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Posterior cingulate and medial prefrontal excitation-inhibition balance in euthymic bipolar disorder

Published online by Cambridge University Press:  03 June 2024

Huai-Hsuan Tseng ,
Cheng Ying Wu ,
Hui Hua Chang ,
Tsung-Hua Lu ,
Wei Hung Chang ,
Chia-Fen Hsu ,
Ren-Yi Lin ,
Ding-Ruey Yeh ,
Fu-Zen Shaw  and
Yen Kuang Yang
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Huai-Hsuan Tseng
Affiliation:
Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Cheng Ying Wu
Affiliation:
Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Hui Hua Chang
Affiliation:
Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan School of Pharmacy, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Pharmacy, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
Tsung-Hua Lu
Affiliation:
Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Wei Hung Chang
Affiliation:
Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Psychiatry, National Cheng Kung University Hospital, Dou-Liou Branch, Yunlin, Taiwan
Chia-Fen Hsu
Affiliation:
Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Ren-Yi Lin
Affiliation:
Mind Research and Imaging Center, National Cheng Kung University, Tainan, Taiwan Department of Psychology, National Cheng Kung University, Tainan, Taiwan
Ding-Ruey Yeh
Affiliation:
Mind Research and Imaging Center, National Cheng Kung University, Tainan, Taiwan Institute of Cognitive Neuroscience, College of Health Sciences and Technology, National Central University, Taoyuan, Taiwan
Fu-Zen Shaw
Affiliation:
Mind Research and Imaging Center, National Cheng Kung University, Tainan, Taiwan Department of Psychology, National Cheng Kung University, Tainan, Taiwan
Yen Kuang Yang
Affiliation:
Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare, Tainan, Taiwan
Po See Chen*
Affiliation:
Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
*
Corresponding author: Po See Chen; Email: [email protected]
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Abstract

Background

Persistent cognitive deficits and functional impairments are associated with bipolar disorder (BD), even during the euthymic phase. The dysfunction of default mode network (DMN) is critical for self-referential and emotional mental processes and is implicated in BD. The current study aims to explore the balance of excitatory and inhibitory neurotransmitters, i.e. glutamate and γ-aminobutyric acid (GABA), in hubs of the DMN during the euthymic patients with BD (euBD).

Method

Thirty-four euBD and 55 healthy controls (HC) were recruited to the study. Using proton magnetic resonance spectroscopy (1H-MRS), glutamate (with PRESS sequence) and GABA levels (with MEGAPRESS sequence) were measured in the medial prefrontal cortex/anterior cingulate cortex (mPFC/ACC) and the posterior cingulate gyrus (PCC). Measured concentrations of excitatory glutamate/glutamine (Glx) and inhibitory GABA were used to calculate the excitatory/inhibitory (E/I) ratio. Executive and attentional functions were respectively assessed using the Wisconsin card-sorting test and continuous performance test.

Results

euBD performed worse on attentional function than controls (p = 0.001). Compared to controls, euBD had higher E/I ratios in the PCC (p = 0.023), mainly driven by a higher Glx level in the PCC of euBD (p = 0.002). Only in the BD group, a marginally significant negative association between the mPFC E/I ratio (Glx/GABA) and executive function was observed (p = 0.068).

Conclusions

Disturbed E/I balance, particularly elevated Glx/GABA ratio in PCC is observed in euBD. The E/I balance in hubs of DMN may serve as potential biomarkers for euBD, which may also contribute to their poorer executive function.

Keywords

bipolar disorderE/I balanceexecutive functionGABAglutamateMRS
Type
Original Article
Information
Psychological Medicine , Volume 54 , Issue 11 , August 2024 , pp. 3168 - 3176
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Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press

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