A Novel Evaluation of Current Psychiatric Treatment Paradigms Involving Polypharmacy via Resting-State Functional Magnetic Resonance Imaging (fMRI) in a Sample of Patients with Bipolar I Disorder

Overview

Bipolar I disorder (BD-I) is characterized by cycling between a manic or mixed episode, followed by a depressive episode. The DSM-Vspecifies criteria for forming a diagnosis, and psychiatric treatment is often decided by this diagnosis. Polypharmacy is commonplace for psychiatric treatment of BD-I, often combining several medication classes. With extremely high rates of inadequate treatment in BD-I, it’s apparent that despite the availability of medications and techniques like polypharmacy, there’s a lack of neuroscientific evidence to support the current treatment paradigm. Thirty-two BD-I patients were separated into two groups by the polypharmacy they were receiving: a second-generation antipsychotic (SGA) with a mood stabilizer, or an SGA with an anxiolytic benzodiazepine. The former is known to influence neurological glutamate levels, and the latter to influence GABA levels. The present study compared resting-state BOLD fMRI signals in the ventral striatum, a region along the glutamate pathway, and hippocampus, a region along the GABA pathway, between the two groups. These regions were chosen by combining knowledge of known neurotransmitter pathways and neurotransmitters known to be affected by the given polypharmacies. Data analysis revealed no significant difference in BOLD activation between groups in the ventral striatum or hippocampus. These results highlight current limitations of polypharmacy and suggest that the current level of integration among psychology, psychiatry, and biology is unable to provide a method for individually-optimized psychiatric treatment that’ll adequately foster rapid and complete resolution of symptoms associated with mental illnesses. Evidence-based neuroscience must have a larger role in selection of psychiatric treatments.

Competition history

JSHS 2022 Category not listed

Resources

National JSHS abstract book

Related projects

ISEF · 2022