Page 8 - JCBP-3-4

Journal of Clinical and
Basic Psychosomatics Neuroimaging of bipolar disorder and self-stigma

that BD is the sixth leading cause of disability-adjusted life using neuroimaging techniques. This article reviews the
years. 6 functional connectivity in different brain regions and
Self-stigma (SS), also referred to as internalized stigma, changes in neurometabolite levels in BD patients and
represents the intrinsic experience of individuals with those with mental disorders who experience SS, providing
mental disorders who gradually become aware of prejudices a reference and scientific basis for neuroimaging studies of
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and stereotypes and begin to apply them to themselves. BD patients with SS.
As one of the severe mental disorders, BD is associated A literature search was conducted using the topic words
with a heightened vulnerability to SS, as patients frequently “bipolar disorder” and “self-stigma” in the PubMed and
encounter stigma and discrimination. A study across 13 Embase databases. The search time range was set to the
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European countries found that the proportion of BD patients past 10 years, and the progress of neuroimaging research
with SS is 21.7%. SS in BD patients has been linked to low in SS and BD was reviewed.
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self-esteem, impaired cognitive and social functioning, a
longer duration of illness, and poor prognosis. 11-14 2. Advances in functional imaging research
on BD
At present, the etiological mechanisms of BD have not
been fully elucidated, making the diagnosis of BD difficult, 2.1. Advances in research on BOLD-fMRI in BD
especially in differentiating between bipolar depression BOLD-fMRI utilizes changes in blood oxygen levels
and unipolar depression. Recent reports indicate that for detecting functional connectivity between various
the proportion of BD misdiagnosed as depressive brain regions, and it is categorized into resting-state
disorders is 20.6%, leading to adverse consequences such functional magnetic resonance imaging (rs-fMRI) and
as exacerbated manic and hypomanic symptoms and task-based functional magnetic resonance imaging
increased suicide risk. The prevention and treatment (tb-fMRI). Among them, rs-fMRI detects different
of BD still face significant challenges. In recent years, patterns of neuronal activation in the brain when it is
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neuroimaging techniques have been widely used in research not stimulated, providing a basis for understanding
on the etiology and pathogenesis of mental disorders, functional connectivity among various brain regions. 19,20
as they can detect subtle changes in brain structure, Therefore, it is widely used in the study of the etiology
metabolism, and functional connectivity, providing a and pathogenesis of mental disorders. Previous studies
reliable basis for the diagnosis and treatment of BD. have found that the strength of functional connectivity in
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Among them, blood oxygen level-dependent functional certain brain regions is correlated with patients’ cognitive
magnetic resonance imaging (BOLD-fMRI) and magnetic function, suicide risk, and emotion regulation. 21-23
resonance spectroscopy (MRS) have become hotspots in Zhang et al. studied rs-fMRI of the thalamus in BD
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current research. Domestic and international studies using patients and found a significant reduction in functional
BOLD-fMRI have found abnormal functional connectivity connectivity between the thalamus and frontal cortex in
between brain regions such as the cerebellum, thalamus, bipolar depressive patients, with a potential association
and cerebral cortex in BD patients. Some studies have between decreased functional connectivity between the
shown weakened functional connectivity signals in the thalamus and frontal cortex and increased suicide risk in
prefrontal-thalamus-cerebellum circuit in BD patients. BD patients. Similarly, Zeng et al. reported decreased
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Meanwhile, studies using MRS have revealed that changes functional connectivity in the prefrontal-thalamic circuit
in neurometabolite levels in many brain regions may in bipolar depressive patients. However, this decrease was
be related to the pathogenesis of BD. In studies of the not observed in BD patients during remission, suggesting
anterior cingulate cortex (ACC), increased overall levels that the two different disease states in BD patients may be
of (glutamine+glutamate [Glu])/creatine, Glu, and choline related to the activation state of the prefrontal-thalamic
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(Cho) have been observed. Research has also found that circuit. The study also indicated weakened functional
patients with SS due to mental disorders or other factors connectivity signals in the prefrontal-thalamic-cerebellar
also exhibit abnormal functional connectivity in brain circuit in bipolar depressive patients, which may be related
regions and changes in neurometabolite levels. A meta- to impaired cognitive function and learning disorders in
analysis found that SS can exacerbate the condition of these patients. These findings are generally consistent with
patients with severe mental disorders and may be related to previous studies. In a study conducted by Saleem et al.,
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increased activation of the ventromedial prefrontal cortex they found that the functional connectivity between the
(vmPFC) and decreased activation of the amygdala. 9 cerebellar vermis and the somatosensory motor cortex, as
At present, there is limited research on the well as the regulatory regions of emotion, was significantly
neuropathophysiological mechanisms of SS in BD patients increased in BD patients, which may serve as a potential

Volume 3 Issue 4 (2025) 2 doi: 10.36922/jcbp.8413