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Uptake of 99mTc-exametazime shown by single photon emission computed tomography before and after lithium withdrawal in bipolar patients: Associations with mania

Published online by Cambridge University Press:  03 January 2018

Guy M. Goodwin ,
Jonathan T. O. Cavanagh ,
M. F. Glabus ,
R. F. Kehoe ,
R. E. O'Carroll  and
K. P. Ebmeier
Guy M. Goodwin*
Affiliation:
Warneford Hospital, Oxford
Jonathan T. O. Cavanagh
Affiliation:
Department of Psychiatry, University of Edinburgh
M. F. Glabus
Affiliation:
Medical Research Council Brain Metabolism Unit, Royal Edinburgh Hospital
R. F. Kehoe
Affiliation:
Airedale General Hospital, Keighley, West Yorkshire
R. E. O'Carroll
Affiliation:
Department of Psychology, University of Stirling
K. P. Ebmeier
Affiliation:
Medical Research Council Brain Metabolism Unit, Royal Edinburgh Hospital
*
Professor G. M. Goodwin, University Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
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Abstract

Background

Early manic relapse following lithium discontinuation offers an important opportunity to investigate the relationship between symptoms, effects of treatment and regional brain activation in bipolar affective disorder.

Method

Fourteen stable bipolar patients on lithium were examined with neuropsychological measures, clinical ratings and single photon emission computed tomography (SPECT) before and after acute double-blind withdrawal of lithium. Brain perfusion maps were spatially transformed into standard stereotactic space and compared pixel-by-pixel. A parametric analysis was used to examine the change in brain perfusion on lithium withdrawal, and the relationship between symptom severity and brain perfusion separately both between and within subjects.

Results

Lithium withdrawal was associated with an important redistribution of brain perfusion, with increases in inferior posterior regions and decreases in limbic areas, particularly anterior cingulate cortex. Seven of the 14 patients developed manic symptoms during the placebo phase, correlating with relative increases in perfusion of superior anterior cingulate and possibly left orbito-frontal cortex.

Conclusions

The important effect of lithium withdrawal on brain perfusion implies that after withdrawal of lithium, the brain develops an abnormal state of activity in limbic cortex. The structures involved did not co-localise with those apparently modulated by manic symptoms.

Type
Papers
Information
The British Journal of Psychiatry , Volume 170 , Issue 5 , May 1997 , pp. 426 - 430
Copyright
Copyright © 1997 The Royal College of Psychiatrists 

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