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Double-Blind Randomized Trial of Risperidone Versus Divalproex in Pediatric Bipolar Disorder: fMRI Outcomes

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journal contribution
posted on 01.03.2012 by Mani N. Pavuluri, Alessandra M. Passarotti, Lisa H. Lu, Julie A. Carbray, John A. Sweeney
The aim of this research was to determine the relative effects of risperidone and divalproex on brain function in pediatric mania. This is a double-blind 6-week fMRI trial with 24 unmedicated manic patients randomized to risperidone or divalproex, and 14 healthy controls (HCs) matched for IQ and demographic factors (mean age: 13.1±3.3 years). A pediatric affective color matching task, in which subjects matched the color of a positive, negative or neutral word with one of two colored circles, was administered. The primary clinical measure was the Young Mania Rating Scale (YMRS). The risperidone group, relative to HC, showed an increase in activation from pre- to post-treatment in right pregenual and subgenual anterior cingulate cortex and decreased activation in bilateral middle frontal gyrus during the negative condition; and decreased activation in left inferior and medial, and right middle frontal gyri, left inferior parietal lobe, and right striatum with positive condition. In the divalproex group, relative to HC, there was an increased activation in right superior temporal gyrus in the negative condition; and in left medial frontal gyrus and right precuneus with the positive condition. Greater pre-treatment right amygdala activity with negative and positive condition in the risperidone group, and left amygdala activity with positive condition in divalproex group, predicted poor response on YMRS. Risperidone and divalproex yield differential patterns of prefrontal activity during an emotion processing task in pediatric mania. Increased amygdala activity at baseline is a potential biomarker predicting poor treatment response to both the risperidone and divalproex.


This research was funded by NIH 1 K23 RR018638-01 and NIH-MO1-RR-13987. Study drugs and matching placebo were provided by Johnson and Johnson and Abbott Pharmaceuticals.


Publisher Statement

NOTICE: this is the author’s version of a work that was accepted for publication in Psychiatry Research. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Psychiatry Research, Vol 193, Issue 1, (July 30, 2011) DOI: 10.1016/j.pscychresns.2011.01.005. The original publication is available at







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