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Neural Correlates of Emotional Distractibility in Bipolar Disorder Patients, Unaffected Relatives, and Individuals With Hypomanic Personality
Philipp Kanske, Ph.D.; Janine Heissler, Ph.D.; Sandra Schönfelder, M.Sc.; Johanna Forneck, M.Sc.; Michèle Wessa, Ph.D.
Am J Psychiatry 2013;170:1487-1496. doi:10.1176/appi.ajp.2013.12081044
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The authors report no financial relationships with commercial interests.

Funded by a grant from the Deutsche Forschungsgemeinschaft (grant We3638/3-1).

From the Section for Experimental Psychopathology and Neuroimaging, Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University, Heidelberg, Germany; Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany; Department of Clinical Psychology and Neuropsychology, Johannes Gutenberg University, Mainz, Germany; and Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Address correspondence to Dr. Kanske (philipp@kanske.de).

Copyright © 2013 by the American Psychiatric Association

Received August 07, 2012; Revised March 20, 2013; Revised May 08, 2013; Accepted May 17, 2013.

Abstract

Objective  Neuropsychological deficits and emotion dysregulation are present in symptomatic and euthymic patients with bipolar disorder. However, there is little evidence on how cognitive functioning is influenced by emotion, what the neural correlates of emotional distraction effects are, and whether such deficits are a consequence or a precursor of the disorder. The authors used functional MRI (fMRI) to investigate these questions.

Method  fMRI was used first to localize the neural network specific to a certain cognitive task (mental arithmetic) and then to test the effect of emotional distractors on this network. Euthymic patients with bipolar I disorder (N=22), two populations at high risk for developing the disorder (unaffected first-degree relatives of individuals with bipolar disorder [N=17]), and healthy participants with hypomanic personality traits [N=22]) were tested, along with three age-, gender-, and education-matched healthy comparison groups (N=22, N=17, N=24, respectively).

Results  There were no differences in performance or activation in the task network for mental arithmetic. However, while all participants exhibited slower responses when emotional distractors were present, this response slowing was greatly enlarged in bipolar patients. Similarly, task-related activation was generally increased under emotional distraction; however, bipolar patients exhibited a further increase in right parietal activation that correlated positively with the response slowing effect.

Conclusions  The results suggest that emotional dysregulation leads to exacerbated neuropsychological deficits in bipolar patients, as evidenced by behavioral slowing and task-related hyperactivation. The lack of such a deficit in high-risk populations suggests that it occurs only after disease onset, rather than representing a vulnerability marker.

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FIGURE 1. Sequence of Events in the Trial of a Localizer to Identify Brain Activation Patterns Specific to Mental Arithmetic Operations (Task 1) and the Experimental Task To Test the Effects of Emotional Distraction in Mental Arithmetic (Task 2)a

a The images shown are examples that resemble those in the experiment but are not part of the International Affective Picture System, which was used in this study.

FIGURE 2. Activation Maps for Mental Arithmetic vs. Number Detection and for Mental Arithmetic on Emotional vs. Neutral Distractor Images

FIGURE 3. Reaction Time and Activation Increase in Emotional vs. Neutral Trialsa

a In panel A, reaction times in task 2 for bipolar patients indicate enlarged distraction effects through emotional background images. In panel B, activation differences between bipolar patients and healthy comparison subjects (blue) are shown on the main effect of distraction (red [as displayed in Figure 2D]). Panel C shows the correlation of the reaction time distraction effect and the parietal hyperactivation for mental arithmetic on emotional background images. Panel D shows the respective percent signal change for bipolar patients and comparison subjects.

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TABLE 1.Demographic and Clinical Characteristics of Patients With Bipolar Disorder, Unaffected Relatives, Healthy Participants With Hypomanic Personality, and Their Respective Comparison Counterparts
Table Footer Note

a Measured with the Mehrfachwahl-Wortschatz-Intelligenztest-B.

Table Footer Note

b Measured with the Edinburgh Handedness Inventory.

