Table 21.
Functional Anatomical Studies of the Ventro-Medial Prefrontal Cortex in BD.
| Study | Sample | Age | Method | Age of Onset |
Illness Duration/# Episodes |
Family History of Illness |
Clinical Status at Testing |
Medication Status | Comorbidity | Findings | Brodmann Map/Stereotaxic Coordinates |
|---|---|---|---|---|---|---|---|---|---|---|---|
| (Drevets et al 1997) | 21 BD 21 HC |
35±8.2 34±8.2 |
1.5T 1mm slice ROI |
NR | NR | Yes | Depressed | Cohort not treated for 4 weeks prior to scans | NR | Decreased metabolism of L sgACC in BD group. | 1; 25; −6 |
| (Blumberg et al 2000) | 11 BD | 33.4±11.6 | 15O-H2O | NR | 14.2±14.9 (manic) 12.0±5.6 (euthymic) |
NR | 5 manic BD; 6 euthymic | MS, AP, AD, BZ | No comorbid axis I or II conditions. Substance abuse taking place > 5 years previously was allowed. | Manic patients had greater rCBF in R ventral ACC than remitted subjects | BA 32 10; 26; −8 |
| (Ketter et al 2001) | 43 BD I + II (treatment resistant) 43 HC |
37.5±10.6 38.1±10.4 |
18 F-FDG | 18.8±9.9 | 18.3±10.4 | NR | Depressed, mildly depressed + euthymic | Unmedicated for 2+ weeks | NR | Decreased metabolism of L middle frontal and inferior frontal gyri in depressed BD patients only. Global cerebral metabolism decreased in depressed BD too. | BA 9 + 44 No coordinates given |
| (Drevets et al 2002a) | 20 MDD 14 HC |
36±10 34±9.1 |
18 F-FDG | NR | NR | NR | Depressed | Patients medication free for 3+ weeks prior to study. | No other psychiatric disorders or substance abuse | Reduced baseline metabolism of L sgACC PFC in MDD | NR |
| (Dunn et al 2002) | 27 BD | 36.7±11.3 | 18 F-FDG | 18.0±9.9 | 26.7±14.6 | NR | Mildly to severely depressed | Unmedicated for 2+ weeks | No active substance abuse, eating disorder, OCD, dementia, medical illness | Anhedonia associated with greater metabolism of R sgACC | 10; 42; −4 |
| (Kegeles et al 2003) | 19 (14 MDD, 5 BD) 10 HC |
36±11 39±19 |
18 F-FDG | NR | NR | Yes | Depressed | BZ discontinued 24 hours before study in 12 cases. 7 subjects on BZ. Patients free of other medication for 2+ weeks. | 3 panic disorder, 2 dysthymia, 1 each with social phobia, simple phobia, anorexia + PTSD. No medical illness | Lower metabolic activity of the R pregenual ACC in MDD. | BA 32 4; 34; −12 |
| (Kruger et al 2003) | 11 depressed BD 9 remitted BD |
43±9 38±12 |
15O-H2O Voxel-wise | 22±6 | 8±3 (dep episodes) 3±2 (manic episodes) 8±5 (dep episodes) 3±2 (manic episodes) |
NR | Depressed/Remitted | MS | No axis I or II disorders. No substance abusers | BL decreases in rCBF to ventral medial PFC after sadness induction in both BD groups | In remitted group increased rCBF to dorsal anterior cingulate – BA24a: 10; 20; 24. Decreased rCBF to orbitomedial and ventromedial cortex – BA 11: 6; 42; −10 14; 46; −20 20; 62; −4 −18; 54; 10 −14; 64; 0 In depressed group: decreased orbitomedial and ventromedial rCBF: 8; 56; −6 4; 58; 9 |
| (Lennox et al 2004) | 10 BD 12 HC |
37.3±12.8 32.6±10.7 |
fMRI 3T voxel-wise |
NR | NR | NR | Manic | 8 Lith, 7 MS, 3 haloperidol, 4 olanzapine | NR | BD patients had attenuated BL activation of sgACC in response to sad faces | −2; 20; −14 BA25 |
| (Bauer et al 2005) | 10 BD I 10 HC |
39.3±7.8 35.0±9.3 |
18 F-FDG | NR | 20.4±7.0 | NR | Depressed | AD + MS | No psychosis | Higher activity in R sgACC which decreased with treatment. | 8; 24; −6 |
| (Haldane et al 2007) | 8 BD I | 42.1±11.8 | fMRI 1.5T 7mm (0.7mm gap) |
23.1±5.6 | 10.1±6.5 episodes | NR | Mildly depressed | Lamotrigine | No alcohol or substance abuse, significant medical or neurological disorder, treatment resistance, suicide attempts, axis I comorbidity | Greater activation of L medial frontal gyrus + R ACC in response to angry faces after lamotrigine therapy relative to baseline. | BA 10 −4; 46; 10 BA 32/24 10; 36; 6 |
| (Mah et al 2007) | 13 BD II 18 HC |
43.0±8.4 39.0±8.0 |
18 F-FDG | 20±10.5 | 22.9±12 | NR | Depressed | Lithium | No substance abuse within 90 days, substance dependence within 5 years. No current psychotic features. 1 OCD, 1 eating disorder | Increased metabolism of R pregenual ACC in BD. | 12; 47; 5 |