title: Abnormal anterior cingulate cortical activity during emotional n-back task performance distinguishes bipolar from unipolar depressed females.
abstract: BACKGROUND
  Depression in the context of bipolar disorder (BDd) is often misdiagnosed as unipolar disorder depression (UDd) leading to poor clinical outcomes for many bipolar sufferers. We examined neural circuitry supporting emotion regulation in females with either BDd or UDd as a first stage toward identifying biomarkers that may differentiate BDd from UDd.
  
  
  METHODS
  Fifty-seven females aged 18-45 years participated in this study: 23 with UDd, 18 with bipolar disorder type I depression (BDId) and 16 healthy females. During 3-T functional magnetic resonance imaging (fMRI), the participants performed an emotional face n-back (EFNBACK) task, that is an n-back task with high (2-back) and low (0-back) memory load conditions flanked by two positive, negative or neutral face distracters. This paradigm examines executive control with emotional distracters-emotion regulation.
  
  
  RESULTS
  High memory load with neutral face distracters elicited greater bilateral and left dorsal anterior midcingulate cortex (dAMCC) activity in UDd than in healthy and BDId females respectively, and greater bilateral putamen activity in both depressed groups versus healthy females. High memory load with happy face distracters elicited greater left putamen activity in UDd than in healthy females. Psychotropic medication was associated with greater putamen activity to these contrasts in UDd females.
  
  
  CONCLUSIONS
  During high memory load with neutral face distracters, elevated dAMCC activity in UDd suggests abnormal recruitment of attentional control circuitry to maintain task performance, whereas elevated putamen activity unrelated to psychotropic medication in BDId females may suggest an attentional bias toward ambiguous neutral face distracters. Differential patterns of functional abnormalities in neural circuitry supporting attentional control during emotion regulation, especially in the dAMCC, is a promising neuroimaging measure to distinguish UDd from BDId in females.
authors.affiliation: Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. bertoccima@upmc.edu
authors.forename: M A
authors.initials: MA
authors.lastname: Bertocci
authors.forename: G M
authors.initials: GM
authors.lastname: Bebko
authors.forename: B C
authors.initials: BC
authors.lastname: Mullin
authors.forename: S A
authors.initials: SA
authors.lastname: Langenecker
authors.forename: C D
authors.initials: CD
authors.lastname: Ladouceur
authors.forename: J R C
authors.initials: JR
authors.lastname: Almeida
authors.forename: M L
authors.initials: ML
authors.lastname: Phillips
mesh_terms: D000293:Adolescent; D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use; D001288:Attention / Q000502:physiology; D001569:Benzodiazepines / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods; D003463:Cues; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D003937:Diagnosis, Differential; D004644:Emotions; D056344:Executive Function / Q000502:physiology*; D005149:Facial Expression; D005260:Female; D006179:Gyrus Cinguli / Q000187:drug effects / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008570:Memory, Short-Term / Q000502:physiology*; D008875:Middle Aged; D009483:Neuropsychological Tests; D011699:Putamen / Q000187:drug effects / Q000503:physiopathology; D013647:Task Performance and Analysis; D055815:Young Adult
chemical_list: D000928:Antidepressive Agents; D001569:Benzodiazepines
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