The British Journal of Psychiatry (2009) 194: 426-433. doi: 10.1192/bjp.bp.107.049205
© 2009 The Royal College of Psychiatrists
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Anterior cingulate cortex abnormalities associated with a first psychotic episode in bipolar disorder

Alex Fornito, PhD

Melbourne Neuropsychiatry Centre, Department of Psychiatry, and Department of Psychology, School of Behavioural Science, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia

Murat Yücel, PhD

Melbourne Neuropsychiatry Centre, Department of Psychiatry, and ORYGEN Research Centre, University of Melbourne, Australia

Stephen J. Wood, PhD

Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Australia

Andreas Bechdolf, MD, MSc

ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia, and Department of Psychiatry and Psychotherapy, University of Cologne, Germany

Simon Carter, BSc

ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia

Chris Adamson, BSc (Hons)

Department of Electrical & Electronic Engineering and Howard Florey Institute, University of Melbourne, Australia

Dennis Velakoulis, MBBS, FRANCP

Melbourne Neuropsychiatry Centre, Department of Psychiatry, University of Melbourne, Australia

Michael M. Saling, PhD

Department of Psychology, School of Behavioural Science, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Australia

Patrick D. McGorry, MBBS, FRANZCP, PhD

ORYGEN Research Centre, Department of Psychiatry, University of Melbourne, Australia

Christos Pantelis, MBBS, FRANCP, MRCPsych, MD

Melbourne Neuropsychiatry Centre, Department of Psychiatry, and Howard Florey Institute University of Melbourne, Australia

Correspondence: Dr Alex Fornito, Melbourne Neuropsychiatry Centre, Levels 2 and 3, National Neuroscience Facility, 161 Barry Street, Carlton South, VIC 3053, Australia. Email: fornitoa{at}unimelb.edu.au

Declaration of interest

None.

Funding

This research was supported by the Melbourne Neuropsychiatry Centre (Sunshine Hospital), Department of Psychiatry, The University of Melbourne; the National Health and Medical Research Council (NHMRC) (ID 236175; 350241); and the Ian Potter Foundation. Neuroimaging analysis was facilitated by the Neuropsychiatry Imaging Laboratory managed by Ms Bridget Soulsby at the Melbourne Neuropsychiatry Centre and supported by Neurosciences Victoria. S.J.W. was supported by a NHMRC Clinical Career Development Award and a NARSAD Young Investigator Award. A.F. was supported by a JN Peters Fellowship and a NHMRC CJ Martin Fellowship (ID 454797).

Background

The anterior cingulate cortex is frequently implicated in the pathophysiology of bipolar disorder, but magnetic resonance imaging (MRI) studies have reported variable findings owing to a reliance on patient samples with chronic illness and to limited appreciation of the region’s heterogeneity.

Aims

To characterise anterior cingulate cortex abnormalities in patients with bipolar disorder experiencing their first episode of psychosis while accounting for regional anatomical variability.

Method

Grey matter volume, surface area and cortical thickness were measured in six anterior cingulate cortex subregions per hemisphere using MRI scans acquired from 26 patients with bipolar I disorder experiencing first-episode psychosis and 26 healthy controls matched for age, gender and regional morphological variability.

Results

Relative to controls, male patients displayed increased thickness in the right subcallosal limbic anterior cingulate cortex. No significant differences were identified in females for grey matter volume or surface area measures. The findings were not attributable to medication effects.

Conclusions

These data suggest that first-episode psychosis in bipolar disorder is associated with a gender-specific, right-lateralised thickness increase in anterior cingulate cortex subregions known to play a role in regulating physiological stress responses.


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