Table 4:

Cross-sectional and repeated-measures MRS studies of severe mood dysregulation

Study	Sample	Methods (Device/FS/TR/TE/Sequence)	Region-of-Interest Voxel Size and Location	Findings
Dickstein et al, 2008⁹³	36 Euthymic unmedicated patients with severe mood dysregulation, (mean age, 12.2 yr),	Signa^{^a}/1.5T/2000/30/PRESS	8 mL in the right frontal cortex,	↓ mIns/tCre in severe mood dysregulation in the left temporal lobe (P = .03);
			8 mL in the left temporal cortex,	no significant group differences in mIns/tCre, NAA/tCre, or Glx/tCre in the other regions of interest;
	43 healthy volunteers, (mean age, 12.9 yr)		8 mL in the central parieto-occipital lobe,	females with severe mood dysregulation showed trends toward
			8 mL in the left parietal lobe	↓ mIns/tCre in the left temporal cortex (P = .07),
				↑ tCre in the left temporal cortex (P = .08), and
				↑ Glx/tCre in the left parietal lobe (P = .08)
Dickstein et al, 2009⁹⁴	25 Euthymic unmedicated patients with severe mood dysregulation, randomized to 6 weeks of treatment with	Signa/1.5T/2000/30/PRESS	8 mL in the right frontal cortex,	There was a significant Group × Time interaction for Glx/tCre in the parieto-occipital lobe (P = .01), with ↑ Glx/tCre in the lithium group and ↓ Glx/tCre in the placebo group;
	lithium (n = 14; mean age, 10.8 yr; mean serum lithium level = 0.82 mmol/L)		8 mL in the left temporal cortex,	Group × Time interactions for mIns/tCre, NAA/tCre, and Glx/tCre in the other regions of interest were nonsignificant
	or		8 mL in the central parieto-occipital lobe,
	placebo (n = 11; mean age, 12.1 yr)		8 mL in the left parietal lobe,
			scans obtained at baseline and 6 weeks

Note:—TR and TE are expressed in milliseconds. FS indicates field strength; PRESS, point-resolved spectroscopic sequence; ↓, decreased; ↑, increased; tCre, total creatine.
↵a GE Healthcare, Milwaukee, Wisconsin.