Koenig Julian, Kemp Andrew H, Feeling Nicole R, Thayer Julian F, Kaess Michael
Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; The Ohio State University, Department of Psychology, Columbus, OH, USA.
University Hospital and Faculty of Medicine, University of São Paulo, São Paulo, Brazil; School of Psychology & Discipline of Psychiatry, University of Sydney, Sydney, Australia.
Prog Neuropsychopharmacol Biol Psychiatry. 2016 Jan 4;64:18-26. doi: 10.1016/j.pnpbp.2015.07.002. Epub 2015 Jul 11.
Borderline personality disorder (BPD) is the most common personality disorder in clinical settings. It is characterized by negative affectivity, emotional liability, anxiety, depression, as well as disinhibition (i.e., impulsivity and risk taking), all of which have been linked to lower resting state vagal tone, which may be indexed by vagally-mediated heart rate variability (vmHRV). Here, we aimed to quantify the current evidence on alterations in resting state vmHRV in individuals with BPD, relative to healthy controls. A rigorous search of the literature, according to the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses", revealed 5 studies suitable for meta-analysis, reporting vmHRV in individuals with BPD (n=95), relative to healthy controls (n=105). Short-term measures of resting state vmHRV were extracted and subjected to meta-analysis using both random- and fixed effect models in RevMan. BPD displayed lower resting state vmHRV relative to healthy controls in random- (Hedges' g=-0.59, 95% CI [-1.11; -0.06], k=5) and fixed-effect meta-analysis (Hedges' g=-0.56, 95% CI [-0.86; -0.27], k=5). Control for potential publication bias did not change observed findings. Lowered resting state vagal tone may be an important trait characteristic underlying BPD. As prior studies have observed lowered vmHRV in a variety of psychiatric disorders, we propose that lowered vmHRV may reflect a common psychophysiological mechanism underlying difficulties in emotion regulation and impulsivity, in particular.
边缘性人格障碍(BPD)是临床环境中最常见的人格障碍。其特征包括消极情感、情绪易感性、焦虑、抑郁以及行为抑制(即冲动性和冒险行为),所有这些都与较低的静息状态迷走神经张力有关,而迷走神经介导的心率变异性(vmHRV)可能是其指标。在此,我们旨在量化目前关于BPD患者静息状态vmHRV改变的证据,并与健康对照进行比较。根据“系统评价和Meta分析的首选报告项目”对文献进行严格检索,发现5项适合进行Meta分析的研究,报告了BPD患者(n = 95)相对于健康对照(n = 105)的vmHRV。提取静息状态vmHRV的短期测量值,并使用RevMan中的随机效应模型和固定效应模型进行Meta分析。在随机效应Meta分析(Hedges' g = -0.59,95% CI [-1.11; -0.06],k = 5)和固定效应Meta分析(Hedges' g = -0.56,95% CI [-0.86; -0.27],k = 5)中,BPD患者的静息状态vmHRV相对于健康对照较低。对潜在发表偏倚的控制并未改变观察结果。静息状态迷走神经张力降低可能是BPD潜在的重要特征。由于先前的研究在多种精神疾病中都观察到vmHRV降低,我们提出vmHRV降低可能反映了情绪调节和冲动性困难背后的一种常见心理生理机制。
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