Supplementary Material for: Brain functional correlates of recall of life events in medication-naïve adolescents with borderline personality disorder

Introduction: Recall of autobiographical events has been found to be impaired in borderline personality disorder (BPD), but few studies have examined if this impairment has brain functional correlates. This study evaluated brain functional alterations during autobiographical recall, using medication-naive adolescent patients to avoid potential confounding effects of treatment. Methods: 32 adolescent female patients with BPD who were never-medicated and without psychiatric comorbidity and 33 matched healthy females underwent fMRI while they viewed individualized cue words that evoked autobiographical memories. Control conditions included viewing non-memory-evoking cues and a low-level baseline (cross fixation). Results: During autobiographical recall, in comparison to the low-level baseline, the BPD patients showed increased brain activity in regions including the posterior hippocampus, the lingual and calcarine cortex and the precuneus compared to the healthy controls. The BPD patients also showed a failure to de-activate the right dorsolateral prefrontal cortex during autobiographical recall. No patient-control differences were found when memory-evoking words were compared to non-memory-evoking words. Discussion/Conclusions: This study finds evidence of hippocampal/lingual/calcarine/precuneus hyperactivation to stimuli that evoke autobiographical memories in patients with BPD. As the changes were seen in never-treated patients without other comorbidities, they could be considered intrinsic to the disorder. Our study also adds to existing evidence for failure of de-activation in BPD, this time outside the default mode network.

引言：已有研究发现，边缘型人格障碍（Borderline Personality Disorder, BPD）患者的自传体事件回忆能力存在受损情况，但目前鲜有研究探讨该损伤是否存在相应的脑功能关联。本研究采用从未接受药物治疗的青少年患者作为研究对象，以排除治疗带来的潜在混杂效应，探讨自传体回忆过程中的脑功能变化。

方法：本研究纳入32例从未接受药物治疗且无精神共病的青少年女性BPD患者，以及33例年龄匹配的健康女性对照。所有受试者在进行功能磁共振成像（functional Magnetic Resonance Imaging, fMRI）扫描时，需观看能够唤起自传体记忆的个性化提示词。实验对照条件包括观看无法唤起记忆的提示词，以及低级别基线任务（十字注视）。

结果：与低级别基线任务相比，在自传体回忆任务中，BPD患者相较于健康对照，在多个脑区出现活动增强，包括后海马体、舌回、距状皮层以及楔前叶。此外，BPD患者在自传体回忆过程中未能对右侧背外侧前额叶皮层实现正常去激活。当比较唤起记忆的提示词与非唤起记忆的提示词时，未发现患者组与对照组间存在显著组间差异。

讨论与结论：本研究发现，BPD患者在接受可唤起自传体记忆的刺激时，海马体、舌回、距状皮层及楔前叶出现过度激活。由于该脑功能变化出现在从未接受治疗且无其他共病的患者中，因此可认为这些变化是该疾病的固有特征。本研究还进一步为BPD患者存在脑区去激活异常提供了新证据——此次异常发生于默认模式网络（Default Mode Network, DMN）之外的脑区。