Movement Disorders Unit Neurology Department Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain.
Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain.
Brain Imaging Behav. 2021 Oct;15(5):2502-2512. doi: 10.1007/s11682-021-00451-6. Epub 2021 Feb 26.
Although previous imaging studies in borderline personality disorder (BPD) have found brain abnormalities, the results have been inconsistent. This study aimed to investigate structural brain abnormalities using voxel-based morphometry (VBM) and cortical thickness (Cth) analyses in a large sample of patients with BPD. Additionally, we aimed to determine the correlation between structural abnormalities and clinical severity and to assess its potential value at predicting psychotherapeutic response. Sixty-one individuals with BPD and 19 healthy controls underwent magnetic resonance imaging. Participants with BPD completed several self-report clinical scales, received dialectical-behavioral therapy skills training and post-therapy changes in clinical scores were also recorded. Gray matter volume (GMV) and Cth differences between groups were compared. Within the BPD group, we further characterized the structural brain correlates of clinical severity and investigated the relationship between pre-therapy structural abnormalities and therapeutic response. As potential confounders we included age, sex, educational level, and total intracranial volume (the latter only in VBM analyses). Compared to controls, the BPD group showed a reduced GMV/Cth in prefrontal areas but increased GMV in the limbic structures (amygdala and parahippocampal regions). Prefrontal abnormalities correlated with higher baseline scores on impulsivity and general BPD severity. Increased GMV in the parahippocampal area correlated with a greater emotion dysregulation. Importantly, several baseline structural abnormalities correlated with worse response to psychotherapy. Patients with BPD showed a reduced GMV in the prefrontal areas but a greater GMV in the limbic structures. Several structural abnormalities (i.e. middle and inferior prefrontal areas, anterior insula, or parahippocampal area) correlated with clinical severity and could potentially be used as imaging biological correlates biomarkers to predict psychotherapy response.
尽管先前在边缘型人格障碍 (BPD) 的影像学研究中发现了大脑异常，但结果并不一致。本研究旨在使用基于体素的形态测量学 (VBM) 和皮质厚度 (Cth) 分析，在大量 BPD 患者中研究结构性脑异常。此外，我们旨在确定结构异常与临床严重程度的相关性，并评估其在预测心理治疗反应中的潜在价值。61 名 BPD 患者和 19 名健康对照者接受了磁共振成像检查。BPD 患者完成了几项自我报告的临床量表，接受了辩证行为治疗技能培训，并记录了治疗后临床评分的变化。比较了两组之间的灰质体积 (GMV) 和 Cth 差异。在 BPD 组中，我们进一步描述了临床严重程度的结构性脑相关性，并研究了治疗前结构性异常与治疗反应之间的关系。作为潜在的混杂因素，我们纳入了年龄、性别、教育程度和总颅内体积（仅在 VBM 分析中）。与对照组相比，BPD 组在前额区域表现出 GMV/Cth 减少，但边缘结构（杏仁核和海马旁回区域）GMV 增加。前额异常与冲动性和一般 BPD 严重程度的基线评分较高相关。海马旁回区域 GMV 的增加与情绪失调的程度更大相关。重要的是，几个基线结构异常与对心理治疗反应更差相关。BPD 患者在前额区域表现出 GMV 减少，但在边缘结构中 GMV 增加。几个结构异常（即中下部前额区域、前岛叶或海马旁回区域）与临床严重程度相关，可能作为影像学生物标志物用于预测心理治疗反应。
