Whole-brain functional connectivity during script-driven aggression in borderline personality disorder
Whole-brain functional connectivity during script-driven aggression in borderline personality disorder
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DOI：
10.1016/j.pnpbp.2019.03.004
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发表时间：
2019-07
影响因子：
5.6
通讯作者：
K. Ueltzhöffer;S. Herpertz;M. Krauch;C. Schmahl;K. Bertsch
中科院分区：
文献类型：
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作者：
K. Ueltzhöffer;S. Herpertz;M. Krauch;C. Schmahl;K. Bertsch
目的：边缘型人格障碍（BPD）患者经常报告强烈愤怒和愤怒相关攻击。最近的研究结果表明，与愤怒相关的攻击及其控制与BPD中不同神经系统的复杂相互作用有关。为了进一步研究这一点，我们通过检查BPD患者在愤怒和反应性攻击期间全脑功能连接的变化来补充标准激活和基于种子的连接分析。方法我们重新分析了33例符合DSM-IV BPD标准8“愤怒倾向”的BPD女性和30名健康女性的功能MRI数据。受试者完成了一项剧本驱动的意象任务，包括四个阶段：基线、由人际拒绝引起的愤怒、对他人进行身体攻击的叙述和放松。我们使用数据驱动、空间受限的光谱聚类方法将大脑分成200个区域。对于每个脚本阶段和主题，我们使用小波系数在0.05-0.10 Hz范围内的相关性计算完整的连接矩阵。我们通过减去每个被试相应的连通性矩阵，计算了从基线到愤怒诱导和身体攻击阶段的个体连通性增加，以及从愤怒诱导到攻击阶段的增加和减少。然后，我们应用基于排列的采样来确定单个连接强度的组合阈值和这些差异矩阵所发现的网络的大小。结果我们发现，与健康女性相比，BPD女性患者从基线到攻击阶段的连通性显著增强，这是一个单一的、大的网络。该网络由扣带前部和后部皮层、楔前叶、背内侧前额叶皮层、颞上回和中回、海马、岛叶、腹外侧和背外侧前额叶皮层、顶叶上叶、丘脑、中央前和中央后回、尾状、苍白球、小脑、枕叶中部、舌回、calcarine沟和梭状回等区域组成。结中心性最高的中枢区域位于右侧尾状体和左侧丘脑。我们发现，从基线到愤怒诱导的连通性增加，以及从愤怒诱导到攻击阶段的增加或减少没有显著差异。结论：与健康女性相比，女性BPD患者从基线到攻击阶段的连通性显著增强。构成该网络的区域属于前面描述的四个功能网络：额顶叶认知控制网络、扩展默认模式网络、视觉系统和运动系统。与行为的认知控制、社会情感和自我参照思维、显著性处理和情绪调节、视觉感知和行动相关的不同功能脑系统区域之间的连通性的增强，是通过丘脑和尾状核的枢纽来调节的，即丘脑皮质纹状体运动回路的核心组成部分，对行动的选择和启动至关重要。研究结果表明，女性BPD患者在攻击性行为冲动的加工过程中，前额叶认知控制过程与丘脑皮质纹状体动作选择过程的相互作用增强，而这种相互作用是由高情绪显著状态及其相关的自我参照和社会加工过程以及无效情绪调节所促进的。
ObjectiveIntense anger and anger-related aggression are frequently reported by patients with borderline personality disorders (BPD). Recent results suggest that anger-related aggression and its control is associated with a complex interplay of different neural systems in BPD. To further investigate this, we complement standard activation and seed-based connectivity analyses by examining whole-brain changes in functional connectivity during anger and reactive aggression in BPD.MethodsWe reanalyzed functional MRI data from 33 women with BPD, all of them fulfilling BPD criterion 8, “anger proneness”, according to DSM-IV, and 30 healthy women. Subjects performed a script-driven imagery task consisting of four phases: baseline, anger-induction by a narrative of interpersonal rejection, a narrative of directing physical aggression towards others, and relaxation. We used a data-driven, spatially constrained spectral clustering approach to parcellate the brain into 200 regions. For each script-phase and subject, we computed the full connectivity matrix using wavelet coefficient correlations in the 0.05–0.10 Hz range. We calculated the individual increase in connectivity from baseline to the anger-induction and physical aggression phases by subtracting the corresponding connectivity matrices per subject, as well as the increase and decrease from the anger-induction to the aggression phase. We then applied permutation-based sampling to determine a combined threshold on the strength of individual connections and the size of the discovered networks for these difference matrices.ResultsWe discovered a single, large network showing a significantly stronger increase in connectivity from baseline to the aggression phase in female patients with BPD compared to healthy women. This network consisted of regions in the anterior and posterior cingulate cortex, precuneus, dorsomedial prefrontal cortex, superior and middle temporal gyrus, hippocampus, insula, ventrolateral and dorsolateral prefrontal cortex, superior parietal lobe, thalamus, precentral and postcentral gyrus, caudate, pallidum, cerebellum, middle occipital lobe, lingual gyrus, calcarine sulcus, and fusiform gyrus. Hub regions with highest node centrality were found in the right caudate and left thalamus. We found no significant differences for the increase of connectivity from baseline to anger-induction, as well as for the increase or decrease from the anger-induction to the aggression phase.ConclusionsWe identified a large network showing a significantly stronger increase in connectivity from baseline to the aggression phase in female patients with BPD compared to healthy women. The regions constituting this network belong to four previously described functional networks: The frontoparietal cognitive control network, the extended default mode network, the visual system, and the motor system. This stronger increase in connectivity between regions of different functional brain systems associated with cognitive control of behavior, socio-affective and self-referential thinking, as well as salience processing and emotion regulation, visual perception, and action is mediated via hubs in the thalamus and caudate, i.e., core components of the thalamocorticostriatal motor loop essential for action selection and initiation. These findings suggest increased interaction of prefrontal cognitive control processes with thalamocorticostriatal action-selection processes in female patients with BPD during the processing of aggressive action impulses, which are facilitated by states of high emotional salience and associated processes of self-referential and social processing, and ineffective emotion regulation.