title: Structural brain changes in first episode mania with and without psychosis: Data from the Systematic Treatment Optimization Program for Early Mania (STOP-EM).
abstract: The neurobiological underpinnings of bipolar I disorder are not yet understood. Previous structural neuroimaging studies of bipolar disorder have produced rather conflicting results. We hypothesise that clinical sub-phenotypes of bipolar I disorder defined by their psychotic symptoms, especially those with mood-incongruent psychotic features, may have more extensive structural brain abnormalities.
  
  
  
  We investigated structural brain alterations in patients with first-episode mania (n = 55) with mood-congruent (n = 16) and mood-incongruent (n = 32) psychotic features, as well as those without psychotic symptoms (n = 7), relative to healthy subjects (n = 56).
  
  
  
  Total intracranial volume was significantly reduced in patients with mood-incongruent psychosis compared to healthy subjects while cerebrospinal fluid (CSF) volume was significantly increased. Patients with mood-congruent psychosis showed significant reduction in total white matter volume and significant CSF volume increase. Patients with psychosis had significant volume reduction in anterior cingulate and medial prefrontal cortices. Relative to mood-congruent psychotic features, mood-incongruent psychotic features were associated with volume reduction in the left middle temporal gyrus, right inferior parietal gyrus, right fusiform gyrus, left middle orbitofrontal gyrus and cerebellum.
  
  
  
  While preliminary, our findings suggest that the presence and type of psychosis in first-episode mania may be phenotypic markers of underlying biological variants of bipolar disorder.
authors.affiliation: a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Keramatian
authors.affiliation: a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.
authors.forename: Taj
authors.initials: T
authors.lastname: Dhanoa
authors.affiliation: a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: McGirr
authors.affiliation: a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Lang
authors.affiliation: a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.
authors.forename: William G
authors.initials: WG
authors.lastname: Honer
authors.affiliation: a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
authors.affiliation: a Department of Psychiatry , University of British Columbia , Vancouver , BC , Canada.
authors.forename: Lakshmi N
authors.initials: LN
authors.lastname: Yatham
mesh_terms: D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000473:pathology*; D001921:Brain / Q000000981:diagnostic imaging* / Q000473:pathology*; D016022:Case-Control Studies; D002555:Cerebrospinal Fluid; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D011618:Psychotic Disorders / Q000150:complications*; D055815:Young Adult
keywords: Bipolar; MRI; first-episode; mania; psychosis