1. The specific neural correlates of aesthetic judgment for paintings: in relation to bipolar temperaments Yoshinori Mizokami 1, Takeshi Terao 1, Kensuke Kodama 1, Koji Hatano 1, Nobuhiko Hoaki 1, Kentaro Kohno 1, Yasuo Araki 1, Mayu Makino 1, Toshihiko Izumi 1, Tsuyoshi Shimomura 2, Minoru Fujiki 2, Takanori Kochiyama 3 1 Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Japan 2 Department of Neurosurgery, Oita University Faculty of Medicine, Oita, Japan 3 The Hakubi Project, Kyoto University, Inuyama, Aichi, Japan

2. INTRODUCTION Our previous study (Mizokami et al, in submission), suggest that bilateral middle occipital gyri and bilateral ligual gyri may be also closely associated with aesthetic judgment of representational paintings. Creativity has been reported to be associated with bipolar disorder (Santosa et al, 2007; Strong et al, 2007; Murray and Johnson, 2010; Rybakowski, 2010; Riccardiello et al, 2012). Also, the association has been shown between creativity and cyclothymic temperament (Vellante et al, 2011). Considering the association between artistic creativity and cyclothymic temperament, if aesthetic judgment takes an important role in artistic creativity, it can be hypothesized that cyclothymic temperament may be associated with activations in lingual gyrus and middle occipital gyrus during aesthetic judgment for paintings. In the present study, this hypothesis was investigated by measuring the association between cyclothymic temperament scores and the activations during aesthetic judgment of paintings in lingual gyrus and middle occipital gyrus.

3. METHODS Subjects Forty-four healthy subjects participated in the experiment but 5 subjects revealed artifacts. Therefore, 39 subjects’ data (mean age = 27.5± 5.7, 17 female) were submitted to analysis. All participants were right-handed and had normal or corrected to normal vision. They gave written informed consent to participate in this study according to procedures approved by the ethical committee at Oita University Faculty of Medicine.

4. Cyclothymic temperament evaluation The Temperament Scale of Memphis, Pisa, Paris and San Diego- Autoquestionnaire (TEMPS-A) has been developed by Akiskal et al. This scale has 110 questions to measure 5 temperaments (depressive, hyperthymic, cyclothymic, irritable and anxious) and has been verified in 32 language versions and widely used in a number of epidemiological and clinical studies with psychiatric patients and healthy subjects. Also in Japan, the scale has been validated and widely used to identify affective temperaments (Matsumoto et al, 2005). In the present study, we used the scores of cyclothymic temperament only.

5. Region-of-interest (ROI) analyses of BOLD signal change We hypothesized that cyclothymic temperament scores may be associated with percent signal changes in lingual gyrus and middle occipital gyrus. ROIs for these area were defined anatomically (each bilaterally) using the MarsBaR toolbox in SPM2, which derives ROIs from the MNI single-subject template. Percent signal change (relative to the low-level baseline activity observed during viewing of the fixation cross) in the ROIs was estimated using the model described above, and extracted for each subject as the mean signal within each ROI for each condition. Statistical Analyses The associations were investigated between cyclothymic temperament scores and the percent signal changes of the ROIs during aesthetic judgment of paintings by Pearson’s coefficient.

6. As shown in Table 1, cyclothymic temperament scores were significantly and negatively associated with percent signal changes of left lingual gyrus and right middle occipital gyrus. Left lingual gyrus Right lingual gyrus Left middle occipital gyrus Right middle occipital gyrus R―0.343*―0.296―0.244―0.318* *: p<0.05 percent signal changes of left lingual gyrus cyclothymic temperament scores percent signal changes of right middle occipital gyrus Table 1. The Association Between Cyclothymic Scores and Percent Signal Changes of ROIs. Result

7. One possibility is that subjects with more cyclothymic temperament have less activation during aesthetic judgment for paintings, suggesting that more cyclothymic subjects are likely to be accustomed to aesthetic judgment and need less activations. Another possibility is that more activations during aesthetic judgment for paintings make subjects less cyclothymic, suggesting that painting therapy may treat mood fluctuations. The latter possibility is interesting because it elucidate at least partially the mechanism of painting therapy. percent signal changes of left lingual gyrus cyclothymic temperament scores DISCUSSION The negative association between cyclothymic temperament scores and activations during aesthetic judgment for paintings in lingual gyrus and middle occipital gyrus suggest two possibilities.

8. Matsumoto S, Akiyama T, Tsuda H, Miyake Y, Kawamura Y, Noda T, Akiskal KK, Akiskal HS.(2005). Reliability and validity of TEMPS-A in a Japanese non- clinical population: application to unipolar and bipolar depressives. Jornal of Affective Disorders 85: 85-92 Santosa CM, Strong CM, Nowakowska C, Wang PW, Rennicke CM, Ketter TA. (2007). Enhanced creativity in bipolar disorder patients: Acontrolled study. Jornal of Affective Disorders 100: 31-39 Strong CM, Nowakowska C, Santosa CM, Wang PW, kraemer HC, Ketter TA. (2007). Temperament-creativity relationships in mood disorder patients, healthy controls and highly creative individuals. Jornal of Affective Disorders 100: 41-48 Murray G and Johnson SL. (2010). The clinical significance of creativity in bipolar disorder. Clinical Psychology Review 30:721-732 Rybakowski JK. (2011). Painting “Mania”. Jornal of Affective Disorders 128: 319-320 Riccardiello L, Fornaro P. (2012). Beyond the cliff of creativity A novel key to Bipolar Disorder and creativity. Medical Hypotheses 80:534-543 Vellante M, Zucca G, Preti A, Sisti D, Rocchi MB, Akiskal KK, Akiskal HS. (2011). Creativity and affective temperaments in non-clinical professional artists: An empirical psychometric investigation. Jornal of Affective Disorders 135: 28-36 References