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The American Journal of Psychiatry, VOL. 157, No. 2

Letter to the Editor | February 01, 2000

Dr. Ahearn and Colleagues Reply

EILEEN P. AHEARN, M.D., PH.D.; DAVID C. STEFFENS, M.D.; FREDERICK CASSIDY, M.D.; SUSAN VAN METER, M.D.; JAMES M. PROVENZALE, M.D.; RICHARD H. WEISLER, M.D.; K. RANGA RAMA KRISHNAN, M.D.

Am J Psychiatry 2000;157:307-307. 10.1176/appi.ajp.157.2.307

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To the Editor: We appreciate Dr. Garside and colleagues’ letter regarding our report of MRI lesions in a family with bipolar disorder. The authors are correct in noting that white matter lesions are common in the elderly. Our study found no age effect when comparing family members with MRI lesions to those without.

While we did not have an active comparison group in this study, our research group did a previous study of comparison subjects (1), using the same spin-echo pulse sequences, the same classification system for reporting the data, and the same raters who were blind to information about the study subjects. These data were reported in the introduction and indicate a low incidence of MRI lesions (1%) in subjects under age 45 and a higher incidence of lesions in the elderly.

The purpose of this study was not to look for correlations between the clinical manifestations of bipolar disorder and MRI lesions. Other researchers have already documented such findings (2–5). Rather, we were specifically looking at the prevalence of MRI lesions in affected and unaffected family members in a family with a substantial history of bipolar disorder. As noted in the article, the prevalence of white matter and subcortical lesions was high in unaffected family members and those with bipolar disorder. In the absence of other diseases that could explain these findings (the family had few risk factors), we postulate that they may correlate with a genotypic risk factor for the disorder.

References

Krishnan KR, McDonald WM, Escalona PR, Doraiswamy PM, Na C, Husain MM, Figiel GS, Boyko OB, Ellinwood EH, Nemeroff CB: Magnetic resonance imaging of the caudate nuclei in depression: preliminary observations. Arch Gen Psychiatry 1992; 49:553–557[PubMed]

Dupont RM, Jernigan TL, Butters N: Subcortical abnormalities detected in bipolar affective disorder using magnetic resonance imaging. Arch Gen Psychiatry 1990; 47:55–59[PubMed]

Swayze VW, Andreasen NC, Alliger RJ, Ehrhardt JC, Yuh WTC: Structural brain abnormalities in bipolar affective disorder: ventricular enlargement and focal signal hyperintensities. Arch Gen Psychiatry1990; 47:1054– 1059

Figiel GS, Krishnan KR, Rao VP, Doraiswamy M, Ellinwood EH Jr, Nemeroff CB, Evans D, Boyko O: Subcortical hyperintensities on brain magnetic resonance imaging: a comparison of normal and bipolar subjects. J Neuropsychiatry Clin Neurosci 1991; 3:18–22[PubMed]

Strakowski SM, Woods BT, Tohen M, Wilson DR, Douglass AW, Stoll AL: MRI subcortical hyperintensities in mania at first hospitalization. Biol Psychiatry 1993; 33:204–206[PubMed][CrossRef]

Dupont RM, Jernigan TL, Butters N: Subcortical abnormalities detected in bipolar affective disorder using magnetic resonance imaging. Arch Gen Psychiatry 1990; 47:55–59[PubMed]

Strakowski SM, Woods BT, Tohen M, Wilson DR, Douglass AW, Stoll AL: MRI subcortical hyperintensities in mania at first hospitalization. Biol Psychiatry 1993; 33:204–206[PubMed][CrossRef]

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EILEEN P. AHEARN, DAVID C. STEFFENS, FREDERICK CASSIDY, SUSAN VAN METER, JAMES M. PROVENZALE, RICHARD H. WEISLER, K. RANGA RAMA KRISHNAN; Dr. Ahearn and Colleagues Reply. American Journal of Psychiatry. 2000 Feb;157(2):307-307.

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