Büetiger Jessica R, Hubl Daniela, Kupferschmid Stephan, Schultze-Lutter Frauke, Schimmelmann Benno G, Federspiel Andrea, Hauf Martinus, Walther Sebastian, Kaess Michael, Michel Chantal, Kindler Jochen
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Front Psychiatry. 2020 Sep 11;11:535652. doi: 10.3389/fpsyt.2020.535652. eCollection 2020.
Depersonalization (DP) and derealization (DR) are symptoms of a disruption of perceptual integration leading to an altered quality of subjective experiences such as feelings of unreality and detachment from the self (DP) or the surroundings (DR). Both DP and DR often occur in concert with other symptoms, for example in subjects at clinical high-risk (CHR) for psychosis, but also appear isolated in the form of DP/DR disorder. Despite evidence that DP/DR causes immense distress, little is known about their neurobiological underpinnings. Therefore, we investigated the neural correlates of DP/DR using pseudo-continuous arterial spin labeling MRI.
We evaluated the frequency of DP/DR symptoms in a clinical sample (N = 217) of help-seeking individuals from the Early Detection and Intervention Centre for Mental Crisis (CHR, n = 97; clinical controls (CC), n = 91; and first-episode psychosis (FEP), n = 29). Further, in a subsample of those CHR subjects who underwent MRI, we investigated the resting-state regional cerebral blood flow (rCBF). Here, individuals with (n = 21) and without (n = 23) DP/DR were contrasted. Finally, rCBF was measured in a small independent second sample of patients with DP/DR disorder (n = 6) and healthy controls (HC, n = 6).
In the complete clinical sample, significantly higher frequency of DP/DR was found in CHR compared to CC (50.5 16.5%; χ = 24.218, p ≤ 0.001, Cramer's V = 0.359) as well as in FEP compared to CC (37.9 16.5%; χ = 5.960, = 0.015, Cramer's V = 0.223). In MRI, significantly lower rCBF was detected in the left orbitofrontal cortex in CHR with without DP/DR (x/y/z = -16/42/-22, p < 0.05, FWE corrected). In patients with DP/DR disorder, significantly higher rCBF was detected in the left caudate nucleus (x/y/z = -18/-32/18, p < 0.05) compared to HC.
This study shows that DP/DR symptoms are frequently found in CHR subjects. Investigating two separate DP/DR populations with an identical neuroimaging technique, our study also indicates that there may be divergent pathophysiological mechanisms-decreased neuronal activity in the orbitofrontal cortex, but increased activity within the caudate nucleus-leading to a final common pathway with similar psychopathological symptoms. This suggests that both top-down (orbitofrontal cortex) and bottom-up (caudate nucleus) mechanisms could contribute to the emergence of DP/DR.
人格解体（DP）和现实解体（DR）是感知整合中断的症状，会导致主观体验质量改变，如现实感缺失以及自我（DP）或周围环境（DR）的脱离感。DP和DR常与其他症状同时出现，例如在临床高危（CHR）精神病患者中，但也以DP/DR障碍的形式单独出现。尽管有证据表明DP/DR会造成巨大痛苦，但其神经生物学基础却知之甚少。因此，我们使用伪连续动脉自旋标记MRI研究了DP/DR的神经关联。
我们评估了来自精神危机早期检测与干预中心的求助个体临床样本（N = 217）中DP/DR症状的频率（CHR，n = 97；临床对照（CC），n = 91；首发精神病（FEP），n = 29）。此外，在接受MRI检查的CHR受试者子样本中，我们研究了静息态局部脑血流量（rCBF）。在此，对有（n = 21）和无（n = 23）DP/DR的个体进行了对比。最后，在一个独立的小样本DP/DR障碍患者（n = 6）和健康对照（HC，n = 6）中测量了rCBF。
在整个临床样本中，CHR组的DP/DR频率显著高于CC组（50.5±16.5%；χ² = 24.218，p≤0.001，克莱默V = 0.359），FEP组的DP/DR频率也显著高于CC组（37.9±16.5%；χ² = 5.960，p = 0.015，克莱默V = 0.223）。在MRI检查中，CHR组有或无DP/DR的个体，左侧眶额皮质的rCBF均显著降低（x/y/z = -16/42/-22，p < 0.05，FWE校正）。与HC相比，DP/DR障碍患者左侧尾状核的rCBF显著升高（x/y/z = -18/-32/18，p < 0.05）。
本研究表明，CHR受试者中经常出现DP/DR症状。我们的研究使用相同的神经成像技术对两个独立的DP/DR群体进行了研究，结果还表明，可能存在不同的病理生理机制——眶额皮质神经元活动减少，但尾状核内活动增加——导致最终出现具有相似精神病理症状的共同通路。这表明自上而下（眶额皮质）和自下而上（尾状核）机制都可能导致DP/DR的出现。
