Neurofunctional effects of quetiapine in patients with bipolar mania

Andrew K. Davis, Melissa P. Delbello, James Eliassen, Jeffrey Welge, Thomas J. Blom, David E. Fleck, Wade A. Weber, Kelly B. Jarvis, Emily Rummelhoff, Stephen M. Strakowski, Caleb M. Adler*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Objectives: Several lines of evidence suggest that abnormalities within portions of the extended limbic network involved in affective regulation and expression contribute to the neuropathophysiology of bipolar disorder. In particular, portions of the prefrontal cortex have been implicated in the appearance of manic symptomatology. The effect of atypical antipsychotics on activation of these regions, however, remains poorly understood. Methods: Twenty-two patients diagnosed with bipolar mania and 26 healthy subjects participated in a baseline functional magnetic resonance imaging scan during which they performed a continuous performance task with neutral and emotional distractors. Nineteen patients with bipolar disorder were treated for eight weeks with quetiapine monotherapy and then rescanned. Regional activity in response to emotional stimuli was compared between healthy and manic subjects at baseline; and in the subjects with bipolar disorder between baseline and eight-week scans. Results: At baseline, functional activity did not differ between subjects with bipolar disorder and healthy subjects in any region examined. After eight weeks of treatment, subjects with bipolar disorder showed a significant decrease in ratings on the Young Mania Rating Scale (YMRS) (p < 0.001), and increased activation in the right orbitofrontal cortex (OFC) (p = 0.002); there was a significant association between increased right OFC activity and YMRS improvement (p = 0.003). Conclusions: These findings are consistent with suggestions that mania involves a loss of emotional modulatory activity in the prefrontal cortex-restoration of the relatively greater elevation in prefrontal activity widely observed in euthymic patients is associated with clinical improvement. It is not clear, however, whether changes are related to quetiapine treatment or represent a non-specific marker of affective change.

Original languageEnglish (US)
Pages (from-to)444-449
Number of pages6
JournalBipolar Disorders
Volume17
Issue number4
DOIs
StatePublished - Jun 1 2015

Keywords

  • fMRI
  • Bipolar disorder
  • Functional magnetic resonance imaging
  • Mania
  • Prefrontal cortex
  • Quetiapine

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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