Common and distinct brain functional alterations in pharmacotherapy treatment-na\xefve female borderline personality disorder patients with and without auditory verbal hallucinations: a pilot study

Chuanjun Zhuo,Xiao Lin,Xiaodong Lin,Lina Wang,Yong Xu,Baoliang Zhong,Feng Ji,Hongjun Tian,Wenqiang Wang

doi:10.1007/s00406-020-01102-5

Abstract

Auditory verbal hallucinations (AVHs) are experienced by approximately 25% of patients with borderline personality disorder (BPD). Despite the high incidence, the pathological features of AVH in BPD remain unclear. This study aimed to investigate whole-brain functional connectivity (FC), as measured by functional connectivity density (FCD), and its relationship with AVH in BPD. 65 pharmacotherapy treatment-naïve female BPD patients (30 with AVH and 35 without AVH), and 35 female healthy controls were investigated. Functional magnetic resonance imaging (fMRI) data were collected to assess whole-brain FC and functional connectivity density mapping (FCDM) was applied to the fMRI data to compute FCD features. Compared to the healthy controls, both BPD groups (BPD–AVH and BPD without AVH) exhibited significantly higher gFCD values in the bilateral prefrontal lobe, bilateral orbital lobule, and bilateral insula, and significantly lower gFCD values in the SMA, right anterior temporal lobule, and the ACC. These altered regions were significantly associated with AVH in the BPD subjects. Moreover, higher gFCD values were observed in the left posterior temporal lobule and posterior frontal lobule. Aberrant alterations also emerged in the left posterior temporal lobule and posterior frontal lobule, mainly in Broca and Wernicke regions. Nevertheless, there was no significant correlation between gFCD values and the severity of AVH as measured by the AVH scores. In summary, we have identified aberrations in the FC and brain metabolism of the aforementioned neural circuits/networks, which may provide new insights into BPD–AVH and facilitate the development of therapeutic approaches for treating AVH in BPD patients.

Highlights

An auditory verbal hallucination (AVH) is a disturbance in perception, recognized as “hearing voices” or experiencing speech directed at the subjects themselves in an absence of any stimulus from real external language [1]
Compared to the healthy controls, both borderline personality disorder (BPD) groups (BPD–AVH and BDP without AVH) showed greater global FCD (gFCD) values in the bilateral prefrontal lobe, bilateral orbital lobule, and bilateral insular, whereas the gFCD values were significantly lower in the sensorimotor area (SMA), right anterior temporal lobule, and anterior cingulate cortex (ACC)
The novel findings obtained in this study of whole-brain functional connectivity density (FCD), as measured by gFCD in BPD subjects with or without AVH, have important implications for better understanding the neural substrates underlying the psychotic symptoms of AVH in BPD patients

Summary

Introduction

An auditory verbal hallucination (AVH) is a disturbance in perception, recognized as “hearing voices” or experiencing speech directed at the subjects themselves in an absence of any stimulus from real external language [1]. AVHs are commonly experienced in patients with schizophrenia spectrum disorders and affect approximately 70% of schizophrenia patients. This symptom is observed in a broad range of other mental illnesses, including major depressive disorder (MDD), bipolar disorder (BD), posttraumatic stress disorder (PTSD) and borderline personality disorder (BPD), as well as in a proportion of healthy individuals [2]. The phenomenological aspects are generally similar to those in patients with schizophrenia Inspired by these important findings, in this pilot study, we explored the common and distinct brain function alterations in BPD patients with and without AVH

Objectives

Methods

Results

Conclusion