Neuroanatomy of Personality Disorders

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Neuroanatomy of Personality Disorders

• Schizotypal PD, Violent/Aggressive PD, Antisocial
  PD, Borderline PD

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Examining the Brain

• Tomography (CT)
• generation of 3D image, IDs gross features
• Resonance Imaging (MRI, fMRI)
• determines which brain areas are active through H
  spin and blood oxygen concentrations
• Tomography (PET/SPECT)
• radioactive particles identify which brain areas
  are active through blood oxygen concentrations

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Schizotypal PD (SPD)

• Symptoms of interest
• Hallucinations/delusions
• Thought and language disorder
• Areas of Interest
• Temporal Lobe
• Corpus Callosum

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SPD Areas of Interest

• 1) Temporal Lobe
• a) Global measure (Siever et al., 2002)
• abnormalities in both SPD and schizophrenics
  versus controls (Cs)
• decreased grey matter volume in the whole
  temporal lobe
• Audition, information processing
• could explain some learning impairments seen in
  these disorders (p.163 Siever et al., 2002)

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Continued...

• 1) Temporal Lobe
• b)Temporal Gyrus (Dickey et al., 2002)
• temporal pole sensory-limbic integration
• planum temporale phonemic processing
• Heschls gyrus processing pure tones from MGN
  (medial geniculate nucleus) of thalamus
• found reduced grey matter in all three areas,
  more specifically in Heschls gyrus
• auditory hallucinations and thought disorder?

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(Dickey et al., 2002)
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Continued...

• 2) Corpus Callosum (Downhill Jr. et al., 2000)
• a) Posterior CC (splenium)
• transfer of sensory processes
• more temporal lobe (little parietal too)
• b) Anterior CC (genu)
• transfer of cognitive processes
• more frontal lobe

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Corpus Callosum(Downhill Jr. et al., 2000)

• 70 Ps13 SPD 27 people with schizophrenia 30
  healthy Cs
• traced divided ROI (region of interest)

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Corpus Callosum continued(Downhill Jr. et al.,
2000)
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Corpus Callosum continued(Downhill Jr. et al.,
2000)

• Splenium/posterior CC (more sensory)
• Cs gt SPD gt people with schizophrenia
• interhemispheric communication re sensory
  processes deficient, but more pronounced in
  those with schizophrenia?
• verbalthoughts could be perceived as not part
  of the self if the right and left hemispheres did
  not have full communication (p 205)
• delusions/auditory hallucinations?
• Genu/anterior CC (more cognitive)
• SPD gt Cs gt people with schizophrenia
• lesser cognitive deficit in SPD than in those
  with schizophrenia
• but did not discuss any thoughts on why they
  found that SPDgtCs

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Violent and Aggressive PDAntisocial PDAreas of
Interest and Symptoms of Interest

• Frontal Lobe Orbitofrontal Cortex (OF)
• poor impulse control
• explosive, aggressive outbursts
• lack of interpersonal sensitivity
• Frontal Lobe Ventromedial (vm) Prefrontal
• judgment, awareness of socially appropriate
  conduct, assessing consequences

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Neuroanatomical Research

• Frontal Lobe Abnormalities
• Raine et al., 2000
• 21 APD, 24 healthy Cs, 26 substance dependent, 21
  psychiatric
• structural imaging (MRI)
• APD PF grey 11.0 lt controls
• Frontal Lobe Abnormalities
• 333 prisoners, displayed habitual physical
  aggression/explosive rages
• 56.9 EEG abnormalities (62.2 frontal)
• 11.8 EEG abnormalities, single episode
• Williams D., (1969) as cited in Brower, 2001

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• PET
• Frontal lobe and violent behaviour
• psychiatric patients versus controls
• decreased cortical blood flow/metabolism
  associated w/repetitive and purposeless violent
  behaviour
• Volkov et al., 1995 as cited in Brower, 2001
• OF and aggression
• antisocial PD versus non-psychiatric controls
• decreased medial and left anterior orbitofrontal
  metabolism correlated with increased scores on
  self reported aggression scales
• Goyer et al., 1994 as cited in Brower, 2001

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But!

• no study can necessarily show that frontal lobe
  (OF and PFC) dysfunction or pathology can predict
  violent crime
• Studies on antisocial PD, aggressive PD are NOT
  CAUSATIONAL
• frontal brain activity merely regarded as having
  a relationship with aggressive behaviour
  (CORRELATION ONLY)

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Borderline PD (BPD)

• Symptoms of interest
• characteristic fear of being abandoned
• rigidity, poorly adapted affective response
• impulsive behaviour
• SIB
• voices

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BPD Areas of Interest

• Limbic System
• Amygdala
• Hippocampus
• Anterior Cingulate Cortex (ACC)
• Frontal Lobe
• OF
• PFC

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Limbic System Amygdala(Herpertz et al., 2001)

• fMRI on amygdalic functioning amongst BPD to
  investigate activity to (low) aversive stimuli
• Abnormal activity on both hemispheres (over
  activity)
• Low-level stressors activate BPD amygdala?
• Butsmall sample size

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Limbic Amygdala Hippocampus(Driessen et al.,
2000 Schmahl et al., 2003 Tebartz van Elst et
al., 2003)

• Volumetric MRI measurements
• BPD (meds trauma/abuse) vs. Cs
• measured volume amygdala and hippocampus
• Driessen et al., 2000
• Amygdala 8 smaller in BPD vs. Cs
• Hippocampus 16 smaller in BPD vs. Cs
• Schmahl et al., 2003
• Amygdala 21.9 smaller in BPD vs. Cs
• Hippocampus 13.1 smaller in BPD vs. Cs
• Confounds?

