Evidence for a dysfunctional prefrontal circuit in patients with an impulsive aggressive disorder
Evidence for a dysfunctional prefrontal circuit in patients with an impulsive aggressive disorder
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DOI：
10.1073/pnas.112604099
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发表时间：
2002-06-11
影响因子：
11.1
通讯作者：
Coccaro, EF
中科院分区：
文献类型：
--
作者：
Best, M;Williams, JM;Coccaro, EF
眼眶/内侧前额叶皮层和相互连接区域受损的人会表现出冲动的攻击行为。为了进一步研究冲动性攻击和眶内侧前额叶功能障碍之间的关系，我们测量了精神病患者的行为表现，其特征是冲动性攻击，间歇性爆炸性障碍（IED）。目前，没有证据表明IED受试者存在局部脑损伤。然而，根据产生后天冲动性攻击的大脑病变的位置，我们假设IED受试者将表现出与眼眶/内侧前额叶皮层病变患者相似的测试表现。受试者与IED和对照组进行了三个测试敏感的眼眶，内侧前额叶回路的病变：爱荷华州赌博任务，面部情绪识别，气味识别，和两个控制测试的工作记忆。在赌博任务中，IED受试者在100次试验中继续做出不利的决定，而控制组则学会了避免不利的决定。在面部识别测试中，IED受试者在识别“愤怒”、“厌恶”和“惊讶”方面受损，他们倾向于用“厌恶”和“恐惧”来标记中性面孔。“在气味识别方面，IED受试者轻度嗅觉缺失，相对于对照组受损。然而，在工作记忆控制测试中，两组的表现相似。在测试中，IED受试者的表现类似于先前研究中眼眶/内侧前额叶病变患者的表现。这些结果扩展了眶内侧前额叶回路功能障碍与冲动性攻击行为之间的联系。
Humans with lesions to the orbital/medial prefrontal cortex and interconnected areas display impulsive aggressive behavior. To examine further the relationship between impulsive aggression and orbital I medial prefrontal dysfunction, we measured the behavioral performance of psychiatric patients with a disorder characterized by impulsive aggression, Intermittent Explosive Disorder (IED). Presently, no evidence exists for a localized brain lesion in IED subjects. However, on the basis of the location of brain lesions that produce acquired impulsive aggression, we hypothesized that IED subjects would exhibit test performance similar to patients with lesions to the orbital/medial prefrontal cortex. Subjects with IED and controls were administered three tests sensitive to lesions of the orbital, medial prefrontal circuit: the Iowa Gambling Task, facial emotion recognition, and odor identification, and two control tests of working memory. On the gambling task, IED subjects continued to make disadvantageous decisions throughout the 100 trials, whereas controls learned to avoid disadvantageous decisions. On the facial recognition test, IED subjects were impaired at recognizing "anger," "disgust," and "surprise," and they were biased to label neutral faces with "disgust" and "fear." On odor identification, IED subjects were mildly anosmic and were impaired relative to controls. However, on the working memory control tests, both groups performed similarly. Across tests, the performance of IED subjects resembles the performance of patients with orbital/medial prefrontal lesions in previous studies. These results extend the link between dysfunction of the orbital:,medial prefrontal circuit and impulsive aggressive behavior.