Frontier
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World J Radiol. Jun 28, 2014; 6(6): 223-229
Published online Jun 28, 2014. doi: 10.4329/wjr.v6.i6.223
White matter abnormalities: Insights into the pathophysiology of major affective disorders
Gianluca Serafini, Xenia Gonda, Zoltan Rihmer, Paolo Girardi, Mario Amore
Gianluca Serafini, Paolo Girardi, Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy
Xenia Gonda, Zoltan Rihmer, Department of Clinical and Theoretical Mental Health, Kutvolgyi Clinical Center, 1125 Budapest, Hungary
Mario Amore, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genova, I-16146 Genova, Italy
Author contributions: Serafini G designed the study and wrote the manuscript; Amore M, Girardi P and Rihmer Z provided the intellectual impetuous and supervised the search strategy; Gonda X contributed in reviewing the literature and provided help in selecting papers in the present manuscript.
Correspondence to: Gianluca Serafini, MD, PhD, Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, 1035-1039, Via di Grottarossa, 00189 Rome, Italy. gianluca.serafini@uniroma1.it
Telephone: +39-06-33775675 Fax: +39-06-33775342
Received: January 23, 2014
Revised: April 13, 2014
Accepted: May 16, 2014
Published online: June 28, 2014
Processing time: 155 Days and 15.6 Hours
Abstract

The presence of white matter hyperintensities (WMHs) has been commonly associated with poor outcome in subjects with major affective disorders. Unfortunately, WMHs may be frequently confounded by the use of psychoactive medications and duration of illness. Although findings from the current literature are quite conflicting, we proposed that subjects with WMHs may be at higher suicidal risk when compared to other subgroups without. Based on the Fazekas modified scale, the severity of WMHs may serve as a trait marker of disease. Interestingly, the presence of WMHs may represent a neurobiological marker between the underlying vulnerability and clinical presentation of major affective disorders.

Keywords: White matter hyperintensities; Major affective disorders; Suicidal behaviour; Neuroimaging; Outcome

Core tip: Understanding neural correlates underlying psychiatric morbidity over time is critical but, to date, structural magnetic resonance imaging studies identified only not stable risk predictors of unfavourable outcome in psychiatric populations. The presence of white matter hyperintensities (WMHs) has been commonly associated with a poor outcome in individuals with major affective disorders. Based on our studies, subjects with WMHs may be considered at higher suicidal risk than those without and the severity of WMHs as assessed by the Fazekas modified scale may serve as a trait marker of disease. WMHs may represent an interesting neurobiological marker between the underlying vulnerability and clinical presentation of major affective disorders.