Ventricular and periventricular structural volumes in first- versus multiple-episode bipolar disorder.
OBJECTIVE
Ventriculomegaly has been reported in bipolar disorder, although whether it occurs at illness onset or progresses during the course of the disorder is unknown. In addition, it is unknown whether ventriculomegaly in bipolar disorder reflects acquired volume loss or underdevelopment of periventricular structures.


METHODS
Magnetic resonance imaging was used to measure the volumes of the lateral and third ventricles and periventricular structures (caudate, putamen, thalamus, hippocampus). Patients with DSM-IV bipolar disorder, 18 who were having a first episode and 17 with multiple episodes, were compared with 32 healthy subjects.


RESULTS
The lateral ventricles were significantly larger in the patients with multiple-episode bipolar disorder than in the first-episode patients or the healthy subjects, even after periventricular and total cerebral volumes were taken into account. Having larger lateral ventricles was associated with a higher number of prior manic episodes. The multiple-episode patients had a smaller total cerebral volume than the healthy subjects but not the first-episode patients. The putamen was significantly larger in the first-episode patients (and nearly so in the multiple-episode patients) than in the healthy subjects, although there was no difference between patient groups.


CONCLUSIONS
Lateral ventriculomegaly was greater in bipolar disorder patients who had had repeated manic episodes, but it does not appear to be secondary to small critical periventricular structures. A larger than normal striatum, which has been reported in previous studies, was observed in first-episode patients. These results support the importance of prospectively studying neuroanatomic changes in bipolar disorder.
Strakowski
Stephen M
SM
Bipolar and Psychotic Disorders Research Program, Department of Psychiatry, University of Cincinnati College of Medicine, cincinnati, OH 45267-0559, USA. Strakosm@email.uc.edu
DelBello
Melissa P
MP
Zimmerman
Molly E
ME
Getz
Glen E
GE
Mills
Neil P
NP
Ret
Jennifer
J
Shear
Paula
P
Adler
Caleb M
CM
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000523:psychology; D001921:Brain / Q000473:pathology*; D001931:Brain Mapping; D002421:Caudate Nucleus / Q000473:pathology; D002552:Cerebral Ventricles / Q000473:pathology*; D002908:Chronic Disease; D004108:Dilatation, Pathologic / Q000175:diagnosis; D005260:Female; D006624:Hippocampus / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D021621:Imaging, Three-Dimensional; D020547:Lateral Ventricles / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D011569:Psychiatric Status Rating Scales; D011699:Putamen / Q000473:pathology; D012008:Recurrence; D013788:Thalamus / Q000473:pathology; D020542:Third Ventricle / Q000473:pathology