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Altered frontal cortex functioning in emotion regulation and hopelessness in bipolar disorder
Author(s) -
Sankar Anjali,
Purves Kirstin,
Colic Lejla,
Cox Lippard Elizabeth T.,
Millard Hun,
Fan Siyan,
Spencer Linda,
Wang Fei,
Pittman Brian,
Constable R. Todd,
Gross James J.,
Blumberg Hilary P.
Publication year - 2021
Publication title -
bipolar disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.285
H-Index - 129
eISSN - 1399-5618
pISSN - 1398-5647
DOI - 10.1111/bdi.12954
Subject(s) - psychology , bipolar disorder , mood , anterior cingulate cortex , clinical psychology , bipolar i disorder , mood disorders , orbitofrontal cortex , mania , depression (economics) , neuroscience , psychiatry , anxiety , cognition , prefrontal cortex , economics , macroeconomics
Objectives Emotion regulation difficulties precipitate and exacerbate acute mood symptoms in individuals with bipolar disorder (BD), and contribute to suicidal behavior. However, few studies have examined regional brain responses in explicit emotion regulation during acute BD mood states, or hopelessness, a major suicide risk factor. We assessed brain responses during explicit emotion regulation, and their relationship with hopelessness, in acutely symptomatic and euthymic individuals with BD. Methods Functional MRI data were obtained from individuals with BD who were either in acute negative (BD‐A; n = 24) or euthymic (BD‐E; n = 24) mood states, and from healthy volunteers (HV; n = 55), while participants performed a paradigm that instructed them to downregulate their responses to fearful (EmReg‐Fear) and happy (EmReg‐Happy) facial stimuli. Emotion regulation‐related differences in brain responses during negative and euthymic BD states, as well as their associations with negative affective symptoms (hopelessness and depression), were examined. Results Decreased responses were observed in ventral and dorsal frontal regions, including medial orbitofrontal (mOFC) and dorsal anterior cingulate cortices, during EmReg‐Fear across symptomatic and euthymic states in participants with BD relative to HVs. The lowest responses were observed in the BD‐A group. Across BD participants, negative associations were observed between mOFC responses and hopelessness, particularly due to loss of motivation. Differences were not significant during EmReg‐Happy. Conclusions Lesser emotion regulation‐related ventral and dorsal frontal engagement in BD could represent a trait abnormality that worsens during acute negative states. The reduced mOFC engagement in BD during explicit regulation of negative emotions may contribute to hopelessness particularly in the context of diminished motivation.