TORONTO— Using functional brain imaging, researchers have established a link between emotional impairment and cognitive deficits in children with bipolar disorder. According to Mani Pavuluri, MD, PhD, extreme emotions can impair cognition and make it difficult for children with the disorder to attend to and organize their thoughts.

"This study is very exciting, because it shows that negative emotions affect cognition differently than do positive emotions in these kids," said Dr. Pavuluri at the 2005 Joint Annual Meeting of the American and Canadian Academies of Child and Adolescent Psychiatry. Dr. Pavuluri is an Associate Professor in the Department of Psychiatry at the University of Illinois at Chicago.

EFFECTS OF POSITIVE AND NEGATIVE EMOTIONS

Dr. Pavuluri and colleagues examined functional MRI in children ages 12 to 18 while the children were performing certain mental tasks. Participants included 10 children with bipolar disorder with normal mood who were not taking medication and 10 healthy children. The children were asked to match words that have positive connotations (eg, cool, amazing, wonderful) or words having negative connotations (eg, jerk, stupid, dumb) with colors, to demonstrate how stimuli affect different areas of the brain that are responsible for emotion and cognition.

"Usually, children with bipolar disorder are easily upset by perceived insults and are highly reactive and rejection sensitive," Dr. Pavuluri told NeuroPsychiatry Reviews. "I wanted to see if the overreactivity and affective instability [would] affect their ability to think through things, organize, problem solve, and attend to detail. So we made up a list of inflammatory words and pleasing words to elicit the hypothesized reactions in children with bipolar disorder to see how they deploy cognitive function under this emotional challenge. I am excited to see what I thought may happen was, in fact, correct."

The researchers found that when children were shown negative words, compared with neutral ones (eg, table or chair), the children with bipolar disorder showed increased activation in the amygdala and ventromedial prefrontal cortex, which controls emotions, and less activation in the dorsolateral prefrontal cortex, which controls cognitive behavior. When shown positive words, children with bipolar disorder showed activation in the ventromedial prefrontal cortex, while healthy children showed activation in attentional circuits, including the posterior cingulate.

Preliminary results suggest some evidence of frontolimbic overreactivity to emotional stimuli in adults with bipolar disorder, said Dr. Pavuluri. However, studies in adult patients are scarce, especially those addressing circuitry function.

CLINICAL IMPLICATIONS

Dr. Pavuluri believes that her group’s findings have direct implications for ongoing and future trials and for the use of cognitive behavioral therapy in treating children with bipolar disorder. She noted that the differential impact of positive and negative words on cognitive function should be taken into account during cognitive behavioral therapy. She also recommended that strategies for dealing with emotional impairment and cognitive dysfunction in children with bipolar disorder include "entraining these children’s minds with positive cognitions through effective psychological treatments to subdue excessive reactivity."

Dr. Pavuluri and her colleagues plan to investigate whether treatment with specific medications can correct the cognitive deficits observed in children with bipolar disorder and emotional impairment.

—Karen L. Spittler

Suggested Reading
Pavuluri MN, Birmaher B, Naylor MW. Pediatric bipolar disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 2005;44:846-871.

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