Neuroimaging and personality disorders

Avoidant Personality Disorder Symptoms and Cardiovascular Reactivity to Psychological Stress Tasks With Increasing Cognitive Demands

Abstract. This study aimed to investigate whether and how avoidant personality disorder symptoms are related to cardiovascular reactivity to stress tasks with different levels of cognitive demands. The revised Chinese edition of the avoidant personality disorder subscale of Personality Diagnosed Questionnaire-4+ (PDQ-4+) was administered to 222 undergraduate students randomly assigned to psychological stress tasks (i.e., mental arithmetic tasks) with low, moderate, or high cognitive demands (manipulated by task difficulty), during which their physiological data were continuously collected. Results showed that avoidant personality disorder symptoms and cognitive demands of tasks interactively predicted systolic blood pressure (SBP) and diastolic blood pressure (DBP) reactivity. In specific, avoidant personality disorder symptoms were not associated with SBP reactivity under the low- and moderate-demand conditions and DBP reactivity under the low-demand condition but were associated with blunted SBP reactivity under the high-demand condition and blunted DBP reactivity under the moderate- and high-demand conditions. These findings indicate that the association between avoidant personality disorder symptoms and cardiovascular reactivity to psychological stress is contingent on the cognitive demands of tasks, which have potential implications for physical health.

Neural Correlates of Schizotypal Personality Disorder: a Systematic Review of Neuroimaging and EEG Studies

BACKGROUND

Schizotypal personality disorder (SPD) is a cluster A personality disorder affecting 1.0% of general population, characterised by disturbances in cognition and reality testing dimensions, affect regulation, and interpersonal function. SPD shares similar but attenuated phenomenological, genetic, and neurobiological abnormalities with schizophrenia (SCZ) and is described as part of schizophrenia spectrum disorders.

OBJECTIVE

Aim of this work was to identify the major neural correlates of SPD.

METHODS

This is a systematic review conducted according to PRISMA statement. The protocol was prospectively registered in PROSPERO - International prospective register of systematic reviews. The review was performed to summarise the most comprehensive and updated evidence on functional neuroimaging and neurophysiology findings obtained through different techniques (DW-MRI, DTI, PET, SPECT, fMRI, MRS, EEG) in individuals with SPD.

RESULTS

Of the 52 studies included in this review, 9 were on DW-MRI and DTI, 11 were on PET and SPECT, 11 were on fMRI and MRS, and 21 were on EEG. It was complex to synthesise all the functional abnormalities found into a single, unified, pathogenetic pathway, but a common theme emerged: the dysfunction of brain circuits including striatal, frontal, temporal, limbic regions (and their networks) together with a dysregulation along the dopaminergic pathways.

CONCLUSION

Brain abnormalities in SPD are similar, but less marked, than those found in SCZ. Furthermore, different patterns of functional abnormalities in SPD and SCZ have been found, confirming the previous literature on the 'presence' of possible compensatory factors, protecting individuals with SPD from frank psychosis and providing diagnostic specificity.

Individual differences in neuroticism personality trait in emotion regulation

BACKGROUND

Higher neuroticism personality trait individuals have more negative mood states, more sensitive to negative information, and higher risk of mental illness. Good emotion regulation ability play an important role in healthy psychological, social and physical outcomes. Previous studies have suggested that higher neuroticism individuals have a diminished ability to regulate emotion regulation. Up to now, few studies investigate the neural basis between neuroticism and emotion regulation.

METHOD

In present study, we want to explore the neuroticism and the activity of some brain regions and functional amygdala connectivity (psycho-physiological interaction [PPI]) in a cognitive reappraisal task. Thus, 160 healthy young participants were scanned during a cognitive reappraisal task.

RESULTS

The results revealed that neuroticism scores showed a significant negative association with the activity of the dorsomedial prefrontal cortex (dmPFC), inferior frontal cortex and middle frontal cortex in regulation of negative emotion. PPI analyses revealed that neuroticism scores were negatively associated with amygdala-dmPFC connectivity in regulation of negative emotion.

