Increased anterior cingulate and caudate activity in bipolar mania

Background: Executive control of cognition, emotion, and behavior are disrupted in the manic state of bipolar disorder. Whereas frontal systems are implicated in such dysfunction, the localization of functional brain abnormalities in the manic state is not well understood. Methods: We utilized a high-sensitivity H2150 positron emission tomography technique to investigate regions of increased brain activity in mania, compared to euthymia, in bipolar disorder. Results: The principal findings were manic state-related increased activity in left dorsal anterior cingulate, and left head of caudate. Conclusions: The findings suggest that the manic state of bipolar disorder may be associated with heightened activity in a frontal cortical–subcortical neural system that includes the anterior cingulate and caudate.