Get access

The functional neuroanatomy of bipolar disorder: a consensus model

Authors

  • Stephen M Strakowski,

    1. Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH
    Search for more papers by this author
  • Caleb M Adler,

    1. Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH
    Search for more papers by this author
  • Jorge Almeida,

    1. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
    Search for more papers by this author
  • Lori L Altshuler,

    1. Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California at Los Angeles
    2. Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
    Search for more papers by this author
  • Hilary P Blumberg,

    1. Department of Psychiatry, Yale University School of Medicine, New Haven, CT
    Search for more papers by this author
  • Kiki D Chang,

    1. Pediatric Bipolar Disorders Research Program, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
    Search for more papers by this author
  • Melissa P DelBello,

    1. Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH
    Search for more papers by this author
  • Sophia Frangou,

    1. Section of Neurobiology of Psychosis, Department of Psychosis Studies, Institute of Psychiatry, King'’s College, London
    Search for more papers by this author
  • Andrew McIntosh,

    1. Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh
    Search for more papers by this author
  • Mary L Phillips,

    1. Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA
    2. Department of Psychological Medicine, Cardiff University School of Medicine, Cardiff, UK
    Search for more papers by this author
  • Jessika E Sussman,

    1. Division of Psychiatry, School of Molecular and Clinical Medicine, University of Edinburgh, Edinburgh
    Search for more papers by this author
  • Jennifer D Townsend

    1. Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, The David Geffen School of Medicine, University of California at Los Angeles
    Search for more papers by this author

Corresponding author:
Stephen M. Strakowski, M.D.
Department of Psychiatry
University of Cincinnati College of Medicine
260 Stetson Suite 3200
Cincinnati, OH 45267-0559 USA
Fax: 513-558-0187
E-mail: stephen.strakowski@uc.edu

Abstract

Strakowski SM, Adler CM, Almeida J, Altshuler LL, Blumberg HP, Chang KD, DelBello MP, Frangou S, McIntosh A, Phillips ML, Sussman JE, Townsend JD. The functional neuroanatomy of bipolar disorder: a consensus model.
Bipolar Disord 2012: 14: 313–325. © 2012 The Authors. Journal compilation © 2012 John Wiley & Sons A/S.

Objectives:  Functional neuroimaging methods have proliferated in recent years, such that functional magnetic resonance imaging, in particular, is now widely used to study bipolar disorder. However, discrepant findings are common. A workgroup was organized by the Department of Psychiatry, University of Cincinnati (Cincinnati, OH, USA) to develop a consensus functional neuroanatomic model of bipolar I disorder based upon the participants’ work as well as that of others.

Methods:  Representatives from several leading bipolar disorder neuroimaging groups were organized to present an overview of their areas of expertise as well as focused reviews of existing data. The workgroup then developed a consensus model of the functional neuroanatomy of bipolar disorder based upon these data.

Results:  Among the participants, a general consensus emerged that bipolar I disorder arises from abnormalities in the structure and function of key emotional control networks in the human brain. Namely, disruption in early development (e.g., white matter connectivity and prefrontal pruning) within brain networks that modulate emotional behavior leads to decreased connectivity among ventral prefrontal networks and limbic brain regions, especially the amygdala. This developmental failure to establish healthy ventral prefrontal–limbic modulation underlies the onset of mania and ultimately, with progressive changes throughout these networks over time and with affective episodes, a bipolar course of illness.

Conclusions:  This model provides a potential substrate to guide future investigations and areas needing additional focus are identified.

Ancillary