LIMITATION

Only cognitive reappraisal were investigated in this study. Other emotion regulation strategies such as expressive suppression need to be explored in the future study.

CONCLUSION

These results may suggest that highly neurotic participants display diminished cognitive reappraisal and diminished control function of the dmPFC over the amygdala in regulation of negative emotion.

Impulsivities and addictions: a multidimensional integrative framework informing assessment and interventions for substance use disorders

Impulse control is becoming a critical survival skill for the twenty-first century. Impulsivity is implicated in virtually all externalizing behaviours and disorders, and figures prominently in the aetiology and long-term sequelae of substance use disorders (SUDs). Despite its robust clinical and predictive validity, the study of impulsivity is complicated by its multidimensional nature, characterized by a variety of trait-like personality dimensions, as well as by more state-dependent neurocognitive dimensions, with variable convergence across measures. This review provides a hierarchical framework for linking self-report and neurocognitive measures to latent constructs of impulsivity and, in turn, to different psychopathology vulnerabilities, including substance-specific addictions and comorbidities. Impulsivity dimensions are presented as novel behavioural targets for prevention and intervention. Novel treatment approaches addressing domains of impulsivity are reviewed and recommendations for future directions in research and clinical interventions for SUDs are offered. This article is part of the theme issue 'Risk taking and impulsive behaviour: fundamental discoveries, theoretical perspectives and clinical implications'.

Personality disorder: a disease in disguise

Personality disorders (PDs) can be described as the manifestation of extreme personality traits that interfere with everyday life and contribute to significant suffering, functional limitations, or both. They are common and are frequently encountered in virtually all forms of health care. PDs are associated with an inferior quality of life (QoL), poor health, and premature mortality. The aetiology of PDs is complex and is influenced by genetic and environmental factors. The clinical expression varies between different PD types; the most common and core aspect is related to an inability to build and maintain healthy interpersonal relationships. This aspect has a negative impact on the interaction between health-care professionals and patients with a PD. From being discrete and categorical disease entities in previous classification systems, the current concept of PD, reflected in the newly proposed ICD-11, is a dimensional description based on the severity of the disturbed functioning rather than on the type of clinical presentation. Insight about the characteristics of PDs among medical practitioners is limited, which is partly because persons do not seek health care for their PD, but instead for other medical issues which are obscured by their underlying personality problems. What needs to be emphasized is that PDs affect both the clinical presentation of other medical problems, and the outcome of these, in a negative manner and that the integrated effects of having a PD are a shortened life expectancy. Accordingly, PDs need to be recognized in clinical practice to a greater extent than previously.

Amygdala hyperactivation to angry faces in intermittent explosive disorder

BACKGROUND

Individuals with intermittent explosive disorder (IED) were previously found to exhibit amygdala hyperactivation and relatively reduced orbital medial prefrontal cortex (OMPFC) activation to angry faces while performing an implicit emotion information processing task during functional magnetic resonance imaging (fMRI). This study examines the neural substrates associated with explicit encoding of facial emotions among individuals with IED.

METHOD

Twenty unmedicated IED subjects and twenty healthy, matched comparison subjects (HC) underwent fMRI while viewing blocks of angry, happy, and neutral faces and identifying the emotional valence of each face (positive, negative or neutral). We compared amygdala and OMPFC reactivity to faces between IED and HC subjects. We also examined the relationship between amygdala/OMPFC activation and aggression severity.

RESULTS

Compared to controls, the IED group exhibited greater amygdala response to angry (vs. neutral) facial expressions. In contrast, IED and control groups did not differ in OMPFC activation to angry faces. Across subjects amygdala activation to angry faces was correlated with number of prior aggressive acts.

CONCLUSIONS

These findings extend previous evidence of amygdala dysfunction in response to the identification of an ecologically-valid social threat signal (processing angry faces) among individuals with IED, further substantiating a link between amygdala hyperactivity to social signals of direct threat and aggression.

