title: Affective neural circuitry during facial emotion processing in pediatric bipolar disorder.
abstract: BACKGROUND
  Facial emotions are central to human interaction. Identifying pathophysiology in affect processing circuitry that supports the ability to assess facial emotions might facilitate understanding of affect regulation in pediatric bipolar disorder.
  
  
  METHODS
  Ten euthymic, unmedicated pediatric bipolar patients and 10 healthy control subjects matched for age, gender, race, socioeconomic status, and IQ were scanned with functional magnetic resonance imaging. Angry, happy, and neutral faces were presented in 30-sec blocks, with a 20-sec rest period between blocks. Subjects were asked to press a button when each face appeared, to ensure that attention was maintained on-task.
  
  
  RESULTS
  In bipolar patients, in response to both angry and happy faces relative to neutral faces, we observed reduced activation of right rostral ventrolateral prefrontal cortex together with increased activity in right pregenual anterior cingulate, amygdala, and paralimbic cortex. Bipolar patients also showed reduced activation of visual areas in occipital cortex together with greater activation in higher-order visual perceptual areas, including superior temporal sulcus and fusiform gyrus with angry faces and posterior parietal cortex with happy faces.
  
  
  CONCLUSIONS
  Findings document a disturbance in affective neurocircuitry in pediatric bipolar disorder. Reduced activation in ventrolateral prefrontal cortex might reflect diminished top-down control that leads to the observed exaggerated activation in amygdala and paralimbic areas. Changes in occipital areas might represent an effort to gate sensory input when affective responses to the faces could not be successfully modulated. Disturbances in affect processing circuitry could contribute to emotional dysregulation and social cognitive difficulties in bipolar youth.
authors.affiliation: Center for Cognitive Medicine, Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois 60612, USA. mpavuluri@psych.uic.edu
authors.forename: Mani N
authors.initials: MN
authors.lastname: Pavuluri
authors.forename: Megan Marlow
authors.initials: MM
authors.lastname: O'Connor
authors.forename: Erin
authors.initials: E
authors.lastname: Harral
authors.forename: John A
authors.initials: JA
authors.lastname: Sweeney
mesh_terms: D000293:Adolescent; D000339:Affect / Q000502:physiology*; D000367:Age Factors; D000679:Amygdala / Q000503:physiopathology; D001714:Bipolar Disorder / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology*; D004644:Emotions; D005149:Facial Expression; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data; D008297:Male; D009434:Neural Pathways / Q000503:physiopathology*; D017397:Prefrontal Cortex / Q000503:physiopathology*; D000297:Psychology, Adolescent; D021641:Recognition, Psychology; D012938:Social Perception; D014796:Visual Perception / Q000502:physiology