title: Structural brain and neuropsychometric changes associated with pediatric bipolar disorder with psychosis.
abstract: OBJECTIVE
  To identify neuropsychological and structural brain changes using a combination of high-resolution structural and diffusion tensor imaging in pediatric bipolar disorder (PBD) with psychosis (presence of delusions and or hallucinations).
  
  
  METHODS
  We recruited 15 patients and 20 euthymic age- and gender-matched healthy controls. All subjects underwent high-resolution structural and diffusion tensor imaging. Voxel-based morphometry (VBM), tract-based spatial statistics (TBSS), and probabilistic tractography were used to analyse magnetic resonance imaging data.
  
  
  RESULTS
  The PBD subjects had normal overall intelligence with specific impairments in working memory, executive function, language function, and verbal memory. Reduced gray matter (GM) density was found in the left orbitofrontal cortex, left pars triangularis, right premotor cortex, occipital cortex, right occipital fusiform gyrus, and right crus of the cerebellum. TBSS analysis showed reduced fractional anisotropy (FA) in the anterior corpus callosum. Probabilistic tractography from this cluster showed that this region of the corpus callosum is connected with the prefrontal cortices, including those regions whose density is decreased in PBD. In addition, FA change was correlated with verbal memory and working memory, while more widespread reductions in GM density correlated with working memory, executive function, language function, and verbal memory.
  
  
  CONCLUSIONS
  The findings suggest widespread cortical changes as well as specific involvement of interhemispheric prefrontal tracts in PBD, which may reflect delayed myelination in these tracts.
authors.affiliation: Highfield Family and Adolescent Unit, Warneford Hospital Oxford Centre for Functional MRI of the Brain (FMRIB), John Radcliffe Hospital, Oxford GSK Clinical Imaging Centre, Imperial College London, London, UK. anthony.james@psych.ox.ac.uk
authors.forename: Anthony
authors.initials: A
authors.lastname: James
authors.forename: Morgan
authors.initials: M
authors.lastname: Hough
authors.forename: Susan
authors.initials: S
authors.lastname: James
authors.forename: Linda
authors.initials: L
authors.lastname: Burge
authors.forename: Louise
authors.initials: L
authors.lastname: Winmill
authors.forename: Sunita
authors.initials: S
authors.lastname: Nijhawan
authors.forename: Paul M
authors.initials: PM
authors.lastname: Matthews
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Zarei
mesh_terms: D000293:Adolescent; D001714:Bipolar Disorder / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D016022:Case-Control Studies; D002648:Child; D003071:Cognition; D003702:Delusions / Q000473:pathology / Q000503:physiopathology / Q000523:psychology; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006212:Hallucinations / Q000473:pathology / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011594:Psychometrics; D011618:Psychotic Disorders / Q000473:pathology* / Q000503:physiopathology / Q000523:psychology; D012720:Severity of Illness Index