Individual Differences in Personality Traits

Abstract. During the last decade, an increasing number of studies have used neuroscientific methods to examine the relationships between different personality traits and brain structures. This includes the Magnetic Resonance Imaging (MRI)-based analysis of correlations between individual differences in personality traits and the structural variance of specific brain regions. Perfectionism is a personality trait that remains relatively stable over time, and it is influenced by heredity. In this study, the possible brain regions that structurally correlated with both positive and negative perfectionism were investigated. Voxel-based morphometry was used to analyze the whole brain MRI images of 49 participants, and their levels of perfectionism were also evaluated using a standard scale. The statistical analysis revealed significant correlations between negative perfectionism and the gray matter volume of the thalamus and left posterior parietal cortex (precuneus) structures. This finding suggests that differences in perfectionism between individuals may reflect structural variances in these regions of the brain.

Test-retest reliability of amygdala response to emotional faces

In the current study, we evaluated the test-retest reliability of amygdala response using an emotional face-matching task that has been widely used to examine pathophysiology and treatment mechanisms in psychiatric populations. Activation within the fusiform face area (FFA) was also examined. Twenty-seven healthy volunteers completed a variation of the face-matching paradigm developed by Hariri et al. (2000) at two time points approximately 90 days apart. Estimates of test-retest reliability of amygdala response to fearful faces were moderate, whereas angry and happy faces showed poor reliability. Test-retest reliability of the FFA was moderate to strong, regardless of facial affect. Collectively, these findings indicate that the reliability of the BOLD MR signal in the amygdala varies substantially by facial affect. Efforts to improve measurement precision, enlarge sample sizes, or increase the number of assessment occasions seem warranted.

Childhood abuse is associated with structural impairment in the ventrolateral prefrontal cortex and aggressiveness in patients with borderline personality disorder

Volume reduction and functional impairment in areas of the prefrontal cortex (PFC) have been found in borderline personality disorder (BPD), particularly in patients with a history of childhood abuse. These abnormalities may contribute to the expression of emotion dysregulation and aggressiveness. In this study we investigated whether the volume of the PFC is reduced in BPD patients and whether a history of childhood abuse would be associated with greater PFC structural changes. Structural MRI data were obtained from 18 BPD patients and 19 healthy individuals matched for age, sex, handedness, and education and were analyzed using voxel based morphometry. The Child Abuse Scale was used to elicit a past history of abuse; aggression was evaluated using the Buss-Durkee Hostility Inventory (BDHI). The volume of the right ventrolateral PFC (VLPFC) was significantly reduced in BPD subjects with a history of childhood abuse compared to those without this risk factor. Additionally, right VLPFC gray matter volume significantly correlated with the BDHI total score and with BDHI irritability and negativism subscale scores in patients with a history of childhood abuse. Our results suggest that a history of childhood abuse may lead to increased aggression mediated by an impairment of the right VLPFC.

Neural correlates of negative emotionality in borderline personality disorder: an activation-likelihood-estimation meta-analysis

BACKGROUND

Emotional vulnerabilities at the core of borderline personality disorder (BPD) involve a dysfunction of frontolimbic systems subserving negative emotionality. The specific regions identified in individual studies, however, vary widely and provide an incomplete understanding of the functional brain abnormalities that characterize this illness. A quantitative synthesis of functional neuroimaging studies might clarify the neural systems dysfunctions that underlie negative emotionality in BPD.

METHODS

An electronic search of Medline and PsycInfo databases from 2000 to 2012 identified 18 potential studies, of which 11 met inclusion criteria for the meta-analysis and comprised a pooled sample of 154 BPD patients and 150 healthy control subjects. Contrasts of negative versus neutral emotion conditions were analyzed with an activation-likelihood-estimation meta-analytic approach. Group comparisons were performed on study-reported between-subjects contrasts and independent subtraction analyses based on within-subjects contrasts.

RESULTS

Healthy control subjects activated a well-characterized network of brain regions associated with processing negative emotions that included the anterior cingulate cortex and amygdala. Compared with healthy control subjects, BPD patients demonstrated greater activation within the insula and posterior cingulate cortex. Conversely, they showed less activation than control subjects in a network of regions that extended from the amygdala to the subgenual anterior cingulate and dorsolateral prefrontal cortex.

