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Structural and metabolic differentiation between bipolar disorder with psychosis and substance-induced psychosis: An integrated MRI/PET study

Published online by Cambridge University Press:  31 December 2016

A.C. Altamura ,
G. Delvecchio ,
G. Marotta ,
L. Oldani ,
A. Pigoni ,
V. Ciappolino ,
E. Caletti ,
C. Rovera ,
C. Dobrea  and
C. Arici
...Show all authors
A.C. Altamura
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
G. Delvecchio
Affiliation:
Scientific Institute IRCCS “E. Medea”, Italy
G. Marotta
Affiliation:
Department of Services, Neuroradiology Unit, Nuclear Medicine Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
L. Oldani
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
A. Pigoni
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
V. Ciappolino
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
E. Caletti
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
C. Rovera
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
C. Dobrea
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
C. Arici
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
B. Benatti
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
G. Camuri
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
C. Prunas
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
R.A. Paoli
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
B. Dell’osso
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy Department of Psychiatry, Bipolar Disorders Clinic, Stanford University, CA, USA
C. Cinnante
Affiliation:
Department of Services, Neuroradiology Unit, Nuclear Medicine Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
F.M. Triulzi
Affiliation:
Department of Services, Neuroradiology Unit, Nuclear Medicine Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
P. Brambilla*
Affiliation:
Department of Neurosciences and Mental Health, Institute of Psychiatry, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy Department of Psychiatry and Behavioural Neurosciences, University of Texas at Houston, Houston, TX, USA
*
⁎Corresponding author at: Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, via F. Sforza 35, 20122 Milan, Italy. E-mail address: paolo.brambilla1@unimi.it (P. Brambilla).
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Abstract

Background

Bipolar disorder (BD) may be characterized by the presence of psychotic symptoms and comorbid substance abuse. In this context, structural and metabolic dysfunctions have been reported in both BD with psychosis and addiction, separately. In this study, we aimed at identifying neural substrates differentiating psychotic BD, with or without substance abuse, versus substance-induced psychosis (SIP) by coupling, for the first time, magnetic resonance imaging (MRI) and positron emission tomography (PET).

Methods

Twenty-seven BD type I psychotic patients with (n = 10) or without (n = 17) substance abuse, 16 SIP patients and 54 healthy controls were enrolled in this study. 3T MRI and 18-FDG-PET scanning were acquired.

Results

Gray matter (GM) volume and cerebral metabolism reductions in temporal cortices were observed in all patients compared to healthy controls. Moreover, a distinct pattern of fronto-limbic alterations were found in patients with substance abuse. Specifically, BD patients with substance abuse showed volume reductions in ventrolateral prefrontal cortex, anterior cingulate, insula and thalamus, whereas SIP patients in dorsolateral prefrontal cortex and posterior cingulate. Common alterations in cerebellum, parahippocampus and posterior cingulate were found in both BD with substance abuse and SIP. Finally, a unique pattern of GM volumes reduction, with concomitant increased of striatal metabolism, were observed in SIP patients.

Conclusions

These findings contribute to shed light on the identification of common and distinct neural markers associated with bipolar psychosis and substance abuse. Future longitudinal studies should explore the effect of single substances of abuse in patients at the first-episode of BD and substance-induced psychosis.

Keywords

Bipolar disorderSubstance-induced psychosisMagnetic resonance imaging (MRI)Positron emission tomography (PET)Gray matterCerebral metabolism
Type
Original article
Information
European Psychiatry , Volume 41 , Issue 1 , March 2017 , pp. 85 - 94
Copyright
Copyright © European Psychiatric Association 2017

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