Anchor for Jump
TABLE 2.Activations During Task 2 for Mental Arithmetic on Emotional vs. Neutral Distractor Images in Patients With Bipolar Disorder, Unaffected Relatives, Healthy Participants With Hypomanic Personality, and Their Respective Comparison Counterparts and the Activation Difference Between Bipolar Patients and Comparison Subjects
Table Footer Note

a MNI=Montreal Neurological Institute.

Table Footer Note

b Number of activated voxels.

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References

Keck  PE  Jr;  McElroy  SL;  Strakowski  SM;  West  SA;  Sax  KW;  Hawkins  JM;  Bourne  ML;  Haggard  P:  12-Month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode.  Am J Psychiatry 1998; 155:646–652
[PubMed]
 
Tohen  M;  Zarate  CA  Jr;  Hennen  J;  Khalsa  HM;  Strakowski  SM;  Gebre-Medhin  P;  Salvatore  P;  Baldessarini  RJ:  The McLean-Harvard First-Episode Mania Study: prediction of recovery and first recurrence.  Am J Psychiatry 2003; 160:2099–2107
[CrossRef] | [PubMed]
 
Martínez-Arán  A;  Vieta  E;  Colom  F;  Torrent  C;  Sánchez-Moreno  J;  Reinares  M;  Benabarre  A;  Goikolea  JM;  Brugué  E;  Daban  C;  Salamero  M:  Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome.  Bipolar Disord 2004; 6:224–232
[CrossRef] | [PubMed]
 
Martínez-Arán  A;  Vieta  E;  Reinares  M;  Colom  F;  Torrent  C;  Sánchez-Moreno  J;  Benabarre  A;  Goikolea  JM;  Comes  M;  Salamero  M:  Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder.  Am J Psychiatry 2004; 161:262–270
[CrossRef] | [PubMed]
 
Dittmann  S;  Fast  K;  Dederra  K;  Seemüller  F;  Möller  H-J;  Riedel  M;  Severus  E:  Kognitive Funktionsfähigkeit bei bipolaren Erkrankungen.  Nervenheilkunde 2008; 3:155–164
 
Arts  B;  Jabben  N;  Krabbendam  L;  van Os  J:  Meta-analyses of cognitive functioning in euthymic bipolar patients and their first-degree relatives.  Psychol Med 2008; 38:771–785
[CrossRef] | [PubMed]
 
Henin  A;  Micco  JA;  Wozniak  J;  Briesch  JM;  Narayan  AJ;  Hirshfeld-Becker  DR:  Neurocognitive functioning in bipolar disorder.  Clin Psychol Sci Pract 2009; 16:231–250
[CrossRef]
 
Strakowski  SM;  Delbello  MP;  Adler  CM:  The functional neuroanatomy of bipolar disorder: a review of neuroimaging findings.  Mol Psychiatry 2005; 10:105–116
[CrossRef] | [PubMed]
 
Altshuler  L;  Bookheimer  S;  Proenza  MA;  Townsend  J;  Sabb  F;  Firestine  A;  Bartzokis  G;  Mintz  J;  Mazziotta  J;  Cohen  MS:  Increased amygdala activation during mania: a functional magnetic resonance imaging study.  Am J Psychiatry 2005; 162:1211–1213
[CrossRef] | [PubMed]
 
Almeida  JR;  Versace  A;  Hassel  S;  Kupfer  DJ;  Phillips  ML:  Elevated amygdala activity to sad facial expressions: a state marker of bipolar but not unipolar depression.  Biol Psychiatry 2010; 67:414–421
[CrossRef] | [PubMed]
 
Lagopoulos  J;  Malhi  GS:  A functional magnetic resonance imaging study of emotional Stroop in euthymic bipolar disorder.  Neuroreport 2007; 18:1583–1587
[CrossRef] | [PubMed]
 
Wessa  M;  Linke  J:  Emotional processing in bipolar disorder: behavioural and neuroimaging findings.  Int Rev Psychiatry 2009; 21:357–367
[CrossRef] | [PubMed]
 