CONCLUSIONS

Processing of negative emotions in BPD might be subserved by an abnormal reciprocal relationship between limbic structures representing the degree of subjectively experienced negative emotion and anterior brain regions that support the regulation of emotion. Contrary to early studies, BPD patients showed less activation than control subjects in the amygdala under conditions of negative emotionality.

Differential diagnosis of bipolar affective disorder type II and borderline personality disorder: analysis of the affective dimension

BACKGROUND

Differential diagnosis between bipolar affective disorder type II and borderline personality disorder can be problematic yet a priority for effective treatment planning. Diagnosis is problematic when symptoms do not present enough intensity or duration to clear the issue but also when there is a relative overlap of criteria between both disorders. If for many patients, the diagnosis is more easily differentiated, confounding conditions are found in 20% of cases for which it becomes a significant issue.

METHOD

A research with the key words affective instability, borderline personality disorder, and bipolar disorder on Medline and Psych-Info was done. Other references were found through this review in related articles. Comparison of data about the affective dimensions concerning bipolar disorder and borderline personality disorder was noted.

RESULTS

Affective instability is a confounding factor: quality and intensity of affects, speed of fluctuations, affective response to social stress, and its modulation are core elements of affective instability that need to be analyzed to clarify a proper diagnosis.

LIMITATIONS

There is further necessity for research about affective instability in the 2 diagnoses.

CONCLUSIONS

Making a valid differential diagnosis has an important clinical value in order for the clinician to plan proper treatment. Analysis of the affective experience and its qualitative and quantitative facets can help establish it.

Corticolimbic function in impulsive aggressive behavior

Building on animal and human lesion evidence, neuroimaging studies are increasingly identifying abnormalities in corticolimbic circuits mediating aggressive behavior. This review focuses on three neural systems involved in impulsive/reactive aggression: 1) subcortical neural systems that support the production of aggressive impulses; 2) decision-making circuits and social-emotional information processing circuits that evaluate the consequences of aggressing or not aggressing; and 3) frontoparietal regions that are involved in regulating emotions and impulsive motivational urges. We review psychiatric disorders, including borderline personality disorder and antisocial personality disorder, characterized by elevated reactive aggression, focusing on abnormalities in these three neural systems.

Neuroanatomical profiles of personality change in frontotemporal lobar degeneration

BACKGROUND

The neurobiological basis of personality is poorly understood. Frontotemporal lobar degeneration (FTLD) frequently presents with complex behavioural changes, and therefore potentially provides a disease model in which to investigate brain substrates of personality.

AIMS

To assess neuroanatomical correlates of personality change in a cohort of individuals with FTLD using voxel-based morphometry (VBM).

METHOD

Thirty consecutive individuals fulfilling consensus criteria for FTLD were assessed. Each participant's carer completed a Big Five Inventory (BFI) questionnaire on five key personality traits; for each trait, a change score was derived based on current compared with estimated premorbid characteristics. All participants underwent volumetric brain magnetic resonance imaging. A VBM analysis was implemented regressing change score for each trait against regional grey matter volume across the FTLD group.

RESULTS

The FTLD group showed a significant decline in extraversion, agreeableness, conscientiousness and openness and an increase in neuroticism. Change in particular personality traits was associated with overlapping profiles of grey matter loss in more anterior cortical areas and relative preservation of grey matter in more posterior areas; the most robust neuroanatomical correlate was identified for reduced conscientiousness in the region of the posterior superior temporal gyrus.

CONCLUSIONS

Quantitative measures of personality change in FTLD can be correlated with changes in regional grey matter. The neuroanatomical profiles for particular personality traits overlap brain circuits previously implicated in aspects of social cognition and suggest that dysfunction at the level of distributed cortical networks underpins personality change in FTLD.

Endophenotypes and the diagnosis of personality disorders

It has been suggested that psychiatric diagnosis should come to depend on endophenotypes, in order to define more precisely the mechanisms behind mental disorders. This construct is associated with the assumption that mental processes can be reduced to activity at a neuronal level. The approach has had a strong influence on the conceptual basis of proposals for DSM-5, but could be consistent either with categorical or dimensional diagnosis. However, application of endophenotypes to personality disorders is unlikely for the foreseeable future, given an insufficient knowledge of etiology and pathogenesis.

