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Uptake of 99mTc-exametazime shown by single photon emission computed tomography before and after lithium withdrawal in bipolar patients: Associations with mania

Published online by Cambridge University Press:  03 January 2018

Guy M. Goodwin ,
Jonathan T. O. Cavanagh ,
M. F. Glabus ,
R. F. Kehoe ,
R. E. O'Carroll  and
K. P. Ebmeier
Guy M. Goodwin*
Affiliation:
Warneford Hospital, Oxford
Jonathan T. O. Cavanagh
Affiliation:
Department of Psychiatry, University of Edinburgh
M. F. Glabus
Affiliation:
Medical Research Council Brain Metabolism Unit, Royal Edinburgh Hospital
R. F. Kehoe
Affiliation:
Airedale General Hospital, Keighley, West Yorkshire
R. E. O'Carroll
Affiliation:
Department of Psychology, University of Stirling
K. P. Ebmeier
Affiliation:
Medical Research Council Brain Metabolism Unit, Royal Edinburgh Hospital
*
Professor G. M. Goodwin, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
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Abstract

Background

Early manic relapse following lithium discontinuation offers an important opportunity to investigate the relationship between symptoms, effects of treatment and regional brain activation in bipolar affective disorder.

Method

Fourteen stable bipolar patients on lithium were examined with neuropsychological measures, clinical ratings and single photon emission computed tomography (SPECT) before and after acute double-blind withdrawal of lithium. Brain perfusion maps were spatially transformed into standard stereotactic space and compared pixel-by-pixel. A parametric analysis was used to examine the change in brain perfusion on lithium withdrawal, and the relationship between symptom severity and brain perfusion separately both between and within subjects.

Results

Lithium withdrawal was associated with an important redistribution of brain perfusion, with increases in inferior posterior regions and decreases in limbic areas, particularly anterior cingulate cortex. Seven of the 14 patients developed manic symptoms during the placebo phase, correlating with relative increases in perfusion of superior anterior cingulate and possibly left orbito-frontal cortex.

Conclusions

The important effect of lithium withdrawal on brain perfusion implies that after withdrawal of lithium, the brain develops an abnormal state of activity in limbic cortex. The structures involved did not co-localise with those apparently modulated by manic symptoms.

Type
Papers
Information
The British Journal of Psychiatry , Volume 170 , Issue 5 , May 1997 , pp. 426 - 430
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

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References

Army Individual Test Battery (1944) Monual of Directions and Scoring Washington. DC: War Department. Adjutant Generals Office.Google Scholar
Austin, M. P., Dougall, N., Ross, M., et al (1992) Single photon emission tomography with 99mTc-exameta2ime in major depression and the pattern of brain activity underlying the psychotic/neurotic continuum. Journal of Affective Disorders. 26, 31–43.CrossRefGoogle ScholarPubMed
Baker, S.C., Frith, C. D. & Dolan, R. J. (1997) The interaction between mood and cognitive function studied with PET. Psychological Medicine, in press.CrossRefGoogle Scholar
Baxter, L R. Jr, Schwartz, J. M., Phelps, M. E., et al (1989) Reduction of prefrontal cortex glucose metabolism common to three types of depression. Archives of General Psychiatry, 46, 243–250.CrossRefGoogle ScholarPubMed
Bench, C. J., Friston, K. J., Brown, R. G., et al (1992) The anatomy of melancholia - focal abnormalities of cerebral blood flow in major depression. Psychological Medicine, 22, 607–615.CrossRefGoogle ScholarPubMed
Bench, C. J., Friston, K. J., Brown, R. G., et al (1993) Regional cerebral blood flow in depression measured by positron emission tomography: the relationship with clinical dimensions. Psychological Medicine, 23, 579–590.CrossRefGoogle ScholarPubMed
Curran, S. M., Murray, C. M., Van Beck, M., et al (1993) A single photon emission computerised tomography study of regional brain function in elderly patients with major depression and with Alzheimer-type dementia. British Journal of Psychiatry, 163, 155–165.CrossRefGoogle ScholarPubMed
Ebert, D. & Ebrneler, K. P. (1996) The role of the cingulate gyrus in depression: from functional anatomy to neurochemistry. Biological Psychiatry, 39, 1044–1050.CrossRefGoogle ScholarPubMed
Friston, K. J., Ashburner, J., Frith, C. D., et al (1995) Spatial registration and normalization of images. Human Brain Mopping, 3, 165–189.CrossRefGoogle Scholar
Frith, C. D., Friston, K. J., Liddle, P. F., et al (1991) A PET study of word finding. Neuropsychologia, 29, 1137–1148.CrossRefGoogle ScholarPubMed
George, M. S., Ketter, T. A., Parekh, P. L., et al (1995) Brain activity during transient sadness and happiness in healthy women. American journal of Psychiatry. 152, 341–351.Google ScholarPubMed
Goodwin, G. M. (1996) Functional imaging, affective disorder and dementia. British Medical Bulletin, 52, 495–512.CrossRefGoogle ScholarPubMed
Goodwin, G. M. (1997) Clinical and biological investigation of mania following lithium withdrawal. In Mechanism of Antibipolar Treatments (eds H. K. Manji, C. L. Bowden & R. H. Belmaker). Washington, DC: American Psychiatric Press, in press.Google Scholar
Mander, A. J. & Loudon, J. B. (1988) Rapid recurrence of mania following abrupt discontinuation of lithium, lancet. ii, 15–17.CrossRefGoogle Scholar
Mayberg, H. S., Lewis, P. J., Regenold, W., et al (1994) Paralimbic hypoperfusion in unipolar depression, Journal of Nuclear Medicine, 35, 929–934.Google ScholarPubMed
Neirinckx, R. D., Canning, L. R., Piper, I. M., et al (1987) Technetium-99m D.I-HMPAO: a new radiopharmaceutical for SPECT imaging of regional cerebral blood perfusion. Journal of Nuclear Medicine, 28, 191–202.Google ScholarPubMed
O'Connell, R. A., Van Heertum, R. L., Luck, Dt, et al (1995) Single-photon emission computed tomography of the brain in acute mania and schizophrenia, journal of Neuroimaging, 5, 101–104.CrossRefGoogle ScholarPubMed
Rey, A. (1964) L'examen Clinique en Psychology. Pans: Presses Universitaires de France.Google Scholar
Schneider, F., Gur, R. E., Harper Moziey, L., et al (1995) Mood effects on limbic blood flow correlate with emotional self-rating: a PET study with oxygen-15 labeled water. Psychiatry Research - Neuroimoging, 61, 265–283.CrossRefGoogle ScholarPubMed
Silfverskiöld, P. & Risberg, J. (1989) Regional cerebral blood flow in depression and mania. Archives of General Psychiatry, 46, 253–259.CrossRefGoogle ScholarPubMed
Souza, F. G. M., Mander, A. J., Foggo, M., et al (1991) The effects of lithium discontinuation and the non-effect of oral inositol upon thyroid hormones and cortisol in patients with bipolar affective disorder, journal of Affective Disorders, 22, 165–170.CrossRefGoogle ScholarPubMed
Suppes, T., Baldessarini, R. J., Faedda, G. L., et al (1991) Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. Archives of General Psychiatry, 48, 1082–1088.CrossRefGoogle ScholarPubMed
Walkar, L. G. (1990) The measurement of anxiety. Postgraduate Medical journal, 66, S11–S17.Google Scholar
Wechsler, D. (1981) Wechsler Adult Intelligence Scale - Revised. New York: The Psychological Corporation.Google Scholar
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