Stephen M. Strakowski, M.D.
Senior Vice President Strategy and Transformation, UC Health
Professor of Biomedical Engineering and Psychology
University of Cincinnati
Bipolar disorder is a leading cause of morbidity worldwide. It is strongly heritable (85%), and the symptoms and signs of bipolar disorder suggest abnormalities within brain systems that control emotional function. These prefrontal-striatal-thalamic iterative networks modulate amygdala, ‘cognitive’ regions of the prefrontal cortex, hypothalamus, and other components of the limbic system. Unfortunately, there are no animal models for bipolar disorder, challenging us to identify approaches toward clarifying its neurophysiology. In the last 10-15 years, magnetic resonance imaging (MRI) techniques have permitted the in vivo exploration of the neurophysiology of bipolar disorder. Structural imaging suggests morphometric abnormalities in emotional networks that progress during adolescence and over time. Functional imaging demonstrates a disconnect in prefrontal modulation of amygdala activation, critical for healthy emotional function. Magnetic resonance spectroscopy suggests metabolic abnormalities in this network as well, particularly in the striatum. As imaging techniques continue to advance, the neurophysiology of bipolar disorder will become even better understood.