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Padovan, Giordano B (2018) Psychoses, language and brain asymmetry: fMRI connectivity alterations in bipolar disorders. [Ph.D. thesis]

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Abstract (italian or english)

INTRODUCTION
A mood characterised by alternating mania and depression have been matter of curiosity and attention since ancient times.
According to T.J. Crow’s theory on psychosis, Schizophrenia is strictly linked to the development of the faculty of language (begun in hominids from 6 to 4.2 million years ago) which depends by (anatomical and functional) asymmetry observable between the two cerebral hemispheres (Crow 2004).
Several data in the recent (and older) (Griesinger 1845) scientific literature support the hypothesis that schizophrenia and bipolar disorder are similar due to a large number of partially common features: symptomatology, genetics, cognitive features, neurobiology, connectivity alteration, etc..
A brief historical account about how often the classification of this disease changed across the last two centuries may suggest how the knowledge underling this diagnostic category is still fragile.

AIM OF THE RESEARCH
The goal of this paper is to study Functional Connectivity (FC) among bipolar patients and to test the compatibility of Crow’s paradigm with Bipolar Disorder, verifying the potential presence of hemispheric asymmetry alteration (left dominance deficit) through fMRI analysis.

MATERIALS AND METHODS
18 outpatients of the Mood Disorders Unit at the Psychiatric Clinic of the University of Padua have been recruited. All subjects had a diagnosis of Bipolar Disorder type I or type II, according to the criteria of the DSM-IV-TR).
16 healthy individuals were chosen matched for age, sex and education. Clinical and psychological conditions at the time of the experiment were investigated through some psychometric scales widely used for the evaluation of mood, anxiety and other psychopathologic aspects. All subjects underwent a MRI scan both in resting state and while they were attending two tasks: a phonemic (verbal fluency) exercise and a visuo-spatial test (mental rotations).

RESULTS
From the neuropsychological point of view the phonemic task revealed no significant (p<0.05) differences between groups; on the contrary patients group showed decreased performance at the visuo-spatial task.
MRI FC was analysed using two different techniques. Independent Component Analysis (ICA) showed mainly a volume within the Dorsal Attention Network located in left Precuneus (Brodmann Area 7) where patient group presented a reduction of FC compared to controls. Graph analysis brought to light a number of inter-hemispheric and left intra-hemispheric connections revealed to be significantly less active in patients compared to controls, on the contrary substantial conservation of indices at the Network Level was observed.

Abstract (a different language)

INTRODUZIONE
Un tono timico caratterizzato da un’alternanza di mania e depressione è stato oggetto di interesse e attenzione fin dai tempi antichi.
Secondo La teoria di T.J. Crow sulla psicosi, la schizofrenia è strettamente legata allo sviluppo della facoltà del linguaggio (che ha avuto origine negli ominidi da 6 a 4,2 milioni di anni fa) che dipende dall'asimmetria (anatomica e funzionale) osservabile tra i due emisferi cerebrali (Crow 2004).
Diversi dati nella letteratura scientifica recente (e più antica – Griesinger 1845) supportano l'ipotesi che la schizofrenia e il disturbo bipolare siano simili per un gran numero di caratteristiche parzialmente comuni: sintomatologia, genetica, cognitività, neurobiologia, alterazione della connettività, ecc.
Un breve resoconto storico di quanto spesso la classificazione di questa malattia sia cambiata negli ultimi due secoli può suggerire come la conoscenza sottesa a questa categoria diagnostica sia ancora fragile.

SCOPO DELLA RICERCA
L'obiettivo di questo studio è quello di studiare la connettività funzionale (FC) tra i pazienti bipolari e testare la compatibilità del paradigma di Crow con il disturbo bipolare, verificando la potenziale presenza di alterazioni dell'asimmetria emisferica (deficit di dominanza sinistra) attraverso l'analisi fMRI (risonanza magnetica funzionale).

MATERIALI E METODI
Sono stati reclutati 18 pazienti ambulatoriali dell'Unità di Disturbi dell'Umore presso la Clinica Psichiatrica dell'Università di Padova. Tutti i soggetti avevano una diagnosi di disturbo bipolare di tipo I o di tipo II, secondo i criteri del DSM-IV-TR).
Sono stati scelti 16 individui sani abbinati per età, sesso e istruzione. Le condizioni cliniche e psicologiche al momento dell'esperimento sono state studiate attraverso alcune scale psicometriche ampiamente utilizzate per la valutazione dell'umore, dell'ansia e di altri aspetti psicopatologici. Tutti i soggetti sono stati sottoposti a una risonanza magnetica sia in stato di riposo che durante l’esecuzione di due compiti: un esercizio fonemico (fluenza verbale) e un test visuo-spaziale (rotazioni mentali).

RISULTATI
Dal punto di vista neuropsicologico, il compito fonemico non ha rivelato differenze significative (p<0.05) tra i gruppi; al contrario, il gruppo di pazienti ha mostrato una riduzione delle prestazioni nel compito visuo-spaziale.
I dati fMRI sono stati analizzati utilizzando due tecniche diverse. L'Independent Component Analysis (ICA) ha mostrato principalmente un volume all'interno della Dorsal Attention Network situato nel precuneo sinistro (area 7 di Brodmann) dove il gruppo di pazienti presentava una riduzione significativa della FC rispetto ai controlli. L'analisi dei grafi ha portato alla luce un numero di connessioni intra-emisferiche e intra-emisferiche di sinistra rivelate significativamente meno attive nei pazienti rispetto ai controlli, al contrario è stata osservata una sostanziale conservazione degli indici a livello di rete.

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EPrint type:Ph.D. thesis
Tutor:Favaro, Angela
Ph.D. course:Ciclo 30 > Corsi 30 > MEDICINA SPECIALISTICA "G.B. MORGAGNI"
Data di deposito della tesi:20 February 2018
Anno di Pubblicazione:18 January 2018
Key Words:Bipolar Disorder, psychosis, functional connectivity, fMRI, ICA, Graph Analysis, hemispheric lateralisation, linguistic functions
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/02 Storia della medicina
Area 06 - Scienze mediche > MED/25 Pschiatria
Area 11 - Scienze storiche, filosofiche, pedagogiche e psicologiche > M-PSI/02 Psicobiologia e psicologia fisiologica
Area 06 - Scienze mediche > MED/26 Neurologia
Area 06 - Scienze mediche > MED/37 Neuroradiologia
Struttura di riferimento:Dipartimenti > Dipartimento di Neuroscienze
Codice ID:11170
Depositato il:16 Nov 2018 10:01
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