Proton magnetic resonance spectroscopy of bipolar disorder versus intermittent explosive disorder in children and adolescents.
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.
Davanzo
Pablo
P
Department of Psychiatry and Behavioral Sciences, UCLA School of Medicine, CA 90024, USA. pdavanzo@mednet.ucla.edu
Yue
Kenneth
K
Thomas
M Albert
MA
Belin
Thomas
T
Mintz
Jim
J
Venkatraman
T N
TN
Santoro
Eliana
E
Barnett
Sarah
S
McCracken
James
J
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
D010725:Phosphocreatine; D001224:Aspartic Acid; D007294:Inositol; C025403:phosphocreatinine; C000179:N-acetylaspartate; D003401:Creatine; D002794:Choline