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The anterior cingulate cortex is frequently implicated in the pathophysiology of bipolar disorder, but magnetic resonance imaging (MRI) studies have reported variable findings owing to a reliance on patient samples with chronic illness and to limited appreciation of the region's heterogeneity.
To characterise anterior cingulate cortex abnormalities in patients with bipolar disorder experiencing their first episode of psychosis while accounting for regional anatomical variability.
Grey matter volume, surface area and cortical thickness were measured in six anterior cingulate cortex subregions per hemisphere using MRI scans acquired from 26 patients with bipolar I disorder experiencing first-episode psychosis and 26 healthy controls matched for age, gender and regional morphological variability.
Relative to controls, male patients displayed increased thickness in the right subcallosal limbic anterior cingulate cortex. No significant differences were identified in females for grey matter volume or surface area measures. The findings were not attributable to medication effects.
These data suggest that first-episode psychosis in bipolar disorder is associated with a gender-specific, right-lateralised thickness increase in anterior cingulate cortex subregions known to play a role in regulating physiological stress responses.
People in a putatively late prodromal state not only have an enhanced
risk for psychosis but already suffer from mental and functional
To evaluate the acute effects of a combined supportive and antipsychotic
treatment on prodromal symptoms
Putatively prodromal individuals were randomly assigned to a
needs-focused intervention without (n=59) or with
amisulpride (n=65). Outcome measures at 12-weeks effects
were prodromal symptoms, global functioning and extrapyramidal
Amisulpride plus the needs-focused intervention produced superior effects
on attenuated and full-blown psychotic symptoms, basic, depressive and
negative symptoms, and global functioning. Main side-effects were
Coadministration of amisulpride yielded a marked symptomatic benefit.
Effects require confirmation by a placebo-controlled study
The Early Detection and Intervention Programme of the German Research Network on Schizophrenia (GRNS) investigates the initial prodromal phase of psychosis in a multidimensional approach. Two intervention strategies are being studied by two large-scale multicentre projects.
To present the concept of the intervention studies, and to provide an interim report of the recruitment procedure.
Comprehensive cognitive-behavioural therapy has been developed for patients in the ‘early initial prodromal state’. For patients in the ‘late initial prodromal state’ the atypical neuroleptic amisulpride is explored. Both interventions are evaluated in randomised controlled trials using clinical management as the control condition.
Between January 2001 and March 2003, 1212 individuals seeking help for mental health problems were screened for putative prodromal symptoms at four university centres. More than 388 individuals fulfilled criteria for both interventions and 188 (48. 5%) gave informed consent to participate in the trials.
The screening procedure appears to be feasible and trial participation seems to be acceptable to a relevant proportion of people at increased risk of developing psychosis.
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