title: Structural and metabolic differentiation between bipolar disorder with psychosis and substance-induced psychosis: An integrated MRI/PET study.
abstract: Bipolar disorder (BD) may be characterized by the presence of psychotic symptoms and comorbid substance abuse. In this context, structural and metabolic dysfunctions have been reported in both BD with psychosis and addiction, separately. In this study, we aimed at identifying neural substrates differentiating psychotic BD, with or without substance abuse, versus substance-induced psychosis (SIP) by coupling, for the first time, magnetic resonance imaging (MRI) and positron emission tomography (PET).
  
  
  
  Twenty-seven BD type I psychotic patients with (n=10) or without (n=17) substance abuse, 16 SIP patients and 54 healthy controls were enrolled in this study. 3T MRI and 18-FDG-PET scanning were acquired.
  
  
  
  Gray matter (GM) volume and cerebral metabolism reductions in temporal cortices were observed in all patients compared to healthy controls. Moreover, a distinct pattern of fronto-limbic alterations were found in patients with substance abuse. Specifically, BD patients with substance abuse showed volume reductions in ventrolateral prefrontal cortex, anterior cingulate, insula and thalamus, whereas SIP patients in dorsolateral prefrontal cortex and posterior cingulate. Common alterations in cerebellum, parahippocampus and posterior cingulate were found in both BD with substance abuse and SIP. Finally, a unique pattern of GM volumes reduction, with concomitant increased of striatal metabolism, were observed in SIP patients.
  
  
  
  These findings contribute to shed light on the identification of common and distinct neural markers associated with bipolar psychosis and substance abuse. Future longitudinal studies should explore the effect of single substances of abuse in patients at the first-episode of BD and substance-induced psychosis.
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: A C
authors.initials: AC
authors.lastname: Altamura
authors.affiliation: Scientific Institute IRCCS "E. Medea", San Vito al Tagliamento (PN), Italy.
authors.forename: G
authors.initials: G
authors.lastname: Delvecchio
authors.affiliation: Department of Services, Neuroradiology Unit, Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Marotta
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Oldani
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Pigoni
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Ciappolino
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Caletti
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Rovera
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Dobrea
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Arici
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Benatti
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Camuri
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Prunas
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy.
authors.forename: R A
authors.initials: RA
authors.lastname: Paoli
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry, Bipolar Disorders Clinic, Stanford University, CA, USA.
authors.forename: B
authors.initials: B
authors.lastname: Dell'osso
authors.affiliation: Department of Services, Neuroradiology Unit, Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Cinnante
authors.affiliation: Department of Services, Neuroradiology Unit, Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: F M
authors.initials: FM
authors.lastname: Triulzi
authors.affiliation: Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, Houston, TX, USA. Electronic address: paolo.brambilla1@unimi.it.
authors.forename: P
authors.initials: P
authors.lastname: Brambilla
mesh_terms: D000328:Adult; D001714:Bipolar Disorder / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000473:pathology; D005260:Female; D066128:Gray Matter / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography; D011618:Psychotic Disorders / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology*; D013702:Temporal Lobe / Q000473:pathology*; D013788:Thalamus / Q000473:pathology; D055815:Young Adult
keywords: Bipolar disorder; Cerebral metabolism; Gray matter; Magnetic resonance imaging (MRI); Positron emission tomography (PET); Substance-induced psychosis