Emotion regulation in bipolar disorder type I: an fMRI study.

BACKGROUND: Bipolar disorder type I (BD-I) is associated with emotion dysregulation. However, experimentally controlled studies of emotion regulation (ER), particularly those examining the brain correlates of the putative deficits, are scarce and their results inconsistent. METHOD: Nineteen euthymic BD-I patients and 17 healthy controls (HC) underwent functional magnetic resonance imaging while performing a visual ER 2 × 2 factorial task, with instruction (Look or Decrease) and valence (Negative or Neutral) as within-subject factors. Emotional ratings were collected after each picture presentation to assess regulation success. RESULTS: BD-I patients were successful at downregulating their emotions, although to a lesser degree than HC. Both groups engaged brain regions previously implicated in ER; however, unlike HC, patients engaged some of those regions, particularly the ventrolateral prefrontal cortex (VLPFC) in the Negative Look and Neutral Decrease conditions. Moreover, patients failed to show the reduced amygdala activation in the Negative Decrease condition observed in HC. CONCLUSION: Our findings suggest that BD-I patients are able to downregulate their emotions when instructed to do so. However, they also appear to engage their ER network, particularly the VLPFC, even when not required to do so. These findings may help explain their often-reported difficulty in regulating emotions in everyday life despite their attempts to do so.

[Utility of 201Tl washout in syndrome X patients]. / Utilidad del washout del 201Tl en pacientes con síndrome X.

INTRODUCTION: The term Syndrome X defines a group of patients who present symptoms of typical angina pectoris, positive exercise test and normal coronaries in the arteriogram. This study aims to compare the results of 201Tl scan images and washout in Syndrome X patients. METHODS: 24 patients with typical angina and normal arteriogram and 30 normal controls were studied with 201Tl SPECT to evaluate uptake and washout. RESULTS: 201Tl perfusion defects were found in 3 out of 24 (12.5%) and washout defects in 22 out of 24 (91.6 %). There is a statistically significant reduction (0 < 0.05) in thallium uptake and washout in patients with syndrome X compared to the control group. In addition, patients with syndrome X had a higher thallium uptake at rest than during exercise compared to the healthy subjects. CONCLUSIONS: Analysis of the 201Tl washout and thallium uptake can provide addition information in the evaluation of patients with syndrome X since the visual assessment of the cardiac scintigraphy with 201Tl is of limited value. Alterations of the myocardial perfusion in patients with chest pain and normal coronaries can be detected non-invasively with a complete scintigraphic study.