Developmental changes at the interface of affective and cognitive systems are examined over a three year period in pediatric bipolar disorder (PBD).
Thirteen participants with PBD and 10 healthy controls (HC) matched on demographics and IQ were scanned at baseline, 16 weeks, and after three years. All patients received pharmacotherapy based on a medication algorithm. A pediatric affective color matching paradigm was used to probe cognitive processing under emotional challenge.
Behavioral data illustrated that patients in PBD group were slower in response time at baseline, but normalized by three years. On fMRI analyses at baseline, in response to emotional vs. neutral words, patients with PBD showed greater activation, relative to HC, in the right dorsal lateral prefrontal cortex (DLPFC) and amygdala, ventral lateral prefrontal cortex (VLPFC), bilateral anterior cingulate cortex (ACC), and ventral striatum. The increased activation in cortical areas in the PBD group normalized with no differences from HC by 16 weeks. By three years, normalization was observed in not only the cortical, but also the subcortical regions such as amygdala and striatum.
These preliminary findings need to be replicated with a larger sample, although it can be challenging to obtain large samples for longitudinal studies.
Greater activation in fronto-striatal and fronto-limbic circuits were observed in unmedicated patients with PBD. With systematic pharmacotherapy for patients with PBD, the time course of recovery was characterized by initial prefrontal changes at 16 weeks, which extended to subcortical normalization at three years. These preliminary findings illustrated that, following appropriate treatment coupled with normal brain development, patients with PBD showed normalization in brain function.