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Parametric empirical Bayes (PEB) analysis was conducted to identify ECs associated with group differences, as well as depression and mania severity. Leave-one-out cross-validation (LOOCV) was used to test predictive accuracy.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291724002885_sec_a3\" sec-type=\"results\"><jats:title>Result<\/jats:title><jats:p>Compared to HCs, PBD patients exhibited primarily excitatory bottom-up connections from the LN to the salience network (SN) and bidirectional excitatory connections between the default mode network (DMN) and SN. In PBD, top-down connectivity from the triple network to the LN was excitatory in individuals with higher depression severity but inhibitory in those with higher mania severity. LOOCV identified dysconnectivity circuits involving the caudate and hippocampus as being associated with mania and depression severity, respectively.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291724002885_sec_a4\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Disrupted bottom-up connections from the LN to the triple network distinguish PBD patients from healthy controls, while top-down disruptions from the triple network to LN relate to mood state differences. These findings offer insight into the neural mechanisms of PBD.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291724002885","type":"journal-article","created":{"date-parts":[[2024,12,16]],"date-time":"2024-12-16T12:47:20Z","timestamp":1734353240000},"page":"4713-4724","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":3,"title":["Causal mechanisms of quadruple networks in pediatric bipolar 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