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

Background: Twenty per cent of patients with bipolar affective disorder suffer an illness that responds inadequately to treatment and has a poor outcome. Many patients, but not all, with bipolar disorder show white matter abnormalities on T₂-weighted magnetic resonance imaging (MRI). Aims: To explore the hypothesis that white matter abnormalities on MRI are seen more frequently in subjects whose illness has a poor outcome compared with 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 20-65 years, were studied. Axial T₂-weighted MRI scans were examined for the 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 good outcome group (P=0.035) or controls (P=0.003) and these abnormalities were of greater severity (P=0.030 and P < 0.014, respectively). Conclusions: Subcortical white matter lesions are associated with poor outcome bipolar disorder. Declaration of interest: This research was supported financially by Newcastle City HealthTrust.