Table 1 Neuroimaging findings and staging models of bipolar disorder
Clinical staging | Clinical presentation | Neuroimaging findings |
|---|---|---|
0 | Increased risk of bipolar disorder; no symptoms currently | Resilience markers: abnormal prefrontal cortical activity increases during cognitive control of emotion and cognitive control tasks; abnormal volumetric increases in right-sided vlPFC and left-sided subcortical regions |
Risk markers: abnormally increased amygdala activity; abnormal prefrontal WM | ||
1 | a) Mild or nonspecific symptoms | Resilience markers: Abnormally increased prefrontal cortical activity during cognitive control of emotion and cognitive control tasks; abnormally increased prefrontal cortical volume |
b) Ultra-high-risk: moderate but subthreshold symptoms, with neurocognitive changes and functional decline to caseness | Risk markers: abnormally decreased prefrontal cortical volumes; left-sided subcortical volume increases; abnormally decreased WM volume | |
2 | First episode of bipolar disorder; full threshold disorder with moderate to severe symptoms, neurocognitive deficits, and functional decline | Emotion processing: abnormally decreased prefrontal cortical activity (especially right-sided vlPFC activity) during cognitive control of emotion and cognitive control tasks; abnormally increased amygdala activity during these tasks; abnormally decreased prefrontal cortical volumes and decreased prefrontal WM; altered subcortical volumes |
Reward processing: abnormally increased left-sided striatal and prefrontal cortical activity during reward processing | ||
3 | a) Incomplete remission from first episode (could be linked or fast-tracked to stage 4) | Markers of disease progression: a negative association between prefrontal cortical volumes (especially right vlPFC gray matter volume) and illness duration; reductions in amygdala, striatal, and hippocampal volumes with illness progression |
b) Recurrence or relapse of psychotic or mood disorder which stabilizes with treatment, residual symptoms, or neurocognition below the best level achieved following remission from first episode | ||
4 | Severe, persistent illness as judged on symptoms, neurocognition, and disability criteria | Â |