title: fMRI brain activation changes following treatment of a first bipolar manic episode.
abstract: We tested the hypothesis that, with treatment, functional magnetic resonance imaging (fMRI) regional brain activation in first-episode mania would normalize - i.e., that differences from healthy subjects would diminish over time, and would be associated with clinical remission status, potentially identifying neuroanatomic treatment response markers.
  
  
  
  Forty-two participants with bipolar I disorder were recruited during their first manic episode, pseudo-randomized to open-label lithium or quetiapine, and followed for 8 weeks. fMRI scans were obtained at baseline and then after 1 and 8 weeks of treatment, while participants performed a continuous performance task with emotional distracters. Healthy participants received fMRI scans at these same intervals. Specific region-of-interest (ROI) activations within prefrontal emotional networks were assessed as potential measures of treatment response.
  
  
  
  ROI data were reduced using exploratory factor analysis, which identified five factors that were organizationally consistent with functional anatomic models of human emotion modulation. Half of the participants with bipolar disorder achieved remission by Week 8 and were contrasted with the other half that did not. Analyses demonstrated that, in the bipolar disorder group in general, treatment led to decreases in activation across brain regions toward healthy subject values. However, differences in activation changes were observed between subjects with bipolar disorder who did or did not achieve remission in subcortical and amygdala factors.
  
  
  
  These findings provide evidence for potential neuroanatomic treatment response markers in first-episode bipolar disorder.
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA. steve.strakowski@austin.utexas.edu.|Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, USA. steve.strakowski@austin.utexas.edu.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Strakowski
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: David E
authors.initials: DE
authors.lastname: Fleck
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Welge
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: James C
authors.initials: JC
authors.lastname: Eliassen
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Norris
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Durling
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Komoroski
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Wen-Jang
authors.initials: WJ
authors.lastname: Chu
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Wade
authors.initials: W
authors.lastname: Weber
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Dudley
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Blom
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Stover
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Klein
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Strawn
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Melissa P
authors.initials: MP
authors.lastname: DelBello
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Jing-Huei
authors.initials: JH
authors.lastname: Lee
authors.affiliation: Department of Psychiatry and Behavioral Neuroscience and Center for Imaging Research, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
authors.forename: Caleb M
authors.initials: CM
authors.lastname: Adler
mesh_terms: D000328:Adult; D000679:Amygdala / Q000000981:diagnostic imaging / Q000503:physiopathology; D018692:Antimanic Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D004644:Emotions / Q000502:physiology; D017050:Episode of Care; D005260:Female; D006801:Humans; D008094:Lithium / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011569:Psychiatric Status Rating Scales; D000069348:Quetiapine Fumarate / Q000627:therapeutic use*; D013647:Task Performance and Analysis; D016896:Treatment Outcome
chemical_list: D018692:Antimanic Agents; D000069348:Quetiapine Fumarate; D008094:Lithium
keywords: amygdala; bipolar disorder; fMRI; first-episode; mania; prefrontal; treatment