Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Prog Neuropsychopharmacol Biol Psychiatry. 2010 Mar 17;34(2):366-71. doi: 10.1016/j.pnpbp.2009.12.021. Epub 2010 Jan 13.
Cognitive dysfunctions, such as attentional impairment, are central features of both treatment-resistant depression (TRD) and borderline personality disorder (BPD). The treatment failure of TRD due to its comorbidity with BPD is debated in the literature. The mismatch negativity (MMN) of the event-related potentials provides an objective marker of involuntary stimulus selective processing, which might help shed light on this issue and provide an avenue for investigating a possible endophenotypic marker for TRD.
We investigated MMN in 22 patients with TRD, 19 with BPD, and 22 with TRD cormorbid with BPD (TRD+BPD), as well as in 32 healthy volunteers, by employing an acoustic frequency deviance paradigm. In addition, we measured the depressive mood using the Plutchik-van Praag (PVP) depression inventory.
There was no significant between-group difference for the N1 latencies/amplitudes, both to the standard and deviant stimuli, and no significant between-group difference for MMN latencies. However, MMN amplitudes were higher in the TRD group than those in the other three groups. PVP scores were highest in TRD+BPD, then TRD, BPD patients, and lowest in healthy subjects. The higher MMN was not correlated with PVP score, nor with the duration of life-long depression, which can be considered as a neurophysiological marker for TRD.
An atypical lack of inhibition on the irrelevant stimuli or increased cortical neuronal activity, especially frontal area, or both, might be responsible for the finding.
认知功能障碍，如注意力损害，是治疗抵抗性抑郁症（TRD）和边缘型人格障碍（BPD）的核心特征。TRD 合并 BPD 导致治疗失败在文献中存在争议。事件相关电位的失匹配负波（MMN）提供了一种对非自愿刺激选择性处理的客观标记，这可能有助于阐明这个问题，并为研究 TRD 的可能表型标记提供途径。
我们通过声学频率偏差范式，对 22 例 TRD 患者、19 例 BPD 患者、22 例 TRD 合并 BPD（TRD+BPD）患者以及 32 例健康志愿者进行了 MMN 研究。此外，我们使用 Plutchik-van Praag（PVP）抑郁量表测量了抑郁情绪。
各组间 N1 潜伏期/振幅，无论是对标准刺激还是偏差刺激，均无显著差异，MMN 潜伏期也无显著差异。然而，TRD 组的 MMN 振幅高于其他三组。TRD+BPD 组的 PVP 评分最高，其次是 TRD 组、BPD 患者，健康受试者的评分最低。较高的 MMN 与 PVP 评分无关，也与终生抑郁的持续时间无关，这可以被认为是 TRD 的神经生理标记。
可能是对无关刺激的抑制缺乏或皮质神经元活动增加，尤其是额叶区域，或两者兼而有之，导致了这一发现。
