Brain biochemical metabolism using proton magnetic resonance spectroscopy in adolescents bipolar depression with verbal auditory hallucinations.

OBJECTIVE

This study utilizes proton magnetic resonance spectroscopy (1H-MRS) imaging to analyze neuro-metabolic alterations in the ventromedial prefrontal cortex (vmPFC) of adolescents with bipolar depression (BD-Dep) and verbal auditory hallucinations (AVHs).

METHODS

A retrospective analysis was conducted on 47 untreated adolescent BD-Dep patients within 30 days, between January 2024 and August 2025. Comprehensive clinical data were collected for all patients, including gender, age, age of onset, years of education, and the presence of suicidal or self-harming behaviors. Patients were divided into two groups: an AVH group (P3 score >3, n = 24) and a non-hallucination group (P3 score ≤3, n = 23), based on PANSS P3 scores and the presence of AVHs. Both groups underwent 1H-MRS scanning of the vmPFC to compare the ratios of N-acetyl aspartate/creatine (NAA/Cr), choline/creatine (Cho/Cr), myo-inositol/creatine (mI/Cr), glutamate/creatine (Glu/Cr), and NAA/Cho.

RESULTS

The comparison of Cho/Cr ratios between the two groups-0.685 (0.653, 0.748) versus 0.600 (0.530, 0.650)-revealed a statistically significant difference (Z = 3.346, P = 0.001, <0.05). No statistically significant differences were found in the NAA/Cr, mI/Cr, and Glu/Cr ratios between the two groups.

CONCLUSION

Adolescent BD-Dep patients with AVHs exhibit elevated Cho/Cr ratios. These biochemical metabolic changes in the vmPFC may be associated with the occurrence of AVHs in these patients.