Neural Substrates of Emotion in Borderline Patients

描述(申请人提供)：边缘性人格障碍(BPD)是一种持续性和严重的精神障碍，具有很高的死亡率、发病率和痛苦程度。情绪失调或对环境事件的反应，特别是分离、挫折或损失等事件，被认为是这种疾病的一个定义特征。这种障碍，几乎没有受到调查的详细审查，而且异常情绪处理的神经关联也没有被理解。惊恐眨眼修正(SEM)方法为情绪加工的研究提供了一种非语言的量化工具。当在令人不快的刺激期间出现短暂的惊吓刺激时，惊吓反应的幅度会增强；愉快的刺激会相对抑制惊吓反应；而中性刺激是中间的。本研究采用扫描电子显微镜和功能神经成像(事件相关功能磁共振成像和FDG-PET)研究了三组严格筛选的BPD患者情绪反应的强度、时间进程、习惯化和功能神经解剖学：26例BPD患者(无共病的A、C类人格障碍)，26例非BPD患者(诊断为分裂型人格障碍，无B、C类人格障碍或A、C类人格障碍)和26名健康对照。在功能磁共振扫描和FDG摄取PET期间，参与者将看到一系列令人不快(例如，憎恨)、令人愉快(例如，快乐)和中性(例如，查看)的单词。在同时摄取FDG期间测量的扫描电子显微镜幅度差分数(例如，不愉快-愉快)将提供对不愉快刺激的情绪处理的强度、时间进程和习惯化的测量，并与局部糖代谢相关。关键大脑区域的fMRI BOLD反应差异分数将提供大脑激活的强度和时间过程的测量。我们专注于三个被认为参与情绪处理的大脑区域：杏仁核、前扣带回和前额叶皮质(眼眶、额叶和背外侧)。这些区域是大脑回路的一部分，被认为是调节情绪体验的一部分，并在BPD症状的表达中发挥重要作用。这一结合心理生理学和功能神经解剖学的方法有可能提供关于情绪处理的规范方面的急需信息，以及对BPD中观察到的情绪失调背后的神经解剖学的洞察。

DESCRIPTION (provided by applicant): Borderline personality disorder (BPD) is a persistent and severe mental disorder with high mortality, morbidity and levels of distress. Emotional dysregulation or reactivity to environmental events, particularly events such as separations, frustrations, or losses is considered a defining feature of this disorder. This disorder, has received little investigative scrutiny and the neural correlates of abnormal emotional processing are not understood. Startle eyeblink modification (SEM) methodology provides a non-verbal, quantitative tool for the study of emotional processing. When a brief startle stimulus is presented during an unpleasant stimulus, the amplitude of the startle response is potentiated; a pleasant stimulus occasions a relative inhibition of the startle response; and a neutral stimulus is intermediate. This study uses SEM and functional neuroimaging (event-related fMRI and FDG-PET) to explore the intensity, time course, habituation and functional neuroanatomy of emotional responses in three rigorously screened groups: 26 BPD patients (with no comorbid Axis I disorder or Cluster A or C personality disorders), 26 non-BPD patients (with a diagnosis of schizotypal personality disorder and no comorbid Cluster B or C personality disorders or Axis I disorder) and 26 healthy controls. During both the fMRI scan and FDG-uptake for PET, participants will view an intermixed series of unpleasant (e.g., hate), pleasant (e.g., happy) and neutral (e.g., view) words. SEM amplitude difference scores (e.g., unpleasant-pleasant) measured during simultaneous FDG uptake will provide a measure of the intensity, time course, and habituation of emotional processing of unpleasant stimuli and be correlated with regional glucose metabolism. fMRI BOLD response difference scores in key brain regions will provide measurement of the intensity and time course of brain activation. We focus on three brain regions thought to be involved in emotional processing: amygdala, anterior cingulate, and prefrontal cortex (orbitofrontal and dorsolateral). These regions are part of a brain circuit thought to mediate emotional experience and play a significant role in the expression of BPD symptoms. This proposed combination of a psychophysiological and functional neuroanatomy approach holds the potential to provide much-needed information on normative aspects of emotional processing and insights into the neuroanatomy underlying the emotional dysregulation observed in BPD.