amelia, Chase, Henry W, Birmaher, Boris, Phillips, Mary L., Diler, Rasim S.
• Format: Article
• Language: English
• Subjects: Adolescent; Bipolar disorder; Bipolar Disorder - diagnostic imaging; Child; Humans; Inpatients; Magnetic Resonance Imaging; Mania; Mental Disorders; Mri; Reward
• ISSN: 0165-1781; 1872-7123
• DOI: 10.1016/j.psychres.2024.115747

•Reward activity differentiates inpatient adolescents with bipolar disorder from other psychopathologies.•Reward related activity is associated with symptoms of mania.•This activity is not associated with symptoms of depression, anxiety, or affect. Pediatric bipolar disorder (BD) is difficult to distinguish from other psychiatric disorders, a challenge which can result in delayed or incorrect interventions. Using neuroimaging we aimed to identify neural measures differentiating a rarified sample of inpatient adolescents with BD from other inpatient psychopathology (OP) and healthy adolescents (HC) during a reward task. We hypothesized reduced subcortical and elevated cortical activation in BD relative to other groups, and that these markers will be related to self-reported mania scores. We examined inpatient adolescents with diagnosis of BD-I/II (n = 29), OP (n = 43), and HC (n = 20) from the Inpatient Child and Adolescent Bipolar Spectrum Imaging study. Inpatient adolescents with BD showed reduced activity in right thalamus, left thalamus, and left amygdala, relative to inpatient adolescents with OP and HC. This reduced neural function explained 21% of the variance in past month and 23% of the variance in lifetime mania scores. Lower activity in regions associated with the reward network, during reward processing, differentiates BD from OP in inpatient adolescents and explains >20% of the variance in mania scores. These findings highlight potential targets to aid earlier identification of, and guide new treatment developments for, pediatric BD.