An fMRI Study of Emotional Dysregulation in Borderline Patients

描述(由申请人提供)：交界性人格障碍(BPD)是一种普遍和持久的精神障碍，在大约2%的人口和20%的住院精神病患者中发现。它的特点是极大的波动性、冲动、自助性和不稳定的人际关系，事实证明很难治疗。据报道，临界性患者的自杀率约为10%。BPD的一个核心潜在特征是极度的情绪不稳定，这已被证明与自杀威胁、手势和行为、不适当的愤怒和身份认同障碍有关，事实证明，这些行为对这些患者来说是如此危险和破坏性。尽管情绪不稳定在BPD的病理中起着核心作用，但人们对它的理解还不是很清楚。本研究使用功能磁共振成像(FMRI)来识别大脑情绪处理系统中的障碍，这可能解释BPD患者情绪控制方面的障碍。当BPD患者有意识地试图控制他们对令人不安的图像的情绪反应时，以及当他们系统地重新接触这些图像时，它特别关注BPD患者的区域大脑活动。识别与有意识的情绪控制或反复暴露的习惯性相关的大脑活动模式可以导致开发新的药理学治疗方法，开发新的和更有针对性的认知/行为心理治疗策略，并识别可能指导未来遗传学研究的BPD的脑活动标记物。为了实现这些目标，我们将获得30名BPD患者的fMRI图像，以及30名非边缘型人格障碍患者(即回避性人格障碍患者)和30名健康志愿者的对照组图像。1)当他们努力控制他们对情绪诱导图片的情绪反应时，2)当他们接触到重复呈现相同的图片时。这项研究的结果可能有助于为BPD制定新的治疗策略，BPD是一种疾病，不仅在边缘患者及其亲人经历的痛苦方面具有巨大的情感成本，而且还具有社会成本，因为BPD患者的功能通常远低于具有类似智力的个人，而且他们消耗了不成比例的金属卫生资源。因此，对这种疾病进行更有效的治疗将极大地有利于公众健康。

DESCRIPTION (provided by applicant): Borderline Personality Disorder (BPD) is a prevalent and enduring psychiatric disorder found in approximately 2% of the population and 20% of hospitalized psychiatric patients. It is characterized by great volatility, impulsivity, sucidality, and unstable interpersonal relationships, and has proved difficult to treat. Suicide rates of approximately 10% have been reported in borderline patients. A core underlying feature of BPD is extreme emotional instability and this has been shown to be associated with the suicide threats, gestures and acts, inappropriate anger, and identity disturbances which prove so dangerous and disruptive for these patients. Despite its central role in the pathology of BPD, emotional instability is not well understood. This study employs functional magnetic resonance imaging (fMRI) to identify the disturbances in brain emotion processing systems that may explain the impairments in emtional control in BPD. It looks in particular at regional brain activity when BPD patients are consciously trying to control their emotional reactions to disturbing images and as they are systematically re-exposed to these images. Identification of the patterns of brain activity that are associated with efforts at conscious emotional control or with habituation to repeated exposure can lead to the development of new pharmacological approaches to treatment, to the development of new and more appropriately targeted cognitive/behavoral psychotherapeutic strategies, and the identification of brain activity markers for BPD that may guide future genetic studies. To achieve these objectives, we will obtain fMRI images of 30 BPD patients, and of comparison groups of 30 non-borderline personality disorder patients (i.e. patients with Avoidant Personality Disorder) and 30 healthy volunteers 1) as they make efforts to control their emotional reactions to emotion- inducing pictures and 2) as they are exposed to repeated presentions of the same pictures. The findings of this study may help in the development of new treatment strategies for BPD, a disorder which has not only great emotional costs in terms of the suffering experienced by borderline patients and their loved ones, but also social costs since BPD patients typically function at a level substantially below that of individuals with comparable intellect and they consume a disproportionate share of metal health resources. A more effective treatment for this disorder would thus greatly benefit public health.