Neural Correlates of Disturbed Emotion Processing in Borderline Personality Disorder: A Multimodal Meta-Analysis
Neural Correlates of Disturbed Emotion Processing in Borderline Personality Disorder: A Multimodal Meta-Analysis
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DOI：
10.1016/j.biopsych.2015.03.027
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发表时间：
2016-01-15
影响因子：
10.6
通讯作者：
Niedtfeld, Inga
中科院分区：
文献类型：
--
作者：
Schulze, Lars;Schmahl, Christian;Niedtfeld, Inga
背景：情绪处理和调节障碍是边缘型人格障碍（BPD）的核心症状。为了进一步阐明 BPD 的神经基础，本荟萃分析总结了情绪处理任务的功能神经影像学发现以及结构神经影像学发现，并研究了多模式影响的大脑区域。 方法：使用各向异性效应大小符号微分映射计算基于坐标和基于图像的组合荟萃分析。纳入了 19 项功能性神经影像研究，调查了总共 281 名 BPD 患者和 293 名健康对照受试者 (HC) 的阴性刺激与中性刺激的处理情况。此外，还分析了 10 项调查 263 名 BPD 患者和 278 名 HC 患者灰质异常的研究。 结果：与 HC 相比，BPD 患者在处理负面情绪刺激时，左侧杏仁核和后扣带皮层的激活相对增加，同时双侧背外侧前额叶皮层的反应减弱。多模态分析发现，与 HC 相比，左侧杏仁核的特点是功能亢进和灰质体积较小。杏仁核的高反应性受到患者样本的药物状态的调节。未接受药物治疗的样本以边缘系统过度活跃为特征，而目前正在服用精神药物的患者则没有发现这样的群体差异。结论：结果强化了这样的假设：功能失调的背外侧前额叶和边缘系统大脑区域是 BPD 的标志性特征，因此与 BPD 作为情绪失调障碍的概念是一致的。
BACKGROUND: Disturbances in the processing and regulation of emotions are core symptoms of borderline personality disorder (BPD). To further elucidate neural underpinnings of BPD, the present meta-analysis summarizes functional neuroimaging findings of emotion processing tasks, as well as structural neuroimaging findings, and investigates multimodally affected brain regions.METHODS: Combined coordinate-and image-based meta-analyses were calculated using anisotropic effect size signed differential mapping. Nineteen functional neuroimaging studies investigating the processing of negative compared with neutral stimuli in a total of 281 patients with BPD and 293 healthy control subjects (HC) were included. In addition, 10 studies investigating gray matter abnormalities in 263 patients with BPD and 278 HC were analyzed.RESULTS: Compared with HC, BPD patients showed relatively increased activation of the left amygdala and posterior cingulate cortex, along with blunted responses of the bilateral dorsolateral prefrontal cortex, during the processing of negative emotional stimuli. The multimodal analysis identified the left amygdala to be characterized by a combination of functional hyperactivity and smaller gray matter volume compared with HC. Hyperresponsivity of the amygdala was moderated by medication status of the patient samples. Medication-free samples were characterized by limbic hyperactivity, whereas no such group differences were found in patients currently taking psychotropic medication.CONCLUSIONS: Results strengthen the assumption that dysfunctional dorsolateral prefrontal and limbic brain regions are a hallmark feature of BPD and therefore are consistent with the conceptualization of BPD as an emotion dysregulation disorder.