FDG PET Study of Laboratory Induced Aggression

描述（由研究者提供）：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巨大的痛苦。这一领域的工作似乎最富有成效时，它的重点是一个方面的障碍，可以客观地衡量。冲动性攻击是这种疾病的一个特别令人不安的属性，也是一种可以客观衡量的行为。 本研究将使用一个实验室模型，点减法攻击范式，在40名边缘患者的冲动攻击和40名正常对照激发攻击。我将用正电子发射断层扫描检查边缘患者和正常对照者在攻击性激发过程中大脑活动的差异，并将重点放在抑制性区域，包括前扣带回和腹内侧眶皮层。如果边缘型患者无法招募抑制性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，解释了为什么他们似乎难以自我控制。它还提供了一种生物模型，可用于描述仅在某些情况下表现出来的行为。边缘患者在许多情况下看起来完全正常，但这是一种与严重功能障碍有关的疾病，自杀率高，经常有攻击行为。由于这种疾病是有点难以捉摸的临床医生在短期接触，它是特别重要的是提供一种方法来表征疾病，捕捉病理清楚。在未来，我希望使用的范例来研究治疗结果的边缘患者，以检查区域大脑控制的攻击性，以响应药物和心理治疗干预的影响。 具体目标1）识别40名冲动/攻击性边缘患者并进行临床特征分析（男20例，女20例），根据DSM-IV定义，40例正常对照（20名男性，20名女性），2）用正电子发射断层扫描仪（PET）测定局部葡萄糖代谢率用18 FDG示踪法对边缘型冲动攻击性患者和正常对照者进行点减攻击性激发扫描。

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.