Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospital, University of Geneva, Geneva, Switzerland.
Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Prilly-Lausanne, Switzerland.
Neurosci Biobehav Rev. 2021 Aug;127:184-192. doi: 10.1016/j.neubiorev.2021.04.017. Epub 2021 Apr 27.
Bipolar disorder (BD) and borderline personality disorder (BPD) are serious and prevalent psychiatric diseases that share common phenomenological characteristics: symptoms (such as anxiety, affective lability or emotion dysregulation), neuroimaging features, risk factors and comorbidities. While several studies have focused on the link between stress and peripheral inflammation in other affective disorders such as anxiety or depression, fewer have explored this relationship in BD and BPD. This review reports on evidence showing an interplay between immune dysregulation, anxiety and stress, and how an altered acute neuroendocrine stress response may exist in these disorders. Moreover, we highlight limitations and confounding factors of these existing studies and discuss multidirectional hypotheses that either suggest inflammation or stress and anxiety as the primum movens in BD and BPD pathophysiology, or inflammation as a consequence of the pathophysiology of these diseases. Untangling these associations and implementing a transdiagnostic approach will have diagnostic, therapeutic and prognostic implications for BD and BPD patients.
双相情感障碍（BD）和边缘型人格障碍（BPD）是严重且常见的精神疾病，它们具有共同的现象学特征：症状（如焦虑、情感不稳定或情绪调节障碍）、神经影像学特征、风险因素和共病。虽然有几项研究集中在其他情感障碍（如焦虑或抑郁）中应激和外周炎症之间的联系，但在 BD 和 BPD 中探索这种关系的研究较少。本综述报告了免疫失调、焦虑和应激之间相互作用的证据，以及这些疾病中是否存在急性神经内分泌应激反应改变的证据。此外，我们强调了这些现有研究的局限性和混杂因素，并讨论了多向假说，这些假说要么认为炎症或应激和焦虑是 BD 和 BPD 病理生理学的最初原因，要么认为炎症是这些疾病病理生理学的结果。理清这些关联并实施跨诊断方法将对 BD 和 BPD 患者具有诊断、治疗和预后意义。
