14.3 Patterns of Cortical Gray Matter Changes in Youth With First-Episode Mania: A Surface-Based Magnetic Resonance Imaging Study With Cluster Analysis

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Objectives

Although structural gray matter abnormalities have been identified in youth with bipolar disorder (BD), findings from existing neuroimaging studies are inconsistent. The pathophysiological heterogeneity of the disorder probably contributes to these differences and limits their clinical impact. The aim of this study was to investigate whether different patterns of cortical gray matter thickness are present and predict treatment response in a group of first-episode manic youth.

Methods

First-episode youth were randomized to blinded treatment with quetiapine versus lithium for six weeks. High-resolution T1-weighted magnetic response images were acquired from 52 youth with first-episode mania and 31 demographically matched healthy youth at baseline for comparison. Cortical segmentation was performed using the FreeSurfer toolbox, and cortical thickness of all the regions within the Desikan Atlas in bilateral hemispheres were calculated and selected as the variables for the

Results

Analysis of morphometric features extracted from 68 cortical regions identified two main subgroups of patients. Patients within group 2 had lower IQs and socioeconomic status relative to healthy comparisons, whereas those in group 1 did not. Group 1 showed widespread thicker cortex compared with healthy comparison youth, mainly in the fronto-temporo-parietal regions. Group 1 consisted of 16 participants, eight of whom were treated with quetiapine and eight of whom were treated with lithium.

Conclusions

Two distinct patterns of cortical gray matter abnormalities were identified, suggesting different pathophysiologic processes that are predictive of treatment response. Future analyses using other modalities, such as neurocognitive and genetic information, may optimize classification.

BD, NEUROA, PPC

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Supported by NIMH Grant R01MH080973

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