Anxiety Disorders Center, Institute of Living, Hartford, Connecticut.
Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2021 Oct;6(10):1013-1022. doi: 10.1016/j.bpsc.2020.12.014. Epub 2021 Jan 12.
Individuals with hoarding disorder (HD) demonstrate exaggerated subjective distress and hyperactivation of cingulate and insular cortex regions when discarding personal possessions. No prior study has sought to determine whether this subjective distress is associated with specific profiles of abnormal brain function in individuals with HD.
We used multimodal canonical correlation analysis plus joint independent component analysis to test whether five hoarding-relevant domains of subjective distress when deciding to discard possessions (anxiety, sadness, monetary value, importance, and sentimental attachment) are associated with functional magnetic resonance imaging-measured whole-brain functional connectivity in 72 participants with HD and 44 healthy controls.
Three extracted components differed between HD participants and healthy control subjects. Each of these components depicted an abnormal profile of functional connectivity in HD participants relative to control subjects during discarding decisions, and a specific distress response profile. One component pair showed a relationship between anxiety ratings during discarding decisions and connectivity among the pallidum, perirhinal ectorhinal cortex, and dorsolateral prefrontal cortex. Another component comprised sadness ratings during discarding decisions and connectivity in the pallidum, nucleus accumbens, amygdala, and dorsolateral prefrontal cortex. The third component linked HD brain connectivity in several dorsolateral prefrontal cortex regions with perceived importance ratings during discarding decisions.
The findings indicate that in patients with HD, the subjective intensity of anxiety, sadness, and perceived possession importance is related to abnormal functional connectivity in key frontal and emotional processing brain regions. The findings are discussed in terms of emerging neurobiological models of HD.
当丢弃个人物品时，囤积障碍（HD）患者表现出明显的主观痛苦和扣带和岛叶皮层区域的过度兴奋。以前的研究尚未试图确定这种主观痛苦是否与 HD 患者大脑功能异常的特定特征有关。
我们使用多模态典范相关分析加联合独立成分分析，来测试在决定丢弃物品时与五个囤积相关的主观痛苦领域（焦虑、悲伤、货币价值、重要性和情感依恋）相关的功能磁共振成像测量的全脑功能连接，该研究纳入了 72 名 HD 患者和 44 名健康对照者。
HD 患者和健康对照组之间有三个提取的成分不同。这些成分中的每一个都描绘了 HD 患者在丢弃决策过程中相对于对照组的异常功能连接模式，以及特定的痛苦反应模式。一对成分显示，在丢弃决策过程中焦虑评分与苍白球、边缘旁回和背外侧前额叶之间的连接有关。另一成分包括在丢弃决策过程中悲伤评分与苍白球、伏隔核、杏仁核和背外侧前额叶之间的连接。第三个成分将几个背外侧前额叶区域的 HD 大脑连接与在丢弃决策过程中感知到的重要性评分联系起来。
这些发现表明，在 HD 患者中，焦虑、悲伤和感知到的重要性的主观强度与关键的额叶和情绪处理脑区的异常功能连接有关。这些发现是根据新兴的 HD 神经生物学模型进行讨论的。