Dorso- and ventro-lateral prefrontal volume and spatial working memory in schizotypal personality disorder

Schizotypal personality disorder (SPD) individuals and borderline personality disorder (BPD) individuals have been reported to show neuropsychological impairments and abnormalities in brain structure. However, relationships between neuropsychological function and brain structure in these groups are not well understood. This study compared visual-spatial working memory (SWM) and its associations with dorsolateral prefrontal cortex (DLPFC) and ventrolateral prefrontal cortex (VLPFC) gray matter volume in 18 unmedicated SPD patients with no BPD traits, 18 unmedicated BPD patients with no SPD traits, and 16 healthy controls (HC). Results showed impaired SWM in SPD but not BPD, compared with HC. Moreover, among the HC group, but not SPD patients, better SWM performance was associated with larger VLPFC (BA44/45) gray matter volume (Fisher's Z p-values <0.05). Findings suggest spatial working memory impairments may be a core neuropsychological deficit specific to SPD patients and highlight the role of VLPFC subcomponents in normal and dysfunctional memory performance.

Amygdala-frontal connectivity during emotion regulation

Successful control of affect partly depends on the capacity to modulate negative emotional responses through the use of cognitive strategies (i.e., reappraisal). Recent studies suggest the involvement of frontal cortical regions in the modulation of amygdala reactivity and the mediation of effective emotion regulation. However, within-subject inter-regional connectivity between amygdala and prefrontal cortex in the context of affect regulation is unknown. Here, using psychophysiological interaction analyses of functional magnetic resonance imaging data, we show that activity in specific areas of the frontal cortex (dorsolateral, dorsal medial, anterior cingulate, orbital) covaries with amygdala activity and that this functional connectivity is dependent on the reappraisal task. Moreover, strength of amygdala coupling with orbitofrontal cortex and dorsal medial prefrontal cortex predicts the extent of attenuation of negative affect following reappraisal. These findings highlight the importance of functional connectivity within limbic-frontal circuitry during emotion regulation.

Indices of orbitofrontal and prefrontal function in Cluster B and Cluster C personality disorders

Neuropsychological studies implicate disruption of frontal systems in personality disorders. Few studies have examined the performance of Cluster B and Cluster C personality disorder patients on tests of orbitofrontal (OFC) and prefrontal (PFC) cortex function. Patients carrying diagnoses of either Cluster B (n=56) or Cluster C (n=19) personality disorders were compared with healthy control subjects (n=61) on the Iowa Gambling Task and University of Pennsylvania Smell Identification Test. They also completed the Wechsler Abbreviated Scale of Intelligence as a control for general intellectual ability. On the gambling task, Cluster B and Cluster C patients made more disadvantageous decisions during certain portions of the task but overall did not differ from healthy controls. Whereas no appreciable differences in olfactory identification performances were detected between patient and healthy control groups, IQ was higher for controls and was related to Cluster B patients' lower educational levels. Overall, there was limited evidence for neurocognitive inefficiency for personality disorder groups on tests sensitive to OFC and PFC function. The present study is among the first to report neurocognitive findings for the full range of Cluster B personality disorders and any Cluster C personality disorder.

Neuroimaging of aggressive and violent behaviour in children and adolescents

In recent years, a number of functional and structural neuroimaging studies have investigated the neural bases of aggressive and violent behaviour in children and adolescents. Most functional neuroimaging studies have persued the hypothesis that pathological aggression is a consequence of deficits in the neural circuits involved in emotion processing. There is converging evidence for abnormal neural responses to emotional stimuli in youths with a propensity towards aggressive behaviour. In addition, recent neuroimaging work has suggested that aggressive behaviour is also associated with abnormalities in neural processes that subserve both the inhibitory control of behaviour and the flexible adaptation of behaviour in accord with reinforcement information. Structural neuroimaging studies in children and adolescents with conduct problems are still scarce, but point to deficits in brain structures in volved in the processing of social information and in the regulation of social and goal-directed behaviour. The indisputable progress that this research field has made in recent years notwithstanding, the overall picture is still rather patchy and there are inconsistencies between studies that await clarification. Despite this, we attempt to provide an integrated view on the neural abnormalities that may contribute to various forms of juvenile aggression and violence, and discuss research strategies that may help to provide a more profound understanding of these important issues in the future.

