Aberrant brain activity during sad-happy emotional switching in adolescents with bipolar disorder: A functional MRI...

Adolescents with bipolar disorder (BD) experience rapid mood fluctuations and cognitive disturbance. However, the underlying neural mechanism for sad-happy emotional switching remains poorly understood in adolescents with BD.

We used an emotional Go/No-Go functional magnetic resonance imaging (fMRI) task paradigm to assess brain activity during the transition between sad and happy emotional states in 43 adolescents with BD and 18 age- and gender-matched healthy control (HC) participants. Neuroimaging data were analyzed using a general linear model with age and gender as covariates, and results were thresholded at p < 0.001 (voxel-wise, uncorrected) with cluster-level False Discovery Rate (FDR) correction at p < 0.05. Behavioral performance data and clinical scale data were compared, and the statistical significance was set at p < 0.05 (FDR-corrected).

Compared to the HC participants, adolescents with BD showed hyperactivation in the default mode network (right precuneus, left medial superior frontal gyrus), and hypoactivation in the extended salience network (left insula, right middle temporal gyrus) and in the cerebellum (p < 0.05). Notably, default mode network hyperactivation was associated with higher omission rates and longer reaction times when performing the Go/No-Go fMRI task paradigm (r = 0.319, p = 0.049; r = 0.320, p = 0.044), while decreased insular and temporal activity was linked to impaired inhibitory control (r = -0.315, p = 0.049; r = -0.389, p = 0.011), and reduced cerebellar activity was linked with poorer executive function, particularly under sad conditions (r = 0.308, p = 0.044).

Adolescents with BD showed aberrant brain activity patterns for regulating emotions, shifting attention, and maintaining cognitive control during emotional switching. These network alterations may serve as potential neuroimaging biomarkers for adolescents with BD, assisting individualized treatment strategies targeting emotion-cognition dysfunctions.