Alteration of fronto-thalamic-striatal and visual network activity to positive emotional stimuli in adolescent patients with bipolar disorder during a Go/No-Go task-based functional brain MRI

• Adolescents with BD showed hyperactivation in fronto-thalamic-striatal and fusiform circuits during emotion inhibition. • Positive stimuli elicit impaired emotion regulation and response inhibition in adolescents with BD. • Our findings offer insights into emotion dysregulation and inform targeted therapeutic strategies. Adolescent patients with bipolar disorder (BD) tend to have abnormal neural activity to emotional stimuli. This study aimed to assess alterations of neural activity within the fronto-thalamic-striatal circuit, and the fusiform gyrus during positive stimuli processing in Go/No-Go task-based brain functional MRI (fMRI). This prospective study enrolled 43 adolescent patients with BD and 18 age- sex-matched healthy controls. All study participants underwent a task-based brain fMRI using a happy versus neutral Go/No-Go paradigm. All study participants also completed multiple affective and cognitive assessment questionnaire. Enhanced activity was found in the fronto-thalamic-striatal circuit including the inferior frontal gyrus and the caudate, the fusiform gyrus, the left cerebellum crus I and the hippocampus in adolescent patients with BD, during response inhibition to happy versus neutral distractors in an emotional Go/No-Go fMRI task, compared with matched healthy controls ( p <0.05). Moreover, the left inferior frontal gyrus, the right fusiform gyrus and the left cerebellum crus I responses to happy versus neutral distractors were positively associated with the differences in false response errors in the patients with BD (all p <0.05, FDR corrected). The enhanced activity of the caudate nucleus and that of the right hippocampus were negatively correlated with cognitive function (all p <0.05, FDR corrected). This study found significant brain functional alterations in the limbic system, the visual brain network and cerebellum, especially the fronto-thalamic-striatal track and fusiform gyrus, which was correlated with cognitive dysfunction in adolescent patients with BD. These changes may serve as potential neuroimaging correlates of BD in adolescent patients.