Smaller superior temporal gyrus volume specificity in schizotypal personality disorder

Department of Psychiatry, Mount Sinai School of Medicine, New York, NY 10029, USA.
Schizophrenia Research (Impact Factor: 3.92). 08/2009; 112(1-3):14-23. DOI: 10.1016/j.schres.2009.04.027
Source: PubMed


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.
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.
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.

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    • "In addition to functional differences in amygdala activity, some (Driessen et al., 2000; Tebartz van Elst et al., 2003) but not all (Goldstein et al., 2009; Rusch et al., 2003) structural MRI studies report significantly smaller amygdala volumes in BPD patients compared with HCs, with discrepant findings possibly due to posttraumatic stress disorder (PTSD) comorbidity (de-Almeida et al., 2012). Dialectical Behavior Therapy (DBT) emphasizes the role of emotion regulation (Bohus et al., 2004; Linehan et al., 1991) and targets the acquisition of skills and techniques to encourage cognitive control over maladaptive behavioral patterns (Neacsiu et al., 2010). "
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    ABSTRACT: Objective: Siever and Davis' (1991) psychobiological framework of borderline personality disorder (BPD) identifies affective instability (AI) as a core dimension characterized by prolonged and intense emotional reactivity. Recently, deficient amygdala habituation, defined as a change in response to repeated relative to novel unpleasant pictures within a session, has emerged as a biological correlate of AI in BPD. Dialectical behavior therapy (DBT), an evidence-based treatment, targets AI by teaching emotion-regulation skills. This study tested the hypothesis that BPD patients would exhibit decreased amygdala activation and improved habituation, as well as improved emotion regulation with standard 12-month DBT. Methods: Event-related fMRI was obtained pre- and post-12-months of standard-DBT in unmedicated BPD patients. Healthy controls (HCs) were studied as a benchmark for normal amygdala activity and change over time (n = 11 per diagnostic-group). During each scan, participants viewed an intermixed series of unpleasant, neutral and pleasant pictures presented twice (novel, repeat). Change in emotion regulation was measured with the Difficulty in Emotion Regulation (DERS) scale. Results: fMRI results showed the predicted Group × Time interaction: compared with HCs, BPD patients exhibited decreased amygdala activation with treatment. This post-treatment amygdala reduction in BPD was observed for all three pictures types, but particularly marked in the left hemisphere and during repeated-emotional pictures. Emotion regulation measured with the DERS significantly improved with DBT in BPD patients. Improved amygdala habituation to repeated-unpleasant pictures in patients was associated with improved overall emotional regulation measured by the DERS (total score and emotion regulation strategy use subscale). Conclusion: These findings have promising treatment implications and support the notion that DBT targets amygdala hyperactivity-part of the disturbed neural circuitry underlying emotional dysregulation in BPD. Future work includes examining how DBT-induced amygdala changes interact with frontal-lobe regions implicated in emotion regulation.
    Journal of Psychiatric Research 10/2014; 57(1). DOI:10.1016/j.jpsychires.2014.06.020 · 3.96 Impact Factor
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    • "Brenner et al. (2003) reported that ASSR power to amplitude modulated tones was unaffected across a wide range of stimulus frequencies in a small sample of persons with SPD (n = 11). However, abnormalities in auditory EEG and event-related potential (ERP) response (Niznikiewicz et al., 2009; Shin et al., 2010) and reduced volume of the superior temporal gyrus (Dickey et al., 2002; Goldstein et al., 2009; Takahashi et al., 2010) in SPD suggest potential impairment in the auditory pathways. "
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    ABSTRACT: The power and phase synchronization of the auditory steady state response (ASSR) at 40 Hz stimulation is usually reduced in schizophrenia (SZ). The sensitivity of the 40 Hz ASSR to schizophrenia spectrum phenotypes, such as schizotypal personality disorder (SPD), or to familial risk has been less well characterized. We compared the ASSR of patients with SZ, persons with schizotypal personality disorder, first degree relatives of patients with SZ, and healthy control participants. ASSRs were obtained to 20, 30, 40 and 50 Hz click trains, and assessed using measures of power (mean trial power or MTP) and phase consistency (phase locking factor or PLF). The MTP to 40 Hz stimulation was reduced in relatives, and there was a trend for MTP reduction in SZ. The 40 Hz ASSR was not reduced in SPD participants. PLF did not differ among groups. These data suggest the 40 Hz ASSR is sensitive to familial risk factors associated with schizophrenia.
    Schizophrenia Research 04/2012; 136(1-3):143-9. DOI:10.1016/j.schres.2012.01.003 · 3.92 Impact Factor
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    • "In two separate samples, our group reported no differences in cingulate gyrus volume between individuals with SPD and healthy controls [21, 22]. However, a third study with a much larger sample of individuals with SPD (ie, n = 79 in Hazlett et al. [18•] vs n = 13 in Haznedar et al. [21] and n = 27 in Goldstein et al. [22]) reported smaller gray and larger white matter volume in the anterior cingulate (BA24, averaged across left and right hemisphere) compared with healthy controls (n = 148). It is important to note that while compared with controls, the SPD patients in Hazlett et al. [18•] showed greater gray matter reductions in BA24 than the schizophrenia patients, they also had significantly greater white matter volume in this same region compared with controls and schizophrenia patients. "
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    ABSTRACT: Individuals with schizotypal personality disorder (SPD) share genetic, phenomenologic, and cognitive abnormalities with people diagnosed with schizophrenia. To date, 15 structural MRI studies of the brain have examined size, and 3 diffusion tensor imaging studies have examined white matter connectivity in SPD. Overall, both types of structural neuroimaging modalities have shown temporal lobe abnormalities similar to those observed in schizophrenia, while frontal lobe regions appear to show more sparing. This intriguing pattern suggests that frontal lobe sparing may suppress psychosis, which is consistent with the idea of a possible neuroprotective factor. In this paper, we review these 18 studies and discuss whether individuals with SPD who both resemble and differ from schizophrenia patients in their phenomenology, share some or all of the structural brain imaging characteristics of schizophrenia. We attempt to group the MRI abnormalities in SPD into three patterns: 1) a spectrum of severity-abnormalities are similar to those observed in schizophrenia but not so severe; 2) a spectrum of region-abnormalities affecting some, but not all, brain regions affected in schizophrenia; and 3) a spectrum of compensation-abnormalities reflecting greater-than-normal white matter volume, possibly serving as a buffer or compensatory mechanism protecting the individual with SPD from the frank psychosis observed in schizophrenia.
    Current Psychiatry Reports 02/2012; 14(1):70-8. DOI:10.1007/s11920-011-0241-z · 3.24 Impact Factor
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