Dysfonctionnement fronto-limbique dans le trouble bipolaire et apports des interventions thérapeutiques psychosociales : approche par l'IRM multimodale

Abstract : Bipolar disorder (BD) is a chronic mood disorder characterized by disturbances in emotional and cognitive processing during periods of depression, mania, and intercritical (euthymic) periods. Recently, the management of BD has been expanded by specific psychosocial interventions, such as psychoeducation, which showed high efficacy in improving BD symptoms. The aim of this thesis was to identify the anatomical and functional cerebral substrate related to (i) enduring cognitive and emotional impairments during euthymic periods, in order to identify trait markers of the disease; (ii) symptomatic improvement due to the participation in a psychoeducation program in BP patients. Our results showed that BD is characterized by dysregulation of the activity and the connectivity of prefrontal and limbic regions, responsible for the cognitive control and the generation/perception of emotions respectively. We also highlighted, both at rest and during a cognitive task, an abnormal cerebral connectivity between the “default mode network”, which is involved in egocentric thought processes, and the “task positive network”, which is involved in exocentric cognitive processes. After three months of psychoeducation, BD patients showed significant reduction of fronto-limbic abnormalities and better diffusivity along the uncinate fasciculus, which connects these regions. Furthermore, abnormalities of the anatomical structure of fronto-limbic regions, as well as of their connections, may be a predictor of psychoeducation outcome. We thus suggest that impairment of emotional regulation and attentional control that characterized BD could be modulated by the improvement of the “top-down” cognitive control induced by the participation in a psychoeducational program.
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Pauline Favre. Dysfonctionnement fronto-limbique dans le trouble bipolaire et apports des interventions thérapeutiques psychosociales : approche par l'IRM multimodale. Médecine humaine et pathologie. Université de Grenoble, 2014. Français. ⟨NNT : 2014GRENS027⟩. ⟨tel-01558171⟩

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