Oquendo Maria A, Krunic Aleksandra, Parsey Ramin V, Milak Matthew, Malone Kevin M, Anderson Amy, van Heertum Ronald L, John Mann J
Department of Psychiatry, Columbia University, College of Physicians & Surgeons, New York, NY, USA.
Neuropsychopharmacology. 2005 Jun;30(6):1163-72. doi: 10.1038/sj.npp.1300689.
Previous neuroimaging studies of major depression have not controlled for the presence of personality disorders characterized by impulsive aggressive behavior, such as borderline personality disorder (BPD). Using positron emission tomography (PET), we studied regional glucose uptake in response to fenfluramine (FEN) in depressed subjects with BPD (n=11) and depressed patients without Cluster B Axis II disorders (n=8). Subjects were scanned while medication-free after a single blind placebo administration and after FEN on a second day. Brain responses were measured by PET imaging of [18F]fluorodeoxyglucose (FDG) and serial prolactin levels. Scans were compared at a voxel level using statistical parametric mapping. Correlations of changes in relative regional cerebral uptake (rCMRglu) with clinical measures were assessed. Depressed borderline patients had greater relative activity in parietotemporal cortical regions (BA 40, BA 22, and BA 42) before and after FEN activation compared to those without BPD. They also had less relative uptake in the anterior cingulate cortex (BA 32) at baseline compared to depressed patients without BPD and FEN abolished this difference. Impulsivity was positively correlated with rCMRglu in superior and middle frontal cortex (BA 6 and 44). Hostility was positively correlated with rCMRglu in temporal cortical regions (BA 21 and 22). In conclusions, borderline pathology in the context of a Major Depressive Disorder is associated with altered activity in parietotemporal and anterior cingulate cortical regions. Controlling for the presence of BPD in future imaging studies of mood disorders may elucidate similarities and differences in regional serotonergic function in these two often comorbid disorders.
既往对重度抑郁症的神经影像学研究未对以冲动攻击行为为特征的人格障碍（如边缘型人格障碍，BPD）的存在进行控制。我们使用正电子发射断层扫描（PET），研究了伴有BPD的抑郁症患者（n = 11）和无B类轴II障碍的抑郁症患者（n = 8）对芬氟拉明（FEN）的区域葡萄糖摄取情况。在单次盲法安慰剂给药后且未服用药物时以及第二天服用FEN后，对受试者进行扫描。通过[18F]氟脱氧葡萄糖（FDG）的PET成像和连续催乳素水平来测量脑反应。使用统计参数映射在体素水平上比较扫描结果。评估相对区域脑摄取（rCMRglu）变化与临床指标的相关性。与无BPD的患者相比，伴有BPD的抑郁症患者在FEN激活前后，顶颞叶皮质区域（BA 40、BA 22和BA 42）的相对活性更高。与无BPD的抑郁症患者相比，他们在基线时前扣带回皮质（BA 32）的相对摄取也较少，而FEN消除了这种差异。冲动性与额上回和额中回皮质（BA 6和44）的rCMRglu呈正相关。敌意与颞叶皮质区域（BA 21和22）的rCMRglu呈正相关。总之，重度抑郁症背景下的边缘型病理与顶颞叶和前扣带回皮质区域的活动改变有关。在未来情绪障碍的影像学研究中控制BPD的存在，可能会阐明这两种常共病的疾病在区域血清素能功能方面的异同。
