Am J Psychiatry 156:1986-1988, December 1999
© 1999 American Psychiatric Association
Rostral and Orbital Prefrontal Cortex Dysfunction in the Manic State of Bipolar Disorder
Hilary P. Blumberg, M.D.,
Emily Stern, M.D.,
Sally Ricketts, M.D.,
Diana Martinez, M.D.,
Jose de Asis, M.D.,
Thomas White, M.S.,
Jane Epstein, M.D.,
Nancy Isenberg, M.D.,
P. Anne McBride, M.D.,
Ingrid Kemperman, M.D.,
Sylvia Emmerich, B.A.,
Vijay Dhawan, Ph.D.,
David Eidelberg, M.D.,
James H. Kocsis, M.D., and
David A. Silbersweig, M.D.
OBJECTIVE: This study investigated prefrontal cortex function in the manic state of bipolar disorder. METHOD: High-sensitivity [15O]H2O positron emission tomography and a word generation activation paradigm were used to study regional cerebral blood flow in five manic and six euthymic individuals with bipolar disorder and in five healthy individuals. RESULTS: Decreased right rostral and orbital prefrontal cortex activation during word generation and decreased orbitofrontal activity during rest were associated with mania. CONCLUSIONS: The data support the presence of rostral and orbital prefrontal dysfunction in primary mania. These findings, when seen in the context of the human brain lesion and the behavioral neuroanatomic literatures, may help to explain some of the neurobehavioral abnormalities characteristic of the manic state.
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