Center for Psychosocial Medicine, Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany.
Department of Psychiatry, Psychotherapy and Psychosomatics, Saarland University, Homburg, Germany.
J Affect Disord. 2015 Mar 15;174:650-7. doi: 10.1016/j.jad.2014.11.059. Epub 2014 Dec 9.
Abnormal brain volume has been frequently demonstrated in major depressive disorder (MDD). It is unclear if these findings are specific for MDD since aberrant brain structure is also present in disorders with depressive comorbidity and affective dysregulation, such as borderline personality disorder (BPD). In this transdiagnostic study, we aimed to investigate if regional brain volume loss differentiates between MDD and BPD. Further, we tested for associations between brain volume and clinical variables within and between diagnostic groups.
22 Females with a DSM-IV diagnosis of MDD, 17 females with a DSM-IV diagnosis of BPD and without comorbid posttraumatic stress disorder, and 22 age-matched female healthy controls (HC) were investigated using magnetic resonance imaging. High-resolution structural data were analyzed using voxel-based morphometry.
A significant (p<0.05, cluster-corrected) volume decrease of the anterior cingulate cortex (ACC) was found in MDD compared to HC, as opposed to volume decreases of the amygdala in BPD compared to both HC and MDD. Sensitivity and specificity of regional gray matter volume for a diagnosis of MDD were modest to fair. Amygdala volume was related to depressive symptoms across the entire patient sample.
Potential limitations of this study include the modest sample size and the heterogeneous psychotropic drug treatment.
ACC volume reduction is more pronounced in MDD with an intermediate degree of volume loss in BPD compared to HC. In contrast, amygdala volume loss is more pronounced in BPD compared to MDD, yet amygdala volume is associated with affective symptom expression in both disorders.
在重度抑郁症（MDD）中经常发现异常的脑容量。这些发现是否特定于 MDD 尚不清楚，因为在伴有抑郁共病和情感失调的疾病中，如边缘性人格障碍（BPD），也存在异常的大脑结构。在这项跨诊断研究中，我们旨在研究区域性脑容量减少是否区分 MDD 和 BPD。此外，我们测试了脑容量与诊断组内和组间临床变量之间的关联。
22 名女性符合 DSM-IV 诊断为 MDD，17 名女性符合 DSM-IV 诊断为 BPD 且无并发创伤后应激障碍，以及 22 名年龄匹配的女性健康对照组（HC）接受了磁共振成像检查。使用基于体素的形态计量学分析高分辨率结构数据。
与 HC 相比，MDD 中前扣带皮层（ACC）的体积显著（p<0.05，簇校正）减少，而 BPD 中杏仁核的体积减少则与 HC 和 MDD 相比。区域灰质体积对 MDD 诊断的敏感性和特异性为中等至良好。杏仁核体积与整个患者样本的抑郁症状有关。
这项研究的潜在局限性包括样本量适中且精神药物治疗存在异质性。
与 HC 相比，MDD 中的 ACC 体积减少更为明显，BPD 中的体积减少程度中等。相比之下，BPD 中杏仁核体积减少更为明显，而在两种疾病中，杏仁核体积与情感症状的表达有关。
