Double-blind randomized trial of risperidone versus divalproex in pediatric
bipolar disorder: fMRI outcomes.
Author(s): Pavuluri MN, Passarotti AM, Lu LH, Carbray JA, Sweeney JA.
Affiliation(s): Institute for Juvenile Research, Center for Cognitive Medicine, Department of
Psychiatry, University of Illinois at Chicago, Chicago, IL 60608, USA.
mpavuluri@psych.uic.edu
Publication date & source: 2011, Psychiatry Res. , 193(1):28-37
The aim of this research was to determine the relative effects of risperidone and
divalproex on brain function in pediatric mania. This is a double-blind 6-week
functional magnetic resonance imaging trial with 24 unmedicated manic patients
randomized to risperidone or divalproex, and 14 healthy controls (HCs) matched
for IQ and demographic factors (mean age: 13.1±3.3years). A pediatric affective
color matching task, in which subjects matched the color of a positive, negative
or neutral word with one of two colored circles, was administered. The primary
clinical measure was the Young Mania Rating Scale (YMRS). The risperidone group,
relative to HC, showed an increase in activation from pre- to post-treatment in
right pregenual and subgenual anterior cingulate cortex and decreased activation
in bilateral middle frontal gyrus during the negative condition; and decreased
activation in left inferior and medial, and right middle frontal gyri, left
inferior parietal lobe, and right striatum with positive condition. In the
divalproex group, relative to HC, there was an increased activation in right
superior temporal gyrus in the negative condition; and in left medial frontal
gyrus and right precuneus with the positive condition. Greater pre-treatment
right amygdala activity with negative and positive condition in the risperidone
group, and left amygdala activity with positive condition in divalproex group,
predicted poor response on YMRS. Risperidone and divalproex yield differential
patterns of prefrontal activity during an emotion processing task in pediatric
mania. Increased amygdala activity at baseline is a potential biomarker
predicting poor treatment response to both the risperidone and divalproex.
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