Functional connectivity delineates distinct roles of the inferior frontal cortex and presupplementary motor area in stop signal inhibition

The neural basis of motor response inhibition has drawn considerable attention in recent imaging literature. Many studies have used the go/no-go or stop signal task to examine the neural processes underlying motor response inhibition. In particular, showing greater activity during no-go (stop) compared with go trials and during stop success compared with stop error trials, the right inferior prefrontal cortex (IFC) has been suggested by numerous studies as the cortical area mediating response inhibition. Many of these same studies as well as others have also implicated the presupplementary motor area (preSMA) in this process, in accord with a function of the medial prefrontal cortex in goal-directed action. Here we used connectivity analyses to delineate the roles of IFC and preSMA during stop signal inhibition. Specifically, we hypothesized that, as an integral part of the ventral attention system, the IFC responds to a stop signal and expedites the stop process in the preSMA, the primary site of motor response inhibition. This hypothesis predicted that preSMA and primary motor cortex would show functional interconnectivity via the basal ganglia circuitry to mediate response execution or inhibition, whereas the IFC would influence the basal ganglia circuitry via connectivity with preSMA. The results of Granger causality analyses in 57 participants confirmed this hypothesis. Furthermore, psychophysiological interaction showed that, compared with stop errors, stop successes evoked greater effective connectivity between the IFC and preSMA, providing additional support for this hypothesis. These new findings provided evidence critically differentiating the roles of IFC and preSMA during stop signal inhibition and have important implications for our understanding of the component processes of inhibitory control.

Evaluation of behavioral impulsivity and aggression tasks as endophenotypes for borderline personality disorder

Borderline personality disorder (BPD) is marked by aggression and impulsive, often self-destructive behavior. Despite the severe risks associated with BPD, relatively little is known about the disorder's etiology. Identification of genetic correlates (endophenotypes) of BPD would improve the prospects of targeted interventions for more homogeneous subsets of borderline patients characterized by specific genetic vulnerabilities. The current study evaluated behavioral measures of aggression and impulsivity as potential endophenotypes for BPD. Subjects with BPD (N=127), a non cluster B personality disorder (OPD N=122), or healthy volunteers (HV N=112) completed self report and behavioral measures of aggression, motor impulsivity and cognitive impulsivity. Results showed that BPD subjects demonstrated more aggression and motor impulsivity than HV (but not OPD) subjects on behavioral tasks. In contrast, BPD subjects self-reported more impulsivity and aggression than either comparison group. Subsequent analyses showed that among BPD subjects behavioral aggression was associated with self-reported aggression, while behavioral and self-report impulsivity measures were more modestly associated. Overall, the results provide partial support for the use of behavioral measures of aggression and motor impulsivity as endophenotypes for BPD, with stronger support for behavioral aggression measures as an endophenotype for aggression within BPD samples.

Smaller superior temporal gyrus volume specificity in schizotypal personality disorder

BACKGROUND

Superior temporal gyrus (STG/BA22) volume is reduced in schizophrenia and to a milder degree in schizotypal personality disorder (SPD), representing a less severe disorder in the schizophrenia spectrum. SPD and Borderline personality disorder (BPD) are severe personality disorders characterized by social and cognitive dysfunction. However, while SPD is characterized by social withdrawal/anhedonia, BPD is marked by hyper-reactivity to interpersonal stimuli and hyper-emotionality. This is the first morphometric study to directly compare SPD and BPD patients in temporal lobe volume.

METHODS

We compared three age-, sex-, and education-matched groups: 27 unmedicated SPD individuals with no BPD traits, 52 unmedicated BPD individuals with no SPD traits, and 45 healthy controls. We examined gray matter volume of frontal and temporal lobe Brodmann areas (BAs), and dorsal/ventral amygdala from 3-T magnetic resonance imaging.

