title: Changes in brain activation following psychotherapy for youth with mood dysregulation at familial risk for bipolar disorder.
abstract: BACKGROUND
  Psychotherapy for youth with mood dysregulation can help stabilize mood and improve functioning, but the neural mechanisms of this improvement are not known. In this study we investigated the changes in brain activation underlying improvement in mood symptoms.
  
  
  METHODS
  Twenty-four subjects (ages 13-17) participated: 12 patients with clinically significant symptoms of depression and/or mania, and 12 healthy comparison subjects (HC) matched for age and sex. All subjects completed functional magnetic resonance imaging while viewing facial expressions. The patients then received up to 4 months of psychotherapy and were rescanned at end of treatment. Whole brain differences between patient and control groups were assessed with a voxel-wise analysis. Changes in activation from pre- to post-treatment within the patient group were tested for correlation with changes in mood symptoms.
  
  
  RESULTS
  At baseline the patient group had hypoactivation in the dorsolateral prefrontal cortex (DLPFC) and hyperactivation in the posterior cingulate cortex compared to the HC group. Between pre- and post-treatment activation increased in the DLPFC and decreased in the amygdala. Increases in DLPFC activation were significantly correlated with improvement in mania symptoms.
  
  
  CONCLUSIONS
  Enhancement of frontal executive control brain regions may underlie improvement in mood dysregulation in pediatric patients at familial risk for bipolar disorder.
authors.affiliation: Stanford University School of Medicine, Department of Psychiatry, United States; Center for Interdisciplinary Brain Sciences Research, Stanford University, United States; Pediatric Bipolar Disorders Program, Stanford University, United States. Electronic address: agarrett@stanford.edu.
authors.forename: Amy S
authors.initials: AS
authors.lastname: Garrett
authors.affiliation: University of California, Los Angeles, Department of Psychiatry, United States.
authors.forename: David J
authors.initials: DJ
authors.lastname: Miklowitz
authors.affiliation: Stanford University School of Medicine, Department of Psychiatry, United States; Pediatric Bipolar Disorders Program, Stanford University, United States.
authors.forename: Meghan E
authors.initials: ME
authors.lastname: Howe
authors.affiliation: Stanford University School of Medicine, Department of Psychiatry, United States; Pediatric Bipolar Disorders Program, Stanford University, United States.
authors.forename: Manpreet K
authors.initials: MK
authors.lastname: Singh
authors.affiliation: Stanford University School of Medicine, Department of Psychiatry, United States; Pediatric Bipolar Disorders Program, Stanford University, United States.
authors.forename: Tenah K
authors.initials: TK
authors.lastname: Acquaye
authors.affiliation: University of Colorado, Boulder, Department of Psychology and Neuroscience, United States.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Hawkey
authors.affiliation: Department of Radiology, Stanford University, United States.
authors.forename: Gary H
authors.initials: GH
authors.lastname: Glover
authors.affiliation: Stanford University School of Medicine, Department of Psychiatry, United States; Center for Interdisciplinary Brain Sciences Research, Stanford University, United States.
authors.forename: Allan L
authors.initials: AL
authors.lastname: Reiss
authors.affiliation: Stanford University School of Medicine, Department of Psychiatry, United States; Pediatric Bipolar Disorders Program, Stanford University, United States.
authors.forename: Kiki D
authors.initials: KD
authors.lastname: Chang
mesh_terms: D000293:Adolescent; D000928:Antidepressive Agents / Q000494:pharmacology / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy / Q000473:pathology* / Q000534:rehabilitation*; D016022:Case-Control Studies; D002648:Child; D005149:Facial Expression; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D010100:Oxygen / Q000097:blood; D017397:Prefrontal Cortex / Q000098:blood supply / Q000187:drug effects / Q000503:physiopathology*; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D010100:Oxygen
keywords: Bipolar; FMRI; Pediatric; Prefrontal; Psychotherapy