FDG PET Study of Laboratory Induced Aggression

描述(由研究人员提供)：我致力于了解边缘型人格障碍的神经生物学基础。这种疾病给患者及其家人带来了极大的痛苦。当这一领域的工作集中在可以客观衡量的障碍的一个维度上时，这方面的工作似乎最有成效。冲动攻击性是这种障碍的一个特别令人不安的特征，也形成了一种可以客观衡量的行为类型。 这项研究将使用一个实验室模型，即点减法攻击范式，对40名冲动性攻击的临界性患者和40名正常对照进行攻击。我将用正电子发射断层扫描检查临界患者和正常对照组在攻击挑衅时脑活动的差异，并将重点放在包括扣带回前部和腹内侧眶皮质在内的抑制性区域。如果边缘患者无法招募抑制大脑区域来控制攻击性，那么这就为患者提供了一个非常有临床意义的解释，为什么他们似乎难以自控。它还提供了一个生物学模型，可以用来描述只有在特定情况下才表现出来的行为。在许多情况下，临界性患者看起来完全正常，但这是一种与严重功能障碍相关的障碍，自杀率高，并伴有频繁的攻击行为。由于这种疾病对短期接触的临床医生来说有些难以捉摸，因此提供一种明确反映病理的疾病特征的方法尤为重要。在未来，我希望使用这一范式来研究边缘患者的治疗结果，以检验药物和心理治疗干预对攻击性的区域大脑控制的影响。 具体目的1)对DSM-IV定义的40例冲动性/攻击性边缘患者(男20例，女20例)和40例正常对照(男20例，女20例)进行为期四年的临床研究；2)以18FDG为示踪剂，采用点减法攻击范式对冲动性攻击性边缘患者和正常对照组进行正电子发射断层扫描，测量局部葡萄糖代谢率。

DESCRIPTION (provided by investigator): I am committed to understanding the neurobiological underpinnings of borderline personality disorder. This disorder causes a great deal of suffering to patients and their families. Work in this area seems most productive when it focuses on a dimension of the disorder that can be measured objectively. Impulsive aggression is a particularly troubling attribute of this disorder and also forms a type of behavior that can be measured objectively. This study will use a laboratory model, the Point Subtraction Aggression Paradigm, to provoke aggression in 40 borderline patients with impulsive aggression and 40 normal controls. I will examine the differences between borderline patients and normal controls in brain activity during aggression provocation with positron emmission tomography and will focus on inhibitory regions including anterior cingulate gyrus and ventromedial orbital cortex. If borderline patients are unable to recruit inhibitory brain regions to control aggression, then this provides a very clinically meaningful explanation to patients about why they seem to struggle with self-control. It also provides a biological model that can be used to characterize a behavior that is only manifest under certain circumstances. Borderline patients can appear in many situations to be completely normal, and yet this is a disorder associated with severe functional impairment, with a high rate of suicide and with frequent acts of aggression. Because this disorder is somewhat elusive to clinicians in short-term contacts, it is especially important to provide a way of characterizing the disorder that captures the pathology clearly. In the future, I hope to use the paradigm to study treatment outcomes in borderline patients to examine the effects on regional brain control of aggression in response to both pharmacologic and psychotherapeutic interventions. Specific Aims 1) To identify and clinically characterize 40 impulsive/aggressive borderline patients (20 males, 20 females) as defined by DSM-IV and 40 normal controls (20 males, 20 females) over four years, 2) To measure regional glucose metabolic rate by Positron Emission Tomography camera (PET) scan using 18FDG as a tracer in the impulsive aggressive borderline patients and normal controls during provocation with the Point Subtraction Aggression Paradigm.