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6. Distinguishing Remitted Bipolar Disorder from Remitted Unipolar Depression in Pre-Adolescent Children: A Neural Reward Processing Perspective
Bipolar disorder (BD) is often misdiagnosed as unipolar depression (UD), highlighting the need to identify clinically useful markers to differentiate them. To provide insights into this endeavor, the current study utilized fMRI data from the Adolescent Brain and Cognitive Development study to examine the similarities and differences between remitted BD, remitted UD, and healthy controls (HC) in brain activation patterns during reward processing, as evoked by the Monetary Incentive Delay task. Results revealed differential connectivity between the orbitofrontal cortex (OFC) and the ventral striatum (VS) during reward processing among BD, UD, and HC. Specifically, BD exhibited increases in OFC-VS connectivity during anticipation of larger reward, whereas UD and HC showed no changes in OFC-VS connectivity across anticipation conditions ranging from large loss to large reward. The current study represents the first study of neural reward processing abnormalities in pre-adolescent mood disorders. As early onset BD or UD often is associated with long treatment delays and a persistently pernicious illness course, this study might aid efforts to ensure early accurate diagnosis, which might improve our ability to intervene with appropriate treatments and result in a more benign prognosis and course of illness over the lifespan.