Phillips  ML;  Ladouceur  CD;  Drevets  WC:  A neural model of voluntary and automatic emotion regulation: implications for understanding the pathophysiology and neurodevelopment of bipolar disorder.  Mol Psychiatry 2008; 13:833–857
[CrossRef]
 
Malhi  GS;  Lagopoulos  J;  Sachdev  PS;  Ivanovski  B;  Shnier  R:  An emotional Stroop functional MRI study of euthymic bipolar disorder.  Bipolar Disord 2005; 7(suppl 5):58–69
[CrossRef] | [PubMed]
 
Wessa  M;  Houenou  J;  Paillère-Martinot  ML;  Berthoz  S;  Artiges  E;  Leboyer  M;  Martinot  JL:  Fronto-striatal overactivation in euthymic bipolar patients during an emotional go/nogo task.  Am J Psychiatry 2007; 164:638–646
[CrossRef] | [PubMed]
 
Deckersbach  T;  Rauch  SL;  Buhlmann  U;  Ostacher  MJ;  Beucke  JC;  Nierenberg  AA;  Sachs  G;  Dougherty  DD:  An fMRI investigation of working memory and sadness in females with bipolar disorder: a brief report.  Bipolar Disord 2008; 10:928–942
[CrossRef] | [PubMed]
 
Bertocci  MA;  Bebko  GM;  Mullin  BC;  Langenecker  SA;  Ladouceur  CD;  Almeida  JR;  Phillips  ML:  Abnormal anterior cingulate cortical activity during emotional n-back task performance distinguishes bipolar from unipolar depressed females.  Psychol Med 2012; 42:1417–1428
[CrossRef] | [PubMed]
 
Wessa  M;  Heissler  J;  Schönfelder  S;  Kanske  P:  Goal-directed behavior under emotional distraction is preserved by enhanced task-specific activation.  Soc Cogn Affect Neurosci 2013; 8:305–312
[CrossRef] | [PubMed]
 
Menon  V;  Rivera  SM;  White  CD;  Glover  GH;  Reiss  AL:  Dissociating prefrontal and parietal cortex activation during arithmetic processing.  Neuroimage 2000; 12:357–365
[CrossRef] | [PubMed]
 
Ischebeck  A;  Zamarian  L;  Schocke  M;  Delazer  M:  Flexible transfer of knowledge in mental arithmetic: an fMRI study.  Neuroimage 2009; 44:1103–1112
[CrossRef] | [PubMed]
 
Eckblad  M;  Chapman  LJ:  Development and validation of a scale for hypomanic personality.  J Abnorm Psychol 1986; 95:214–222
[CrossRef] | [PubMed]
 
Kwapil  TR;  Miller  MB;  Zinser  MC;  Chapman  LJ;  Chapman  J;  Eckblad  M:  A longitudinal study of high scorers on the Hypomanic Personality Scale.  J Abnorm Psychol 2000; 109:222–226
[CrossRef] | [PubMed]
 
First  MB;  Gibbon  M;  Spitzer  RL;  Williams  JBW:  Structured Clinical Interview for DSM IV Axis I Disorders (SCID-I) .  Washington, DC,  American Psychiatric Publishing, 1997
 
First  MB;  Gibbon  M;  Spitzer  RL;  Williams  JBW;  Benjamin  L:  Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) .  Washington DC,  American Psychiatric Publishing, 1997
 
Wittchen  H-U;  Zaudig  M;  Fydrich  T:  SKID-I: Strukturiertes Klinisches Interview für DSM-IV .  Göttingen,  Hogrefe, 1997. [Structural Clinical Interview for DSM-IV Axis I Disorders]
 
Wittchen  H-U;  Zaudig  M;  Fydrich  T:  SKID-II: Strukturiertes Klinisches Interview für DSM-IV .  Göttingen,  Hogrefe, 1997. [Structural Clinical Interview for DSM-IV Axis II Disorders]
 
