Multimodal Neuroimaging of Treatment Effects in Adolescent Mania
Condition: Mania; Bipolar Disorder
MeSH terms: Mania; Bipolar Disorder
Study type: Interventional

Summary: 
      Specific Aim 1: To determine the effects of treatment with quetiapine or lithium on brain
      activation in adolescents. The investigators will use functional magnetic resonance imaging
      (fMRI) to examine brain activation during an attentional task.

      Specific Aim 2: To determine the effects of treatment with quetiapine or lithium on
      neurometabolite measures, early in their illness course. The investigators will use 1H-MRS to
      identify myo-inositol (mI), N-acetyl aspartate (NAA), and glutamate (Glu) levels in
      prefrontal ALN regions.

      Specific Aim 3: To determine the relationships among the changes in brain activation and
      neurometabolite measures, as well as symptomatic improvement in manic adolescents.
    

Detailed description: 
      Hypotheses 1 & 2 predict that following 6 weeks of treatment with lithium or quetiapine,
      manic adolescents who demonstrate symptomatic improvement will exhibit normalized (decreased)
      VLPFC and ACC activation and increased activation of compensatory posterior attentional brain
      areas as well as normalization of VLPFC and ACC neurometabolite measures (increased NAA and
      decreased Glu levels) compared with those who do not experience symptomatic improvement and
      healthy adolescents.

      Hypothesis 3 predicts significant associations between fMRI activation changes (i.e.
      decreased activation in VLPFC and ACC ROIs and increased activation in the posterior
      attention ROI) and MRS changes (increases in NAA and decreases in Glu levels in the VLPFC and
      ACC) for patients who exhibit symptomatic improvement with either treatment.

      Hypothesis 4 predicts that decreases in mI levels at 1 week will be associated with lithium,
      but not quetiapine, response at endpoint.

      In contrast, Hypothesis 5 predicts higher baseline Cho levels will be associated with
      quetiapine, but not lithium, response at endpoint.
    

Intervention name(s): Quetiapine & Placebo; Lithium and Placebo; Healthy Controls
Intervention type(s): Drug; Drug; Other
Intervention description(s): Bipolar adolescents will be initiated on 100 mg per day of quetiapine (or placebo) and 30 mg/kg (maximum starting dose of 600 mg twice daily) of lithium carbonate (or placebo), depending on randomization assignment. Patients will be given placebo for the medication to which they were not assigned. Quetiapine will be adjusted based on tolerability and response to a target dose of 400-600 mg and lithium will be adjusted to a target dose based on achieving a serum level of 1.0-1.2 mEq/L.; Bipolar adolescents will be initiated on 100 mg per day of quetiapine (or placebo) and 30 mg/kg (maximum starting dose of 600 mg twice daily) of lithium carbonate (or placebo), depending on randomization assignment. Patients will be given placebo for the medication to which they were not assigned. Quetiapine will be adjusted based on tolerability and response to a target dose of 400-600 mg and lithium will be adjusted to a target dose based on achieving a serum level of 1.0-1.2 mEq/L.; Healthy control (patients given placebo -- sugar pill intended to mimic drug)
Intervention MeSH terms: Quetiapine Fumarate
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Care Provider, Investigator)
Primary purpose: Diagnostic
Keywords: mania; adolescent; bipolar