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Emotion Processing Influences Working Memory Circuits in Pediatric Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder

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Objective

This functional magnetic resonance imaging (fMRI) study examined how working memory circuits are affected by face emotion processing in pediatric bipolar disorder (PBD) and attention-deficit/hyperactivity disorder (ADHD).

Methods

A total of 23 patients with PBD, 14 patients with ADHD, and 19 healthy control (HC) subjects (mean age, 13.36 ± 2.55 years) underwent an affective, two-back fMRI task with blocks of happy, angry, and neutral faces.

Results

For angry versus neutral faces PBD patients, relative to ADHD patients, exhibited increased activation in the subgenual anterior cingulate cortex (ACC) and orbitofrontal cortex, and reduced activation in the dorsolateral prefrontal cortex (DLPFC) and premotor cortex. Relative to the HC group, the PBD group showed no increased activation and reduced activation at the junction of DLPFC and ventrolateral prefrontal cortex (VLPFC). Relative to HC, the ADHD patients exhibited greater activation in the DLPFC and reduced activation in the ventral and medial PFC, pregenual ACC, striatum, and temporo-parietal regions. For happy versus neutral faces, relative to the ADHD group, the PBD group exhibited greater activation in the bilateral caudate, and relative to the HC group the ADHD group showed increased activation in the DLPFC, striatal, and parietal regions, and no reduced activation. The ADHD group, compared with the HC group, showed no reduced activation and increased activation in regions that were underactive for the angry face condition.

Conclusions

Relative to the ADHD group, the PBD group exhibited greater deployment of the emotion-processing circuitry and reduced deployment of working memory circuitry. Commonalities across PBD and ADHD patients, relative to the HC individuals, entailed cortico-subcortical activity that was reduced under negative emotional challenge and increased under positive emotional challenge.

Section snippets

Participants

Patient participants were recruited from the child psychiatry clinics at the University of Illinois at Chicago (UIC), and healthy controls were recruited from the neighboring community through word-of-mouth and advertisement. This study was approved by the UIC Institutional Review Board. We obtained assent for children and adolescents aged less than 15 years, and informed consent for adolescents aged 15 years or more. Consent from at least one parent or legal guardian was also obtained.

We

Demographic and Clinical Data

Clinical and demographic data for the three study groups are illustrated in Table 1. Separate ANOVAs for each demographic measure revealed no group differences for age, [F(2,53) = 0.23, p = .79], and estimated IQ [F(2,53) = 2.44, p = .10]. For SES, there were no significant group differences, although there was a nonsignificant trend [F(2,53) = 2.79, p = .07] suggesting somewhat lower SES scores in the PBD group compared with the ADHD and the HC groups. We also found no significant group

Discussion

The central finding of the present fMRI study is that the neural substrate of working memory is differentially influenced by face emotion processing in PBD and ADHD, in that relative to the ADHD group the PBD group exhibited greater deployment of the emotion processing circuitry and relative to the PBD group the ADHD group showed greater deployment of prefrontal working memory circuitry. Albeit preliminary, this finding suggests the possibility of different neural phenotypes for the interface

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    This work is supported by National Institutes of Health (NIH K23 RR18638-01), the Dana Foundation, and the National Alliance for Research on Schizophrenia and Depression.

    We thank the children and families who participated in this study. We also thank Ms. Erin Harral of the University of Illinois at Chicago for help with subject testing and data processing.

    Disclosure: Dr. Pavuluri has received research support from the National Alliance for Research on Schizophrenia and Depression Independent Investigator Award, the National Institute of Child Health and Human Development, GlaxoSmithKline–NeuroHealth, Abbott Pharmaceuticals, and Janssen Research Foundation. Dr. Sweeney has received research support from the National Institutes of Health, GlaxoSmithKline, AstraZeneca, Janssen, and Eli Lilly and Co. Dr. Passarotti reports no biomedical financial interests or potential conflicts of interest.

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