title: Neuroprogression and episode recurrence in bipolar I disorder: A study of gray matter volume changes in first-episode mania and association with clinical outcome.
abstract: Bipolar I disorder (BD-I) is associated with gray matter volume (GMV) alterations in neural regions important for emotional regulation. Reductions found in patients with multiple episodes are not seen at illness onset, suggesting that changes occur with illness progression, although no prospective studies to date have examined this. In the present study, we assessed GMV at baseline and one year following a first manic episode, examining the impact of episode recurrence on the trajectory of change.
  
  
  
  A total of 41 recently remitted first manic episode patients with BD-I and 25 healthy subjects (HS) underwent 3T magnetic resonance imaging at baseline and one year later. Using voxel-based morphometry, we compared GMV change between HS, patients who experienced a recurrence of a mood episode (BDrecurr), and patients in sustained remission (BDwell).
  
  
  
  The GMV change from baseline to one year did not differ significantly between HS and the full BD-I group or BDwelland HS. However, the BDrecurrgroup had greater GMV loss than HS in left frontal and bilateral temporal regions, and BDwellpatients involving bilateral frontal, temporal and left parietal regions.
  
  
  
  GMV change early in the course of BD-I is associated with clinical outcome, such that neuroprogression found in patients who experience a recurrence of a mood episode is not seen in those with sustained remission. These findings have important implications for the treatment of BD-I as they suggest that prevention of recurrence might minimize neuroprogression of the disease, possibly requiring a multipronged early intervention approach to achieve this goal.
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Jan-Marie
authors.initials: JM
authors.lastname: Kozicky
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Alexander
authors.initials: A
authors.lastname: McGirr
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.|Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Bond
authors.affiliation: Department of Nuclear Medicine, Vancouver Coastal Health Authority, Vancouver, BC, Canada.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Gonzalez
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.|Laboratory of Molecular Psychiatry, Centro de Pesquisas Experimentais, Hospital de Clínicas de Porto Alegre and INCT for Translational Medicine, Porto Alegre, RS, Brazil.
authors.forename: Leonardo E
authors.initials: LE
authors.lastname: Silveira
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Keramatian
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.|BC Psychosis Program, British Columbia Mental Health and Addictions Services, Vancouver, BC, Canada.
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Torres
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Raymond W
authors.initials: RW
authors.lastname: Lam
authors.affiliation: Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada. yatham@mail.ubc.ca.
authors.forename: Lakshmi N
authors.initials: LN
authors.lastname: Yatham
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D018450:Disease Progression; D004644:Emotions / Q000502:physiology*; D017050:Episode of Care; D005260:Female; D005500:Follow-Up Studies; D066128:Gray Matter / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D009929:Organ Size; D011446:Prospective Studies; D055502:Secondary Prevention / Q000379:methods
keywords: 
  MRI
  ; 
  VBM
  ; Neuroprogression; Recovery; bipolar disorder; first-episode mania; longitudinal