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The impact of periventricular white matter lesions in patients with bipolar disorder type I

Published online by Cambridge University Press:  10 January 2014

Gianluca Serafini ,
Maurizio Pompili ,
Marco Innamorati ,
Nicoletta Girardi ,
Leonardo Strusi ,
Mario Amore ,
Leo Sher ,
Xenia Gonda ,
Zoltan Rihmer  and
Paolo Girardi
Gianluca Serafini*
Affiliation:
Department of Neurosciences, Mental Health and Sensory Organs—Suicide Prevention Center, Sant'Andrea Hospital, Rome, Italy
Maurizio Pompili
Affiliation:
Department of Neurosciences, Mental Health and Sensory Organs—Suicide Prevention Center, Sant'Andrea Hospital, Rome, Italy
Marco Innamorati
Affiliation:
Department of Neurosciences, Mental Health and Sensory Organs—Suicide Prevention Center, Sant'Andrea Hospital, Rome, Italy
Nicoletta Girardi
Affiliation:
Department of Neurology and Psychiatry, Sapienza University of Rome, Rome, Italy
Leonardo Strusi
Affiliation:
Casa di Cura “Samadi”, Rome, Italy
Mario Amore
Affiliation:
Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genova, Genova, Italy
Leo Sher
Affiliation:
Department of Psychiatry, Columbia University College of Physicians and Surgeons, and New York State Psychiatric Institute, New York, New York, USA
Xenia Gonda
Affiliation:
Department of Clinical and Theoretical Mental Health, Semmelweis University, Budapest, Hungary Department of Pharmacodynamics, Semmelweis University, Budapest, Hungary Neuropsychopharmacology and Neurochemistry Research Group, National Academy of Sciences and Semmelweis University, Budapest, Hungary National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Budapest, Hungary
Zoltan Rihmer
Affiliation:
Department of Clinical and Theoretical Mental Health, Semmelweis University, Budapest, Hungary National Institute of Psychiatry and Addictions, Laboratory for Suicide Research and Prevention, Budapest, Hungary
Paolo Girardi
Affiliation:
Department of Neurosciences, Mental Health and Sensory Organs—Suicide Prevention Center, Sant'Andrea Hospital, Rome, Italy
*
*Address for correspondence: Gianluca Serafini, MD, PhD, Department of Neurosciences, Mental Health and Sensory Organs, Sant'Andrea Hospital, Sapienza University of Rome, 1035-1039 Via di Grottarossa, 00189, Rome, Italy. (Email gianluca.serafini@uniroma1.it)
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Abstract

Introduction

White matter hyperintensities (WMHs) are one the most common neuroimaging findings in patients with bipolar disorder (BD). It has been suggested that WMHs are associated with impaired insight in schizophrenia and schizoaffective patients; however, the relationship between insight and WMHs in BD type I has not been directly investigated.

Methods

Patients with BD-I (148) were recruited and underwent brain magnetic resonance imaging (MRI). Affective symptoms were assessed using Young Mania Rating Scale (YMRS) and Hamilton Depression Rating Scale (HDRS17); the presence of impaired insight was based on the corresponding items of YMRS and HDRS17.

Results

Multiple punctate periventricular WMHs (PWMHs) and deep WMHs (DWMHs) were observed in 49.3% and 39.9% of the cases, respectively. Subjects with lower insight for mania had significantly more PWMHs (54.6% vs 22.2%; p < 0.05) when compared to BD-I patients with higher insight for mania. The presence of PWMHs was independently associated with lower insight for mania: patients who denied illness according to the YMRS were 4 times more likely to have PWMHs (95% CI: 1.21/13.42) than other patients.

Conclusions

Impaired insight in BD-I is associated with periventricular WMHs. The early identification of BD-I subjects with PWMHs and impaired insight may be crucial for clinicians.

Keywords

Affective symptomsBD-IinsightMRIperiventricular WMHs
Type
Original Research
Information
CNS Spectrums , Volume 21 , Issue 1 , February 2016 , pp. 23 - 34
Copyright
Copyright © Cambridge University Press 2014 

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Footnotes

Xenia Gonda is recipient of the János Bolyai Research Fellowship of Hungarian Academy of Sciences.

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