Coccaro Emil F, Fitzgerald Daniel A, Lee Royce, McCloskey Michael, Phan K Luan
Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, Pritzker School of Medicine, The University of Chicago.
Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL; Mental Health Service Line, Jesse Brown Veterans Administration Medical Center, Chicago, Illinois.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2016 Jan;1(1):32-38. doi: 10.1016/j.bpsc.2015.09.006. Epub 2015 Oct 14.
Converging evidence from neuroimaging studies suggests that impulsive aggression, the core behavior in the DSM-5 diagnosis intermittent explosive disorder (IED), is regulated by frontolimbic brain structures, particularly orbitofrontal cortex, ventral medial prefrontal cortex, anterior cingulate cortex, amygdala, insula, and uncus. Despite this evidence, no brain volumetric studies of IED have been reported as yet. This study was conducted to test the hypothesis that gray matter volume in frontolimbic brain structures of subjects with IED is lower than in healthy subjects and subjects with other psychiatric conditions.
High-resolution magnetic resonance imaging scans using a three-dimensional magnetization-prepared rapid acquisition gradient-echo sequence were performed in 168 subjects (n = 53 healthy control subjects, n = 58 psychiatric controls, n = 57 subjects with IED). Imaging data were analyzed by voxel-based morphometry methods employing Statistical Parametric Mapping (SPM8) software.
Gray matter volume was found to be significantly lower in subjects with IED compared with healthy control subjects and psychiatric controls in orbitofrontal cortex, ventral medial prefrontal cortex, anterior cingulate cortex, amygdala, insula, and uncus. These differences were not due to various confounding factors or to comorbidity with other disorders previously reported to have reduced gray matter volume. Gray matter volume in these areas was significantly and inversely correlated with measures of aggression.
Reductions in the gray matter volume of frontolimbic structures may be a neuronal characteristic of impulsively aggressive individuals with DSM-5 IED. These data suggest an anatomic correlate accounting for functional deficits in social-emotional information processing in these individuals.
神经影像学研究的证据表明，冲动性攻击行为是《精神疾病诊断与统计手册》第五版（DSM-5）中间歇性爆发障碍（IED）的核心行为，受额叶边缘脑区结构调节，特别是眶额皮质、腹内侧前额叶皮质、前扣带回皮质、杏仁核、脑岛和钩回。尽管有这些证据，但尚未有关于IED的脑容量研究报告。本研究旨在检验以下假设：IED患者额叶边缘脑区结构的灰质体积低于健康受试者和患有其他精神疾病的受试者。
对168名受试者（n = 53名健康对照者，n = 58名精神疾病对照者，n = 57名IED患者）进行了高分辨率磁共振成像扫描，使用三维磁化准备快速采集梯度回波序列。成像数据采用基于体素的形态计量学方法，使用统计参数映射（SPM8）软件进行分析。
与健康对照者和精神疾病对照者相比，IED患者在眶额皮质、腹内侧前额叶皮质、前扣带回皮质、杏仁核、脑岛和钩回的灰质体积显著降低。这些差异并非由各种混杂因素或先前报道的灰质体积减少的其他疾病合并症所致。这些区域的灰质体积与攻击行为测量指标显著负相关。
额叶边缘结构灰质体积减少可能是DSM-5 IED冲动性攻击个体的神经特征。这些数据表明了解剖学关联，解释了这些个体在社会情感信息处理方面的功能缺陷。
