The neurobiological features of pediatric bipolar disorder (BD) are
largely unknown. Children and adolescents with BD may be important to study
with functional neuroimaging techniques because of their unique status of
early-onset BD and high familial loading for the disorder. Neuroimaging studies
of adults with BD have implicated the dorsolateral prefrontal cortex (DLPFC)
and anterior cingulate cortex (ACC) in the development of this disorder.
To study children and adolescents with BD via functional magnetic resonance
imaging using cognitive and affective tasks and to examine possible abnormalities
in the DLPFC and ACC, as well as selected subcortical areas, in pediatric
We evaluated 12 male subjects aged 9 to 18 years with BD who had at
least 1 parent with BD as well as 10 age- and IQ-matched healthy male controls.
Stimulants were discontinued for at least 24 hours; other medications were
continued. Subjects underwent functional magnetic resonance imaging at 3 T
while performing a 2-back visuospatial working memory task and an affective
task involving the visualization of positively, neutrally, or negatively valenced
An academic referral setting, drawing from the Bay Area of San Francisco,
Compared with controls, for the visuospatial working memory task, subjects
with BD had greater activation in several areas including the bilateral ACC,
left putamen, left thalamus, left DLPFC, and right inferior frontal gyrus.
Controls had greater activation in the cerebellar vermis. In viewing negatively
valenced pictures, subjects with BD had greater activation in the bilateral
DLPFC, inferior frontal gyrus, and right insula. Controls had greater activation
in the right posterior cingulate gyrus. For positively valenced pictures,
subjects with BD had greater activation in the bilateral caudate and thalamus,
left middle/superior frontal gyrus, and left ACC, whereas controls had no
areas of greater activation.
Children and adolescents with BD may have underlying abnormalities in
the regulation of prefrontal-subcortical circuits. Further functional magnetic
resonance imaging studies of attention and mood with greater sample sizes