Young  RC;  Biggs  JT;  Ziegler  VE;  Meyer  DA:  A rating scale for mania: reliability, validity and sensitivity.  Br J Psychiatry 1978; 133:429–435
[CrossRef] | [PubMed]
 
Hamilton  M:  A rating scale for depression.  J Neurol Neurosurg Psychiatry 1960; 23:56–62
[CrossRef] | [PubMed]
 
Beck  AT;  Ward  CH;  Mendelson  M;  Mock  J;  Erbaugh  J:  An inventory for measuring depression.  Arch Gen Psychiatry 1961; 4:561–571
[CrossRef] | [PubMed]
 
Hautzinger  M;  Keller  F;  Kühner  C:  BDI-II: Beck-Depressions-Inventar Revision .  Frankfurt,  Pearson Assessment, 2009
 
Mercer  L;  Becerra  R:  A unique emotional processing profile of euthymic bipolar disorder? A critical review.  J Affect Disord 2013; 146:295–309
[CrossRef] | [PubMed]
 
Sackeim  HA:  The definition and meaning of treatment-resistant depression.  J Clin Psychiatry 2001; 62(suppl 16):10–17
[PubMed]
 
Phillips  ML;  Travis  MJ;  Fagiolini  A;  Kupfer  DJ:  Medication effects in neuroimaging studies of bipolar disorder.  Am J Psychiatry 2008; 165:313–320
[CrossRef] | [PubMed]
 
Meyer  TD;  Drüke  B;  Hautzinger  M:  Hypomane persönlichkeit: psychometrische evaluation und erste ergebnisse zur validität der deutschen version der Chapman-Skala.  Z Klin Psychol Psychother 2000; 29:35–42
[CrossRef]
 
Kanske  P;  Heissler  J;  Schönfelder  S;  Bongers  A;  Wessa  M:  How to regulate emotion? Neural networks for reappraisal and distraction.  Cereb Cortex 2011; 21:1379–1388
[CrossRef] | [PubMed]
 
Lang PJ, Bradley MM, Cuthbert BN: International Affective Picture System (IAPS): Affective Ratings of Pictures and Instruction Manual (Technical Report A–6). Gainesville, University of Florida, Center for Research in Psychophysiology, 2005
 
Rickard  TC;  Romero  SG;  Basso  G;  Wharton  C;  Flitman  S;  Grafman  J:  The calculating brain: an fMRI study.  Neuropsychologia 2000; 38:325–335
[CrossRef] | [PubMed]
 
Grabner  RH;  Ansari  D;  Koschutnig  K;  Reishofer  G;  Ebner  F;  Neuper  C:  To retrieve or to calculate? Left angular gyrus mediates the retrieval of arithmetic facts during problem solving.  Neuropsychologia 2009; 47:604–608
[CrossRef] | [PubMed]
 
Blair  KS;  Smith  BW;  Mitchell  DG;  Morton  J;  Vythilingam  M;  Pessoa  L;  Fridberg  D;  Zametkin  A;  Sturman  D;  Nelson  EE;  Drevets  WC;  Pine  DS;  Martin  A;  Blair  RJ:  Modulation of emotion by cognition and cognition by emotion.  Neuroimage 2007; 35:430–440
[CrossRef] | [PubMed]
 
Hart  SJ;  Green  SR;  Casp  M;  Belger  A:  Emotional priming effects during Stroop task performance.  Neuroimage 2010; 49:2662–2670
[CrossRef] | [PubMed]
 
Pereira  MG;  de Oliveira  L;  Erthal  FS;  Joffily  M;  Mocaiber  IF;  Volchan  E;  Pessoa  L:  Emotion affects action: midcingulate cortex as a pivotal node of interaction between negative emotion and motor signals.  Cogn Affect Behav Neurosci 2010; 10:94–106
[CrossRef] | [PubMed]
 
