Modulation of brain response to emotional conflict as a function of current mood in bipolar disorder: Preliminary findings from a follow-up state-based fMRI study

We used functional magnetic resonance imaging (fMRI) to examine affective control longitudinally in a group of patients with bipolar disorder (BD). Participants comprised 12 BD patients who underwent repeated fMRI scans in euthymic (n=11), depressed (n=9), or hypomanic (n=9) states, and were compared with 12 age-matched healthy controls. During fMRI, participants performed an emotional face-word interference task with either low or high attentional demands. Relative to healthy controls, patients showed decreased activation of the cognitive control network normally associated with conflict processing, more severely during hypomania than during depression, but regardless of level of task demand in both cases. During euthymia, a decreased response to conflict was observed only during the high load condition. Additionally, unlike healthy participants, patients exhibited deactivation in several key areas in response to emotion-conflict trials - including the rostral anterior cingulate cortex during euthymia, the hippocampus during depression, and the posterior cingulate cortex during hypomania. Our results indicate that the ability of BD patients to recruit control networks when processing affective conflict, and the abnormal suppression of activity in distinct components of the default mode network, may depend on their current clinical state and attentional demand.