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

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.

Structural Correlates of Lifetime Voice-Hearing in Patients with Borderline Personality Disorder: A Pilot Study

“…Despite the clinical relevance of AVH in BPD, neuroimaging data specifically addressing these phenomena are scarce, as there is only one functional MRI study investigating functional connectivity density in AVH BPD patients in comparison to non-hallucinating BPD patients. Contrasting the extant literature on AVH in SZ to their findings, the authors highlighted the importance of frontal and temporal regions to AVH in BPD patients as well [33]. Functional neuroimaging studies in SZ have revealed that activation of the right IFG including Broca's homologue during AVH [34] and a lack of synchronization between Broca's region and its homologue are associated with the negative emotional content of AVH.…”

Transcranial direct current stimulation of the occipital lobes with adjunct lithium attenuates the progression of cognitive impairment in patients with first episode schizophrenia

“…Our data, from a large-scale imaging perspective, provide evidence suggesting that lithium can improve cognitive impairments by enhancing functional connectivity on a whole-brain level. Functional connectivity represents the information communication capability of the brain ( 36 – 42 ). Thus, increased gFCD, especially in the occipital lobe, basal ganglia, and frontal lobe, reflects enhanced communication throughout the brain.…”

Functional MRI findings in personality disorders: A review

“…BPD‐rs‐4, 115 BPD‐rs‐6, 116 and BPD‐rs‐7 117 highlight aberrations in FC of the ACC. The ACC is involved in various cognitive processes, such as motivation, decision making, emotion processing, learning, and conflict and error monitoring.…”

“…113 The altered processing of fearful stimuli may also clarify why persons with BPD have a heightened fear of abandonment and instability when compared to persons without BPD. 114 BPD-rs-4, 115 BPD-rs-6, 116 and BPD-rs-7 117 highlight aberrations in FC of the ACC. The ACC is involved in various cognitive processes, such as motivation, decision making, emotion processing, learning, and conflict and error monitoring.…”