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The Journal of Neuroscience, September 2, 2009, 29(35):10863-10868; doi:10.1523/JNEUROSCI.2204-09.2009

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Neurobiology of Disease
Dissociable Brain Structural Changes Associated with Predisposition, Resilience, and Disease Expression in Bipolar Disorder

Matthew J. Kempton,¹ Morgan Haldane,¹ Jigar Jogia,¹ Paul M. Grasby,³ David Collier,² and Sophia Frangou¹

¹Section of Neurobiology of Psychosis and ²Social, Genetic and Developmental Psychiatry Research Centre, Institute of Psychiatry, King's College London, London SE5 8AF, United Kingdom, and ³Medical Research Council Clinical Sciences Centre, Imperial College, London W12 0NN, United Kingdom

Correspondence should be addressed to Sophia Frangou, Section of Neurobiology of Psychosis, P.O. Box 66, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. Email: sophia.frangou{at}kcl.ac.uk

Genetic factors are important in the etiology of bipolar disorder (BD). However, first-degree relatives of BD patients are at risk for a number of psychiatric conditions, most commonly major depressive disorder (MDD), although the majority remain well. The purpose of the present study was to identify potential brain structural correlates for risk and resilience to mood disorders in patients with BD, type I (BD-I) and their relatives. Structural magnetic resonance imaging scans were acquired from 30 patients with BD-I, 50 of their first-degree relatives (28 had no Axis I disorder, while 14 had MDD) and 52 controls. We used voxel-based morphometry, implemented in SPM5 to identify group differences in regional gray matter volume. From the identified clusters, potential differences were further examined based on diagnostic status (BD-I patients, MDD relatives, healthy relatives, controls). Whole-brain voxel-based analysis identified group differences in the left hemisphere in the insula, cerebellum, and substantia nigra. Increased left insula volume was associated with genetic preposition to BD-I independent of clinical phenotype. In contrast, increased left substantia nigra volume was observed in those with the clinical phenotype of BD-I. Changes uniquely associated with the absence of a clinical diagnosis in BD relatives were observed in the left cerebellum. Our data suggest that in BD, genetic and phenotype-related influences on brain structure are dissociable; if replicated, these findings may help with early identification of high-risk individuals who are more likely to transition to syndromal states.

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Received May 7, 2009; revised June 22, 2009; accepted July 20, 2009.

Correspondence should be addressed to Sophia Frangou, Section of Neurobiology of Psychosis, P.O. Box 66, Institute of Psychiatry, King's College London, De Crespigny Park, London SE5 8AF, UK. Email: sophia.frangou{at}kcl.ac.uk

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