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Limbic Amygdala, Hippocampus, ACCFrontal
OF(Tebartz van Elst et al., 2003)

• Volumetric MRI
• 8 unmedicated w/BPD vs. 8 Cs
• Amygdala 23-55 smaller in BPD
• Hippocampus 20-21 smaller in BPD
• ACC 26 smaller in BPD
• OF 24 smaller in BPD

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Frontal OF and PFC

• frontolimbic brain pathology correlated with
  affective and impulsive or aggressive behaviour?
  (Tebartz van Elst et al., 2003)
• OF impulsivity?
• Uroxocide perpetrators (killed wives during
  attempted abandonment) and decreased PFC
  metabolism (Dutton, 2002)
• PFC aggression?

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Summary

• SPD
• Temporal (global gyrus)
• CC (anterior posterior)
• Aggressive/Violent PD
• Frontal Lobe (OF, VMPFC)
• APD
• PFC
• BPD
• Limbic System (amygdala, hippocampus, ACC)
• Frontal Lobe (OF, PFC)

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BUT!

• Possible research limitations
• Small sample sizes
• Confounds (medications, comorbidity with other
  disorders)
• Research conclusions may vary according to
  methodology
• RESEARCH CORRELATIONAL ONLY

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References

• Brower, M.C. Price, B.H. (2001).
  Neuropsychiatry of frontal lobe dysfunction in
  violent and criminal behaviour a critical
  review. Journal of Neurology, Neurosurgery and
  Psychiatry, 71, 720-726.
• Dickey, C.C. McCarley, R.W., Voglmaier, M.M.,
  Frumin, M., Niznikievicz, M.A., Hirayasu, Y.,
  Fraone, S., Seidman, L.J. Shenton, M.E. (2002).
  Smaller left Heschls gyrus volume in patients
  with schizotypal personality disorder. American
  Journal of Psychiatry, 159, 1521-1527.
• Downhill Jr., J.E., Buchsbaum, M.S., Wei, T.,
  Spiegel-Cohen, J.S., Hazlett, E.A., Haznedear,
  M.M., Silverman, J. Siever, L.J. (2000). Shape
  and size of the corpus callosum in schizophrenia
  and schizotypal personality disorder.
  Schizophrenia Research, 42, 193-208.
• Driessen, M., Hermann, J., Stahl, K., Zwaan, M.,
  Meier, S., Hill, A., Osterheider, M. Petersen,
  D. (2000). Magnetic resonance imaging volumes of
  the hippocampus and the amygdala in women with
  borderline personality disorder and early
  traumatization. Archives of General Psychiatry,
  57, 1115-1122.
• Dutton, D.G. (2001). The neurobiology of
  abandonment homicide. Aggression and Violent
  Behavior, 7, 407-421.
• Herpertz, S.C., Dietrich, T.M., Wenning, B.,
  Krings, T., Erberich, S.G., Wilmes, K., Thron, A.
  Sass, H. (2001). Evidence of abnormal amygdala
  functioning in borderline personality disorder a
  functional MRI study. Society of Biological
  Psychiatry, 50, 292-298.

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References contd

• Raine, A., Lencz, T., Bihrle, S., LaCasse, L.
  Colletti, P. (2000). Reduced prefrontal gray
  matter volume and reduced autonomic activity in
  antisocial personality disorder. Archives of
  General Psychiatry, 57, 119-127.
• Schmahl, C.G., Vermetten, E., Elzinga, B.M.
  Bremner, J.D. (2003). Magnetic resonance imaging
  of hippocampal and amygdala volume in women with
  childhood abuse and borderline personality
  disorder. Psychiatry Research Neuroimaging, 122,
  193-198.
• Siever L.J., Koenigsberg, H.W., Harvey, P.,
  Mitropolou, V., Laruelle, M., Abi-Dargham, A.,
  Goodman, M. Buchsbaum, M. (2002). Cognitive and
  brain function in schizotypal personality
  disorder. Schizophrenia Research, 54, 157-167.
• Tebartz van Elst, L., Hesslinger, B., Thiel, T.
  Geiger, E., Haegle, K., Lemieux, L., Lieb, K.,
  Bohus, M., Hennig, J Ebert, D. (2003).
  Frontolimbic brain abnormalities in patients with
  borderline personality disorder a volumetric
  magnetic resonance imaging study. Society of
  Biological Psychiatry, 54, 163-171.
• Van Reekum, R., Links, P., Federov, C. (1994).
  Impulsivity in Borderline Personality Disorder.
  Biological and Neurobehavioural Studies of
  Borderline Personality Disorder, \ in Psychiatry,
  45, 1-23.
• Other resources
• For gross anatomy University of Arkansas for
  Medical Sciences, retrieved on November 22, 2002.
  http//anatomy.uams.edu/HTMLpages/anatomyhtml/brai
  n.html