title: Proton magnetic resonance spectroscopy of bipolar disorder versus intermittent explosive disorder in children and adolescents.
abstract: OBJECTIVE
  The diagnosis of bipolar disorder in juveniles is controversial. This study was designed to compare proton magnetic resonance spectroscopy ((1)H MRS) in patients with bipolar disorder or intermittent explosive disorder, two groups with symptomatic overlap but categorical distinction. Children with intermittent explosive disorder designate patients whose illness clinically resembles pediatric bipolar disorder but does not satisfy DSM-IV criteria for mania. Based on the authors' previous report of higher levels of (1)H MRS cingulate myo-inositol/creatine in youngsters with bipolar disorder than in normal comparison subjects, they hypothesized that patients with bipolar disorder would have higher cingulate myo-inositol/creatine-phosphocreatine measurements than patients with intermittent explosive disorder and normal comparison subjects.
  
  
  METHODS
  Myo-inositol levels were measured with a 2x2x2 cm(3) voxel placed in the anterior cingulate for acquisition of (1)H MRS in 10 patients with bipolar disorder, 10 patients with intermittent explosive disorder, and 13 normal comparison subjects. N-Acetylaspartate, choline moieties, creatine-phosphocreatine, and glutamate-glutamine metabolite levels were also measured.
  
  
  RESULTS
  The patients with bipolar disorder showed significantly higher anterior cingulate myo-inositol/creatine-phosphocreatine and myo-inositol (mmol/liter) levels than the patients with intermittent explosive disorder and the normal comparison subjects. No significant differences were found across groups for myo-inositol or other metabolites in the occipital cortex.
  
  
  CONCLUSIONS
  These data provide evidence that differences in the concentration of myo-inositol (mmol/liter) in the anterior cingulate cortex in (1)H MRS may differentiate these two populations. Follow-up studies involving larger samples may conclusively estimate the biological specificity between pediatric bipolar disorder and other disorders, which overlap clinically.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, UCLA School of Medicine, CA 90024, USA. pdavanzo@mednet.ucla.edu
authors.forename: Pablo
authors.initials: P
authors.lastname: Davanzo
authors.forename: Kenneth
authors.initials: K
authors.lastname: Yue
authors.forename: M Albert
authors.initials: MA
authors.lastname: Thomas
authors.forename: Thomas
authors.initials: T
authors.lastname: Belin
authors.forename: Jim
authors.initials: J
authors.lastname: Mintz
authors.forename: T N
authors.initials: TN
authors.lastname: Venkatraman
authors.forename: Eliana
authors.initials: E
authors.lastname: Santoro
authors.forename: Sarah
authors.initials: S
authors.lastname: Barnett
authors.forename: James
authors.initials: J
authors.lastname: McCracken
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001224:Aspartic Acid / Q000031:analogs & derivatives* / Q000378:metabolism; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000378:metabolism; D002648:Child; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D003937:Diagnosis, Differential; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000175:diagnosis* / Q000378:metabolism; D005260:Female; D006179:Gyrus Cinguli / Q000737:chemistry / Q000378:metabolism*; D006801:Humans; D007294:Inositol / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D009778:Occipital Lobe / Q000737:chemistry / Q000378:metabolism; D010725:Phosphocreatine / Q000031:analogs & derivatives* / Q000378:metabolism
chemical_list: D010725:Phosphocreatine; D001224:Aspartic Acid; D007294:Inositol; C025403:phosphocreatinine; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline