Cerebral white matter lesions in bipolar affective disorder: relationship to outcome

Background Twenty percent of patients with bipolar affective disorder suffe r an illness that responds inadequately to treatment and has a poor outcome . Many patients, but not all, with bipolar disorder show white matter abnor malities on T-2-weighted magnetic resonance imaging (MRI). Aims To explore the hypothesis that white matter abnormalities on MRI are s een more frequently in subjects whose illness has a poor outcome compared w ith those with a good outcome or controls. Method Two groups of age-and gender-matched patients with bipolar disorder (14 with a good outcome and 15 with a poor outcome) and 15 controls, aged 2 0-65 years, were studied. Axial T-2-weighted MRI scans were examined for th e presence and severity of white matter abnormalities. Results Significantly more poor outcome group members had deep subcortical punctate, but not periventricular, white matter hyperintensities than the g ood outcome group (P=0.035) or controls (P=0.003) and these abnormalities w ere of greater severity (P=0.030 and P < 0.014, respectively). Conclusions Subcortical white matter lesions are associated with poor outco me bipolar disorder.