Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States.
Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI, United States.
J Affect Disord. 2019 Jun 1;252:253-262. doi: 10.1016/j.jad.2019.04.050. Epub 2019 Apr 8.
Negative affective interference with executive cognition is associated with emotion dysregulation and behavioral dyscontrol in BPD, including a diathesis to suicidal and self-injurious behavior. While clinically well described, the neural basis of affective interference with central executive network function, and resulting suicidal behavior is poorly understood.
In an fMRI study, 23 BPD suicide attempters completed an affectively modified Continuous Performance Task(X-CPT), in which targets and distractors were rendered on Negative, Positive and Neutral Ekman faces, with a Distorted image as a behavioral baseline. Responses to targets were contextualized by the affective context of the face. Lethality Rating Scale scores (LRS) were modeled as the primary regressor of interest on activation peaks, with HamD scores covaried.
In the Negative vs. Neutral contrast, LRS scores were inversely related to activation in the ACC, parietal precuneus, BG and OFC, with no positive relationships. Results were similar in the Negative vs Positive contrast. In the Neutral vs. Positive contrast, activations were much less extensive, with mixed positive and negative relationships. Contextualizing responses based on the effects of valence decreased participant's ability to distinguish between targets and distracters; however, no differences were observed between valence contexts. fMRI-estimated effects were not confounded by differences in behavioral sensitivity across contexts.
In this female-only sample, possible gender differences were not addressed.
With negative affective interference, increased lethality of suicidal behavior in BPD predicted diminished neural activation in areas critical to executive cognitive function. Therapies diminishing affective interference may reduce risk of suicidal behavior.
在 BPD 中，负性情感干扰执行认知与情绪调节和行为失控有关，包括自杀和自残行为的易感性。尽管临床上描述得很好，但情感干扰中央执行网络功能的神经基础以及由此导致的自杀行为仍知之甚少。
在 fMRI 研究中，23 名 BPD 自杀未遂者完成了一项情感修饰的连续性能任务（X-CPT），其中目标和分心物呈现为负面、正面和中性的 Ekman 面孔，以失真图像作为行为基线。目标的反应受面孔情感背景的影响。Lethality Rating Scale 评分（LRS）作为主要回归变量，在激活峰上对 LRS 评分进行建模，同时对 HamD 评分进行协方差分析。
在负性与中性对比中，LRS 评分与 ACC、顶叶楔前叶、BG 和 OFC 的激活呈负相关，没有正相关关系。在负性与正性对比中，结果相似。在中性与正性对比中，激活范围要小得多，存在混合的正相关和负相关关系。基于效价的影响来调整反应会降低参与者区分目标和分心物的能力；然而，在不同的效价环境中没有观察到差异。fMRI 估计的效应不受跨环境行为敏感性差异的影响。
在这个仅由女性组成的样本中，没有探讨可能存在的性别差异。
在 BPD 中，随着负性情感干扰的增加，自杀行为的致死性增加，预测到执行认知功能关键区域的神经激活减少。减少情感干扰的治疗方法可能会降低自杀行为的风险。
