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.

Introduction: 目前已有研究证实，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损伤，但鲜有研究探讨该损伤是否存在对应的脑功能关联。本研究纳入未经药物治疗的青少年患者以排除治疗带来的潜在混杂效应，旨在探讨自传体回忆过程中的脑功能变化。
Methods: 本研究共纳入32名未接受过药物治疗且无精神共病的青少年女性BPD患者，以及33名人口学特征匹配的健康女性对照。所有受试者在观看可唤起自传体记忆的个性化提示词时完成功能磁共振成像（fMRI）扫描；对照任务包括观看非记忆唤起型提示词，以及低水平基线任务（十字注视）。
Results: 与低水平基线任务相比，在自传体回忆阶段，BPD患者较健康对照在多个脑区出现活动增强，包括海马后部、舌回、距状皮层以及楔前叶。同时，BPD患者在自传体回忆过程中未能正常抑制右侧背外侧前额叶皮层的活动。当直接比较记忆唤起型提示词与非记忆唤起型提示词时，未发现患者组与对照组间存在显著组间差异。
Discussion/Conclusions: 本研究证实，BPD患者在面对可唤起自传体记忆的刺激时，海马、舌回、距状皮层及楔前叶存在过度激活现象。由于该脑功能变化出现于未接受药物治疗且无精神共病的患者中，因此可认为其属于该疾病的固有病理特征。本研究还进一步补充了BPD患者存在去激活功能障碍的相关证据，此次发现的异常脑区位于默认模式网络（Default Mode Network, DMN）之外。