Medial prefrontal dysfunction and prolonged amygdala response during instructed fear processing in borderline personality disorder
Medial prefrontal dysfunction and prolonged amygdala response during instructed fear processing in borderline personality disorder
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DOI：
10.3109/15622975.2012.665174
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发表时间：
2013-05-01
影响因子：
3.1
通讯作者：
Tuescher, Oliver
中科院分区：
文献类型：
--
作者：
Kamphausen, Susanne;Schroeder, Patricia;Tuescher, Oliver
目标。情感调节障碍是临界性人格障碍(BPD)的临床特征。本研究使用指导恐惧任务，结合功能磁共振成像(FMRI)和皮肤电导反应(Scr)来测试有关BPD患者情绪处理功能障碍的额缘神经回路紊乱机制的假说。方法：研究方法。女性BPD患者和匹配的对照组在fMRI扫描和SCR记录过程中暴露于两种视觉刺激。受试者在扫描前不久被告知，一个刺激(威胁)可能代表厌恶事件，而另一个刺激(安全)代表安全。厌恶事件(皮肤电刺激)本身只在本指令之前经历过，在fMRI扫描期间从未发生过。结果。与安全相比，这两组人对威胁的SCR都更强，这表明随着时间的推移习惯了不同的恐惧反应。与对照组相比，BPD患者没有表现出杏仁核活动的fMRI信号随时间的减少或相对腹内侧额叶皮质(VmPFC)活动的增加。此外，与对照组相比，BPD患者杏仁核与vmPFC的连接性增加，而膝下型ACC与背侧ACC的连接性降低。结论。杏仁核反应延长和腹侧和背侧mPFC区之间的功能分离可能是BPD患者情绪调节障碍的神经机制的一部分。
Objectives. Affective dysregulation is a clinical hallmark of borderline personality disorder (BPD). This study used an instructed fear task combined with functional MRI (fMRI) and skin conductance response (SCR) to test hypotheses about mechanisms of disturbed fronto-limbic neural circuitry underlying dysfunctional emotional processing in BPD. Methods. Female BPD patients and matched control subjects were exposed to two visual stimuli during fMRI scanning and SCR recording. Subjects were instructed shortly before scanning that one stimulus (Threat) potentially represents an aversive event whereas another stimulus (Safe) represents safety. The aversive event (electrodermal stimulation) itself was only experienced before this instruction and never occurred during fMRI scanning. Results. Both groups showed stronger SCR to Threat compared to Safe indicating differential fear response which habituated over time. BPD compared to control subjects did not show fMRI signal decrease of amygdala activity or relative ventromedial prefrontal cortex (vmPFC) activity increase over time. Moreover, BPD patients showed increased connectivity of the amygdala with vmPFC but decreased connectivity of subgenual ACC with dorsal ACC compared to control subjects. Conclusions. Prolonged amygdala response and a functional disconnection between ventral and dorsal mPFC regions may be part of the neural mechanisms underlying emotional dysregulation in BPD patients.