Surguladze  SA;  Marshall  N;  Schulze  K;  Hall  MH;  Walshe  M;  Bramon  E;  Phillips  ML;  Murray  RM;  McDonald  C:  Exaggerated neural response to emotional faces in patients with bipolar disorder and their first-degree relatives.  Neuroimage 2010; 53:58–64
[CrossRef] | [PubMed]
 
Olsavsky  AK;  Brotman  MA;  Rutenberg  JG;  Muhrer  EJ;  Deveney  CM;  Fromm  SJ;  Towbin  K;  Pine  DS;  Leibenluft  E:  Amygdala hyperactivation during face emotion processing in unaffected youth at risk for bipolar disorder.  J Am Acad Child Adolesc Psychiatry 2012; 51:294–303
[CrossRef] | [PubMed]
 
Green  MJ;  Lino  BJ;  Hwang  EJ;  Sparks  A;  James  C;  Mitchell  PB:  Cognitive regulation of emotion in bipolar I disorder and unaffected biological relatives.  Acta Psychiatr Scand 2011; 124:307–316
[CrossRef] | [PubMed]
 
Carver  CS;  Johnson  SL:  Tendencies toward mania and tendencies toward depression have distinct motivational, affective, and cognitive correlates.  Cognit Ther Res 2009; 33:552–569
[CrossRef] | [PubMed]
 
Gruber  J;  Johnson  SL;  Oveis  C;  Keltner  D:  Risk for mania and positive emotional responding: too much of a good thing? Emotion 2008; 8:23–33
[CrossRef] | [PubMed]
 
Kwapil  TR;  Barrantes-Vidal  N;  Armistead  MS;  Hope  GA;  Brown  LH;  Silvia  PJ;  Myin-Germeys  I:  The expression of bipolar spectrum psychopathology in daily life.  J Affect Disord 2011; 130:166–170
[CrossRef] | [PubMed]
 
Rich  BA;  Vinton  DT;  Roberson-Nay  R;  Hommer  RE;  Berghorst  LH;  McClure  EB;  Fromm  SJ;  Pine  DS;  Leibenluft  E:  Limbic hyperactivation during processing of neutral facial expressions in children with bipolar disorder.  Proc Natl Acad Sci USA 2006; 103:8900–8905
[CrossRef] | [PubMed]
 
Strakowski  SM;  Adler  CM;  Holland  SK;  Mills  N;  DelBello  MP:  A preliminary fMRI study of sustained attention in euthymic, unmedicated bipolar disorder.  Neuropsychopharmacology 2004; 29:1734–1740
[CrossRef] | [PubMed]
 
Adler  CM;  Holland  SK;  Schmithorst  V;  Tuchfarber  MJ;  Strakowski  SM:  Changes in neuronal activation in patients with bipolar disorder during performance of a working memory task.  Bipolar Disord 2004; 6:540–549
[CrossRef] | [PubMed]
 
Kanske  P;  Heissler  J;  Schönfelder  S;  Wessa  M:  Neural correlates of emotion regulation deficits in remitted depression: the influence of regulation strategy, habitual regulation use, and emotional valence.  Neuroimage 2012; 61:686–693
[CrossRef] | [PubMed]
 
Versace  A;  Almeida  JR;  Hassel  S;  Walsh  ND;  Novelli  M;  Klein  CR;  Kupfer  DJ;  Phillips  ML:  Elevated left and reduced right orbitomedial prefrontal fractional anisotropy in adults with bipolar disorder revealed by tract-based spatial statistics.  Arch Gen Psychiatry 2008; 65:1041–1052
[CrossRef] | [PubMed]
 
Linke  J;  King  AV;  Rietschel  M;  Strohmaier  J;  Hennerici  M;  Gass  A;  Meyer-Lindenberg  A;  Wessa  M:  Increased medial orbitofrontal and amygdala activation: evidence for a systems-level endophenotype of bipolar I disorder.  Am J Psychiatry 2012; 169:316–325
[CrossRef] | [PubMed]
 
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