RESULTS

In the STG, an auditory association area reported to be dysfunctional in SPD and BPD, the SPD patients had significantly smaller volume than healthy controls and BPD patients. No group differences were found between BPD patients and controls. Smaller BA22 volume was associated with greater symptom severity in SPD patients. Reduced STG volume may be an important endophenotype for schizophrenia-spectrum disorders. SPD is distinct from BPD in terms of STG volume abnormalities which may reflect different underlying pathophysiological mechanisms and could help discriminate between them.

[Schizophrenia-like personality disorders]

According to DSM-IV the cluster A personality disorders include paranoid, schizoid, and schizotypal personality disorders. There exists a phenomenological similarity between the experience and behaviour of the so-called odd or eccentric personality disorders and the symptoms of schizophrenia. Evidence of common etiological factors is still the best for the schizotypal personality disorder. The cluster A personality disorders are among the less common personality disorders with a high co-occurrence. Present findings about the neurobiological substrate of the schizotypal personality disorder are discussed also taking neuropsychological results into consideration. A central prerequisite of psychotherapeutic and pharmacological treatment of cluster A personality disorders is a strong therapeutic patient relationship.

Neurophysiological correlates of borderline personality disorder: a transcranial magnetic stimulation study

BACKGROUND

Cortical inhibition deficits have been demonstrated in several disorders with deficits in impulsive control (e.g., attention-deficit/hyperactivity disorder [ADHD], tic disorder, Tourette syndrome) by using transcranial magnetic stimulation (TMS). With borderline personality disorder (BPD), we investigated another disorder associated with high impulsivity by TMS. We hypothesized that BPD patients display decreased cortical inhibition and/or increased cortical excitation as assessed with TMS.

METHODS

Different inhibitory and excitatory TMS parameters were investigated in 19 unmedicated female BPD patients and 19 healthy control subjects matched for sex, age, handedness, and body height. Additionally, the results were controlled for ADHD symptomatology.

RESULTS

A reduced cortical silent period (CSP) duration was found in BPD patients compared with healthy control subjects in the right cortex. Even after controlling for ADHD symptoms, this result remained significant.

CONCLUSIONS

These findings support an association between BPD and cortical inhibition deficits as indexed through TMS. The results are discussed considering basic neurobiological mechanisms that may explain our findings of decreased intracortical inhibition in BPD patients.

Structural and functional MRI- findings in children and adolescents with antisocial behavior

BACKGROUND

The developmental course of children with conduct disorder (CD) is heterogeneous. Especially children who exhibit symptoms early in their lifetimes are characterized by a negative outcome. Neurobiological aspects of CD have been investigated in these children but little is known about structural and functional brain aberrations.

METHODS

We describe the developmental taxonomy of children with CD and focus on those with the early onset subtype. Structural MRI data of these children and antisocial adults are recapitulated. The impact of investigating neurobiological underpinnings of antisocial behavior and how this might contribute to future forensic and psychiatric assessments is discussed. RESULTS/ CONCLUSION: Children display similar structural aberrations of fronto-limbic structures to adults with antisocial behavior, and amygdala dysfunction might be closely related to dysregulated emotions. Though the investigation of biological factors in antisocial subjects has made great progress in recent years, today MRI is still a rather complex, expensive and indistinct method for forensic assessment.

Inferior frontal white matter microstructure and patterns of psychopathology in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder

BACKGROUND

Inferior frontal white matter circuits are likely to be relevant to dysfunctional affect regulation, aggression, dissociative symptoms, neuropsychological functioning and psychopathology in women with borderline personality disorder (BPD) and comorbid attention-deficit hyperactivity disorder (ADHD).

METHODS

20 women with BPD and comorbid ADHD and 20 healthy women were investigated, and groups were matched for age, education and premorbid intelligence. Mean diffusivity and fractional anisotropy were measured bilaterally in the inferior frontal white matter by diffusion tensor imaging (DTI). Conflict resolution was assessed by the Attention Network Test, sustained vigilance by the Degraded-Stimulus Continuous Performance Test.

