Orbitofrontal dysfunction in a monozygotic twin discordant for postpartum affective psychosis: A functional magnetic resonance imaging study

Cherine Fahim, Emmanuel Stip, Adham Mancini-marïe, Stéphane Potvin, Dolores Malaspina

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

Abstract

Backgound: Incomplete concordance for psychosis in monozygotic (MZ) twins has been interpreted as indicative of non-genetic cofactors in transmission of the illness. In this case study, we consider childbirth a landmark in the onset of psychotic symptoms, leading to the diagnosis of puerperal psychosis and then to bipolar/schizoaffective disorder. At the end of the third trimester, there is a sudden drop in estrogen, which exerts prominent effects on the serotonergic system in the orbitofrontal cortex (OFC). Objectives: The purpose of the present study was to investigate OFC activation during emotional processing in MZ twins discordant for affective psychosis. Methods: Blood-oxygen-level-dependent activation using functional magnetic resonance imaging was measured during the passive viewing of emotional film excerpts. Results: Consistent with our hypothesis, a significant locus of activation was found in the left OFC in the normal MZ twin, but not in the psychosis MZ twin. Conclusions: The personality changes noted in the psychosis MZ twin (postpartum psychosis) may be related to dysfunctional OFC. Ms J's childbirth may have triggered the onset of psychotic symptoms, leading to the diagnosis of bipolar or schizoaffective disorder.

Original languageEnglish
Pages (from-to)541-545
Number of pages5
JournalBipolar Disorders
Volume9
Issue number5
DOIs
Publication statusPublished - Aug 2007
Externally publishedYes

Keywords

  • Bipolar disorder
  • Functional magnetic resonance imaging
  • Orbitofrontal cortex
  • Puerperal psychosis
  • Schizoaffective disorder

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Biological Psychiatry

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