Minzenberg Michael J, Fan Jin, New Antonia S, Tang Cheuk Y, Siever Larry J
Psychiatry, Mount Sinai School of Medicine, New York, NY, USA.
Psychiatry Res. 2007 Aug 15;155(3):231-43. doi: 10.1016/j.pscychresns.2007.03.006. Epub 2007 Jul 2.
Clinical hallmarks of borderline personality disorder (BPD) include social and emotional dysregulation. We tested a model of fronto-limbic dysfunction in facial emotion processing in BPD. Groups of 12 unmedicated adults with BPD by DSM-IV and 12 demographically-matched healthy controls (HC) viewed facial expressions (Conditions) of neutral emotion, fear and anger, and made gender discriminations during rapid event-related functional magnetic resonance imaging (fMRI). Analysis of variance of Region of Interest signal change revealed a statistically significant effect of the Group-by-Region-by-Condition interaction. This was due to the BPD group exhibiting a significantly larger magnitude of deactivation (relative to HC) in the bilateral rostral/subgenual anterior cingulate cortex (ACC) to fear and in the left ACC to fear minus neutral; and significantly greater activation in the right amygdala to fear minus neutral. There were no significant between-group differences in ROI signal change in response to anger. In voxel-wise analyses constrained within these ROIs, the BPD group exhibited significant changes in the fear minus neutral contrast, with relatively less activation in the bilateral rostral/subgenual ACC, and greater activation in the right amygdala. In the anger minus neutral contrast this pattern was reversed, with the BPD group showing greater activation in the bilateral rostral/subgenual ACC and less activation in the bilateral amygdala. We conclude that adults with BPD exhibit changes in fronto-limbic activity in the processing of fear stimuli, with exaggerated amygdala response and impaired emotion-modulation of ACC activity. The neural substrates underlying processing of anger may also be altered. These changes may represent an expression of the volumetric and serotonergic deficits observed in these brain areas in BPD.
边缘型人格障碍（BPD）的临床特征包括社交和情绪调节障碍。我们测试了一个关于BPD患者面部情绪加工中前额叶-边缘系统功能障碍的模型。12名符合《精神疾病诊断与统计手册》第四版（DSM-IV）标准的未服药成年BPD患者和12名人口统计学匹配的健康对照者（HC）在快速事件相关功能磁共振成像（fMRI）过程中观看中性情绪、恐惧和愤怒的面部表情（条件），并进行性别辨别。感兴趣区域信号变化的方差分析显示，组×区域×条件交互作用具有统计学意义。这是因为BPD组在双侧喙部/膝下前扣带回皮质（ACC）对恐惧刺激的失活程度（相对于HC）显著更大，在左侧ACC对恐惧减去中性刺激的失活程度也显著更大；在右侧杏仁核对恐惧减去中性刺激的激活程度显著更高。对愤怒刺激的反应中，两组在感兴趣区域信号变化上没有显著差异。在这些感兴趣区域内进行的体素水平分析中，BPD组在恐惧减去中性刺激的对比中表现出显著变化，双侧喙部/膝下ACC的激活相对较少，而右侧杏仁核的激活较多。在愤怒减去中性刺激的对比中，这种模式相反，BPD组在双侧喙部/膝下ACC的激活较多，而双侧杏仁核的激活较少。我们得出结论，成年BPD患者在恐惧刺激加工过程中前额叶-边缘系统活动发生变化，杏仁核反应过度，ACC活动的情绪调节受损。愤怒加工的神经基础也可能发生改变。这些变化可能代表了BPD患者这些脑区中观察到的体积和血清素能缺陷的一种表现。
