Unawareness of bipolar disorder: the role of the cingulate cortex

Reduced awareness of illness is a well-known phenomenon that has been understudied in remitted patients with bipolar disorder. In particular, the relationship between reduced awareness and executive dysfunction is an intriguing question that has yet to be resolved. The aim of the current study is to analyze the link between reduced awareness, brain dysfunction and concomitant cognitive-behavioral disturbances from a neurocognitive perspective. In previous studies, we demonstrated a role of the Anterior Cingulate Cortex in the unawareness of distinct pathologies that exhibit overlapping symptoms in the context of overlapping circuit-specific dysfunction. Given the clinical importance of the results obtained, the present study considers six aware and four unaware remitted bipolar disorder patients. Cingulate functionality was assessed with functional magnetic resonance imaging while patients performed a go/no-go task. Patients were also studied on an overall cognitive tasks battery and with behavioural assessment of mood changes in terms of apathy and disinhibited behavior. Unaware patients showed fronto-parietal hypo-perfusion with a significant reduction of task-sensitive activity in the bilateral superior and middle frontal gyrus, putamen, insular and anterior cingulate cortices.