The effect of electroconvulsive therapy on executive functioning in a treatment-resistant man with depression: a case report.

This case examines the executive functioning in a 42-year-old married white man before receiving and after an index course of electroconvulsive therapy for 4 weeks using right unilateral lead placement. Results indicate clear cognitive improvements on objective measures of executive functioning, attention, and memory after electroconvulsive therapy. However, the patient expressed continued elevated impairments on the subjective questionnaire examining behaviors thought to be controlled by executive functioning.

Anterior cingulate subregion volumes and executive function in bipolar disorder.

OBJECTIVE: Although research findings suggest a relationship between the function of anterior cingulate cortex (ACC) and both cognitive ability and the pathophysiology of bipolar disorder (BPD), few studies have examined cognitive correlates of specific ACC subregion volumes in BPD. Therefore, the primary aim of this study was to examine the relationship between magnetic resonance imaging (MRI)-derived gray and white matter volumes of ACC subregions (caudal, rostral, and subgenual) and performance on tests of executive function in 27 patients with BPD and 22 healthy subjects. METHODS: 1.5T MRI and neuropsychological assessment were conducted with all participants. RESULTS: MANCOVA revealed statistically significant group differences in performance on executive function measures. However, no group differences were observed in any of the ACC white matter or gray matter regions of interest. Multiple regression analyses revealed that rostral and subgenual gray matter each interacted significantly with group in predicting performance on the Wisconsin Card Sorting Test. In addition, a significant interaction was observed between group and both rostral gray and white matter in predicting performance on the Trail Making Test. CONCLUSIONS: The results of this preliminary study support the extant literature that suggests that patients with BPD perform more poorly than healthy subjects on tests of executive function. Furthermore, the relationship between ACC subregion volumes and cognitive test performance was found to differ between patients with BPD and healthy subjects, despite comparable ACC volumes in the two groups.

Magnetic resonance imaging analysis of amygdala and other subcortical brain regions in adolescents with bipolar disorder.

OBJECTIVES: Few studies have examined the abnormalities that underlie the neuroanatomy of bipolar disorder in youth. The aim of this study was to evaluate brain regions that are thought to modulate mood utilizing quantitative analyses of thin-slice magnetic resonance imaging (MRI) scans of adolescents with bipolar disorder. We hypothesized that adolescents with bipolar disorder would exhibit abnormalities in brain regions that are involved in the regulation of mood including the amygdala, globus pallidus, caudate, putamen, and thalamus. METHODS: Bipolar adolescents (n = 23) and healthy subjects (n = 20) matched for age, race, sex, socioeconomic status, IQ, education and Tanner stage, were evaluated using the Washington University at St Louis Kiddie-Schedule for Affective Disorders and Schizophrenia (WASH-U K-SADS). Contiguous 1 mm axial T1-weighted MRI slices were obtained using a GE 1.5 T MR scanner. Regions of interest (ROI) included total cerebral volume, amygdala, globus pallidus, caudate, putamen, and thalamus. RESULTS: Total cerebral volume was smaller in bipolar adolescents than in healthy adolescents. A MANCOVA revealed a significant group difference in overall ROI volumes after adjusting for total cerebral volume. Specifically, adolescents with bipolar disorder exhibited smaller amygdala and enlarged putamen compared with healthy subjects. CONCLUSIONS: Our findings indicate that adolescents with bipolar disorder exhibit abnormalities in some of the brain regions that are thought to be involved in the regulation of mood. Additional structural and functional neuroimaging investigations of children, adolescents, and adults with bipolar disorder are necessary to clarify the role of these brain regions in the neurophysiology of adolescent bipolar disorder.

Verbal memory in mania: effects of clinical state and task requirements.

OBJECTIVES: Manic patients exhibit impaired verbal learning and memory, particularly following longstanding illness. However, it is unclear whether recognition and recall performance are differentially influenced by a manic mood state. METHODS: To examine this issue, we administered the California Verbal Learning Test and symptom-rating scales to inpatients with pure or mixed mania, euthymic outpatients, and healthy comparison subjects. RESULTS: An overall performance difference was identified between groups. Manic and euthymic patients performed more poorly than healthy subjects on recall. However, manic patients performed more poorly than euthymic patients and healthy subjects on recognition. CONCLUSIONS: These results suggest that verbal retrieval deficits are stable vulnerability indicators in bipolar disorder, whereas verbal encoding deficits are manic episode indicators. The known subcortical dysfunction in this disorder may produce stable retrieval deficits while acute mood symptoms attenuate encoding during affective episodes only.

Facial affect recognition deficits in bipolar disorder.

Patients diagnosed with bipolar disorder (BPD), by definition, have problems with emotional regulation. However, it remains uncertain whether these patients are also deficient at processing other people's emotions, particularly while manic. The present study examined the ability of 25 manic bipolar patients and 25 healthy participants on tasks of facial recognition and facial affect recognition at three different presentation durations: 500 ms, 750 ms, and 1000 ms. The groups did not differ in terms of age, education, sex, ethnicity, or estimated IQ. The groups did not differ significantly on either a novel computerized facial recognition task or the Benton Facial Recognition Test. In contrast, the bipolar group performed significantly more poorly than did the comparison group on a novel facial affect labeling task. Although the patient group had slower reaction times on all 3 computerized tasks, the presentation duration did not have an effect on performance in the patients. This study suggests that patients with bipolar disorder are able to recognize faces, but have difficulty processing facial affective cues.

Ventricular and periventricular structural volumes in first- versus multiple-episode bipolar disorder.

OBJECTIVE: Ventriculomegaly has been reported in bipolar disorder, although whether it occurs at illness onset or progresses during the course of the disorder is unknown. In addition, it is unknown whether ventriculomegaly in bipolar disorder reflects acquired volume loss or underdevelopment of periventricular structures. METHOD: Magnetic resonance imaging was used to measure the volumes of the lateral and third ventricles and periventricular structures (caudate, putamen, thalamus, hippocampus). Patients with DSM-IV bipolar disorder, 18 who were having a first episode and 17 with multiple episodes, were compared with 32 healthy subjects. RESULTS: The lateral ventricles were significantly larger in the patients with multiple-episode bipolar disorder than in the first-episode patients or the healthy subjects, even after periventricular and total cerebral volumes were taken into account. Having larger lateral ventricles was associated with a higher number of prior manic episodes. The multiple-episode patients had a smaller total cerebral volume than the healthy subjects but not the first-episode patients. The putamen was significantly larger in the first-episode patients (and nearly so in the multiple-episode patients) than in the healthy subjects, although there was no difference between patient groups. CONCLUSIONS: Lateral ventriculomegaly was greater in bipolar disorder patients who had had repeated manic episodes, but it does not appear to be secondary to small critical periventricular structures. A larger than normal striatum, which has been reported in previous studies, was observed in first-episode patients. These results support the importance of prospectively studying neuroanatomic changes in bipolar disorder.

Neuroanatomic characterization of schizoaffective disorder using MRI: a pilot study.

For over 50 years, there has been uncertainty in the conceptual understanding and neuropathogenesis of the diagnosis of schizoaffective disorder (SCA). In order to better characterize SCA, we performed a quantitative assessment of MRI neuroanatomical structures in patients with SCA (n = 12), compared to patients with bipolar disorder (BPD) (n = 12) and healthy volunteers (HV) (n = 12). Patients diagnosed with SCA exhibited regional abnormalities on the striatum that resemble those seen in BPD. This study suggests that SCA has some neuroanatomical characteristics similar to BPD.