RESULTS

Among women with BPD and comorbid ADHD, increased mean diffusivity in inferior frontal white matter was associated with higher levels of dysfunctional affect regulation, anger-hostility, dissociative symptoms, and general psychopathology (p<.05, uncorrected). Poor conflict resolution during the attention task was positively associated with anger-hostility, psychopathology, dissociation and the number of ADHD-symptoms, but not related to DTI variables. Both groups did not differ significantly with respect to DTI variables or neuropsychological performance. In the BPD group, a lifetime history of major depression or a current eating disorder were associated with impaired inferior frontal white matter integrity, while a history of sexual abuse or a current posttraumatic stress disorder were not.

CONCLUSIONS

Inferior frontal white matter microstructural abnormalities may be linked to key aspects of psychopathology in women with BPD and comorbid ADHD and add to alterations in orbitofrontal and limbic areas. The relationship between neuropsychological functioning and white matter structure remains unclear.

The role of functional neuroimaging in exploring the overlap between borderline personality disorder and bipolar disorder

In light of the recent discussions of possible diagnostic overlap between borderline personality disorder and bipolar disorder, we explored the neuroimaging literature to determine if findings from this literature might illuminate the issue of overlap between the two diagnoses. We looked at studies of executive functions and emotion-related functions. Although similar brain areas have been explored in each population and several findings are suggestive of overlap, as well as differences between the two disorders, conclusions are limited because of the lack of studies that employed the exact same paradigm in the two patient groups. The authors suggest methods for conducting future neuroimaging research that may better clarify some of these issues of possible diagnostic overlap.

Decoding mental states from brain activity in humans

Recent advances in human neuroimaging have shown that it is possible to accurately decode a person's conscious experience based only on non-invasive measurements of their brain activity. Such 'brain reading' has mostly been studied in the domain of visual perception, where it helps reveal the way in which individual experiences are encoded in the human brain. The same approach can also be extended to other types of mental state, such as covert attitudes and lie detection. Such applications raise important ethical issues concerning the privacy of personal thought.

Dissoziale Persönlichkeitsstörung

Deviant behavior is gaining in clinical importance if it is founded on stable, characteristic, and enduring patterns of psychopathologically relevant personality traits which have their onset in childhood or adolescence. The classification of these traits shows variations, so that a distinction between the ICD-10 diagnosis of dis-social personality disorder, DSM-IV diagnosis of antisocial personality disorder, and the concept "psychopathy" is necessary. Our knowledge about the biological basis of antisocial behavior includes neurophysiologic, psychophysiologic, and genetic findings. Also relevant are results of neurotransmitter studies and structural resp. functional neuroimaging findings. Psychosocial risk factors include parental deficits, rejection, disregard, unstable relations, and abuse. Efficient psychotherapeutic treatment is cognitive-behavioral. Pharmacologic treatment is largely "off-label". The diagnosis of antisocial and dis-social personality disorders allows no conclusions on criminal responsibility. In addition to psychiatric diagnostics, considerations on the severity of the disorder and its effects on the ability to inhibit actions are necessary.

Ätiologie und Verlauf kindlichen dissozialen Verhaltens - Risikofaktoren für die Entwicklung einer antisozialen Persönlichkeitsstörung

Zusammenfassung: Gegenstand: Störungen des Sozialverhaltens gehören zu den häufigsten Erkrankungen in unserem Fachgebiet. Methode: Die an der Entstehung von Störungen des Sozialverhaltens wesentlich beteiligten biologischen und psychosozialen Faktoren sowie deren Interaktion werden in dieser Übersichtsarbeit dargestellt. Dabei wird speziell auf Veränderungen der autonomen Reagibilität eingegangen. Ergebnis: Bei den unterschiedlichen Entwicklungspfaden hin zu einer antisozialen Persönlichkeitsstörung kommt frühen Formen von Störungen des Sozialverhaltens und dem psychopathischen Subtyp eine besondere Aussagekraft zu. Schlussfolgerung: Es wird die Bedeutung einer frühzeitigen Förderung gefährdeter Kinder zur Vermeidung einer dissozialen Entwicklung herausgestellt.