Evidence is growing quite strong that a region of the brain called the medial prefrontal cortex is underactive in people with bipolar disorder even when they are having no symptoms at all. Researchers are homing in on regions of the brain which act differently in people with bipolar disorder compared to those without the illness. In this particular task, at least, they were not using the part of the brain known to inhibit impulsive action (not as much as were the control subjects). If you aren’t familiar with reading one of these pictures, and don’t want to learn (not too tough, but maybe not necessary), the bottom line here is: people with bipolar disorder, even when they don’t have any symptoms, don’t seem to use the front part of their brain when making decisions under time pressure. Haldane Making quick decisions about emotional matters Interestingly, these mistakes in facial recognition appear to be reduced by treatment, at least with one of the standard treatment for bipolar disorder, lamotrigine. ![]() However, the error rate may be particularly evident during mania. In other words, this difficulty with facial expression recognition may be one of the more lasting, permanent parts of the illness, not a symptom. When the faces shown exhibited more dramatic expressions, people with bipolar disorder made over twice as many mistakes as people without a mood or anxiety problem.Īll of the above findings were seen even in children who were not symptomatic at the time of the study. Interestingly, their mistake rate was even greater than patients with anxiety disorders, who did not differ greatly from controls. This has been shown several times, including in children, McClure where the following results were obtained:Īs you can see, given the pictures that were shown in this study, everybody makes mistakes and interpreting them, but people with bipolar disorder make those mistakes more often. People with bipolar disorder make mistakes when interpreting the expressions on people’s faces, at least in an experimental setting. Several studies have now shown that lithium appears to be capable of reversing this trend toward frontal atrophy (the studies are referenced in the essay on treatment effects in depression). This is basically the same result which has been seen in severe forms of depression which remain untreated, as shown in my essay on frontal atrophy in depression. Second, the take-home message for now: growing evidence suggests that each episode of severe mood symptoms is associated with increases in these brain size differences, and therefore aggressive pursuit of good symptom control may be associated with preventing some of the brain changes that unfortunately seem to progress in at least some forms of bipolar disorder.Īlthough it has taken years to be certain, because not all studies have shown the same results, there is now fairly good agreement that the frontal cortex (which is associated with decision-making and controlling impulsive behavior) shrinks in size when bipolar disorder is allowed to progress. Link to Chapter 3: The Central Role of the Biological Clock Differences in sizeįirst the good news: many of the differences in brain size which have been shown in many studies of patients with mood problems can be reversed at least in part with effective treatment. Moreover, these differences are present even when no symptoms are present. ![]() ![]() But what we can now see is at least a glimpse of the brain mechanisms by which this occurs: too much activity in emotional centers, and too little in the frontal lobes that are supposed to be able to inhibit action. I know, is that not obvious? True, we already knew that just from experience, as you surely know as well. ![]() Although it is hard to spot differences in the brain by doing simple tests like a CT scan, or even an MRI, there are now consistent differences which are being shown that confirm the working hunch about bipolar disorder - namely, that this is a condition in which emotions gain too much power over behavior. The bottom line: psychiatry is making progress. This chapter is for those people who would like to see with their own eyes what is going on in the brain of people with bipolar disorder that might be different from what is going on in those who do not have this condition. The others lead more directly to implications for treatment. If there are any in this series of five chapters you might wish to skip, this would probably be it.
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