The longitudinal trajectory of emotion regulation and associated neural activity in patients with bipolar disorder: A prospective fMRI study

Hanne Lie Kjaerstad*, Luisa de Siqueira Rotenberg, Gitte Moos Knudsen, Maj Vinberg, Lars Vedel Kessing, Julian Macoveanu, Beny Lafer, Kamilla Woznica Miskowiak

*Corresponding author for this work
2 Citations (Scopus)

Abstract

OBJECTIVES: Impaired emotion regulation is a key feature of bipolar disorder (BD) that presents during acute mood episodes and in remission. The neural correlates of voluntary emotion regulation seem to involve deficient prefrontal top-down regulation already at BD illness onset. However, the trajectory of aberrant neuronal activity during emotion regulation in BD is unclear.

METHODS: We investigated neural activity during emotion regulation in response to aversive pictures from the International Affective Picture System in patients with recently diagnosed BD (n = 43) in full or partial remission and in healthy controls (HC) (n = 38) longitudinally at baseline and 16 months later.

RESULTS: Patients with BD exhibited stable hypo-activity in the left dorsomedial prefrontal cortex (DMPFC) and right dorsolateral prefrontal cortex (DLPFC) and impaired emotion regulation compared to HC over the 16 months follow-up time. More DLPFC hypo-activity during emotion regulation correlated with less successful down-regulation (r = 0.16, p = 0.045), more subsyndromal depression (r = -0.18, p = 0.02) and more functional impairment (r = -0.24, p = 0.002), while more DMPFC hypo-activity correlated with less efficient emotion regulation (r = 0.16, p = 0.048). Finally, more DMPFC hypo-activity during emotion regulation at baseline was associated with an increased likelihood of subsequent relapse during the 16 months follow-up time (β = -2.26, 95% CI [0.01; 0.99], p = 0.048).

CONCLUSION: The stable DLPFC and DMPFC hypo-activity during emotion regulation represents a neuronal trait-marker of persistent emotion regulation difficulties in BD. Hypo-activity in the DMPFC may contribute to greater risk of relapse.

Original languageEnglish
JournalActa Psychiatrica Scandinavica
Volume146
Issue number6
Pages (from-to)568-582
Number of pages15
ISSN0001-690X
DOIs
Publication statusPublished - Dec 2022

Keywords

  • Bipolar Disorder
  • Emotional Regulation
  • Emotions/physiology
  • Humans
  • Magnetic Resonance Imaging
  • Prefrontal Cortex/diagnostic imaging
  • Prospective Studies
  • Recurrence
  • functional neuroimaging
  • emotion regulation
  • bipolar disorder
  • neurobiology
  • longitudinal

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