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Orbitofrontal dysfunction in a monozygotic twin discordant for postpartum affective psychosis: a functional magnetic resonance imaging study

Authors

  • Cherine Fahim,

    1. Department of Psychiatry, Centre de Recherche Fernand-Seguin, Hôpital Louis-H Lafontaine
    2. Department of Psychiatry
    3. Department of Physiology, Neurological Sciences Program, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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  • Emmanuel Stip,

    1. Department of Psychiatry, Centre de Recherche Fernand-Seguin, Hôpital Louis-H Lafontaine
    2. Department of Psychiatry
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  • Adham Mancini-Marïe,

    1. Department of Psychiatry, Centre de Recherche Fernand-Seguin, Hôpital Louis-H Lafontaine
    2. Department of Psychiatry
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  • Stéphane Potvin,

    1. Department of Psychiatry, Centre de Recherche Fernand-Seguin, Hôpital Louis-H Lafontaine
    2. Department of Psychiatry
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  • Dolores Malaspina

    1. Department of Psychiatry, New York University School of Medicine, New York, NY, USA
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  • The authors of this paper do not have any commercial associations that might pose a conflict of interest in connection with this manuscript.

Emmanuel Stip, Centre de Recherche Fernand-Seguin, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada. Fax: +1 514 251 2617; e-mail: emmanuel.stip@umontreal.ca

Abstract

Background:  Incomplete concordance for psychosis in monozygotic (MZ) twins has been interpreted as indicative of non-genetic cofactors in transmission of the illness. In this case study, we consider childbirth a landmark in the onset of psychotic symptoms, leading to the diagnosis of puerperal psychosis and then to bipolar/schizoaffective disorder. At the end of the third trimester, there is a sudden drop in estrogen, which exerts prominent effects on the serotonergic system in the orbitofrontal cortex (OFC).

Objectives:  The purpose of the present study was to investigate OFC activation during emotional processing in MZ twins discordant for affective psychosis.

Methods:  Blood-oxygen-level-dependent activation using functional magnetic resonance imaging was measured during the passive viewing of emotional film excerpts.

Results:  Consistent with our hypothesis, a significant locus of activation was found in the left OFC in the normal MZ twin, but not in the psychosis MZ twin.

Conclusions:  The personality changes noted in the psychosis MZ twin (postpartum psychosis) may be related to dysfunctional OFC. Ms J's childbirth may have triggered the onset of psychotic symptoms, leading to the diagnosis of bipolar or schizoaffective disorder.

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