The functional neuroanatomy of bipolar disorder: a consensus model.
OBJECTIVE
Functional neuroimaging methods have proliferated in recent years, such that functional magnetic resonance imaging, in particular, is now widely used to study bipolar disorder. However, discrepant findings are common. A workgroup was organized by the Department of Psychiatry, University of Cincinnati (Cincinnati, OH, USA) to develop a consensus functional neuroanatomic model of bipolar I disorder based upon the participants' work as well as that of others.


METHODS
Representatives from several leading bipolar disorder neuroimaging groups were organized to present an overview of their areas of expertise as well as focused reviews of existing data. The workgroup then developed a consensus model of the functional neuroanatomy of bipolar disorder based upon these data.


RESULTS
Among the participants, a general consensus emerged that bipolar I disorder arises from abnormalities in the structure and function of key emotional control networks in the human brain. Namely, disruption in early development (e.g., white matter connectivity and prefrontal pruning) within brain networks that modulate emotional behavior leads to decreased connectivity among ventral prefrontal networks and limbic brain regions, especially the amygdala. This developmental failure to establish healthy ventral prefrontal-limbic modulation underlies the onset of mania and ultimately, with progressive changes throughout these networks over time and with affective episodes, a bipolar course of illness.


CONCLUSIONS
This model provides a potential substrate to guide future investigations and areas needing additional focus are identified.
Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0559, USA. stephen.strakowski@uc.edu
Stephen M
SM
Strakowski
Caleb M
CM
Adler
Jorge
J
Almeida
Lori L
LL
Altshuler
Hilary P
HP
Blumberg
Kiki D
KD
Chang
Melissa P
MP
DelBello
Sophia
S
Frangou
Andrew
A
McIntosh
Mary L
ML
Phillips
Jessika E
JE
Sussman
Jennifer D
JD
Townsend
D000679:Amygdala / Q000473:pathology / Q000503:physiopathology*; D001714:Bipolar Disorder / Q000473:pathology* / Q000503:physiopathology*; D001931:Brain Mapping; D004644:Emotions; D059907:Functional Neuroimaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008953:Models, Anatomic; D009434:Neural Pathways / Q000473:pathology / Q000503:physiopathology*; D017397:Prefrontal Cortex / Q000473:pathology / Q000503:physiopathology*