Advances in functional magnetic resonance imaging research on bipolar disorder and self-stigma

Bipolar disorder (BD) is a chronic, recurrent, and severe mental illness. Individuals with BD often internalize prejudices and stereotypes directed toward them, leading to the development of self-stigma (SS). SS can further exacerbate impairments in cognitive and social functioning and contribute to decreased treatment adherence and poor prognosis. Functional magnetic resonance imaging provides a powerful tool for investigating the neuropathophysiological mechanisms underlying BD and SS, facilitating the early identification of SS in BD patients. A review of studies examining functional connectivity and neurometabolism across various brain regions in BD and SS patients suggests that both conditions can alter the functional connectivity of brain regions involved in emotional regulation, such as the prefrontal cortex (PFC) and amygdala. In addition, BD patients show reduced N-acetylaspartate levels in the PFC and anterior cingulate cortex. However, current research has yet to yield conclusive findings regarding the neurometabolites associated with SS. This paper proposes potential research directions for investigating SS in BD patients and lays the groundwork for the early detection of SS, ultimately contributing to a deeper clinical understanding of SS in this patient population.