A History of Psychosis in Bipolar Disorder is Associated With Gray Matter Volume Reduction

Abstract

Psychotic symptoms are prevalent in schizophrenia, bipolar disorder, and other psychiatric and neurological disorders, yet the neurobiological underpinnings of psychosis remain obscure. In the last decade, a large number of magnetic resonance imaging studies have shown differences in local gray matter volume between patients with different psychiatric syndromes and healthy controls. Few studies have focused on the symptoms, which these syndromes are constituted of. Here, we test the association between psychosis and gray matter volume by using a sample of 167 subjects with bipolar disorder, with and without a history of psychosis, and 102 healthy controls. Magnetic resonance images were analyzed on group level using a voxel-wise mass univariate analysis (Voxel-Based Morphometry). We found that patients with a history of psychosis had smaller gray matter volume in left fusiform gyrus, the right rostral dorsolateral prefrontal cortex, and the left inferior frontal gyrus compared with patients without psychosis and with healthy controls. There was no volume difference in these areas between the no-psychosis group and healthy controls. These areas have previously been structurally and functionally coupled to delusions and hallucinations. Our finding adds further evidence to the probability of these regions as key areas in the development of psychotic symptoms.

Keywords: bipolar disorder; magnetic resonance imaging; prefrontal cortex; psychosis; voxel-based morphometry.

Fig. 1.

Areas of smaller gray matter volume in patients with a history of psychosis, P < .05 family-wise error (FWE)-corrected on voxel level. Peak voxels [x = −38 y = −33 z = −20], [x = 39 y = 42 z = 11] and [x = −51 y = 18 z = 21] Montreal Neurological Institute (MNI)-space. 327.5 resels. Full width at half maximum (FWHM) [x = 10.6 y = 10.4 z = 10.1] voxels.