Background

Borderline personality disorder (BPD) is a common mental disorder characterized by instability in interpersonal relationships, impaired self-image, impulsivity and aggressive behaviors that often requires pharmacological treatments. Neuroimaging alterations have been extensively reported in BPD, especially in regions within the fronto-limbic system. Although medications can be an important confounding factor in functional Magnetic Resonance Imaging (fMRI) studies, their role on brain function in BPD patients still remains uncertain. Therefore, this review aims to improve our understanding on the potential effect of the most commonly prescribed drugs for BPD on brain function during processing of emotional tasks.

Methods

A search on PubMed, Scopus and Web of Science of fMRI studies exploring the effect of antipsychotics, antidepressants and mood stabilizers on brain activity during processing of emotional tasks on BPD was conducted.

Results

Overall the studies showed small or no effect of pharmacological treatments on brain activity and connectivity in BPD patients during processing of emotional tasks.

Limitations

The small sample size, the observational design, the elevated percentage of women, the concomitant use of psychostimulants, anticholinergics and opioids substitute treatments and the high rate of comorbidities limit the conclusion of this review.

Conclusions

Pharmacological treatments seem to have minor role on brain activity/connectivity in BPD patients during emotional tasks, ultimately suggesting that in BPD patients brain deficits seem not be influenced by medications. This might be due to functional brain specificities of BPD and to the differences in pharmacological regimens and compliance to therapy between BPD and other common psychiatric disorders.

中文翻译：

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药物治疗对边缘型人格障碍情绪任务的影响：功能磁共振成像研究综述

背景

边缘型人格障碍（BPD）是一种常见的精神障碍，其特点是人际关系不稳定、自我形象受损、冲动和攻击性行为，通常需要药物治疗。神经影像学改变已在 BPD 中得到广泛报道，特别是在额边缘系统内的区域。尽管药物可能是功能性磁共振成像 (fMRI) 研究中的一个重要混杂因素，但它们对 BPD 患者脑功能的作用仍不确定。因此，本综述旨在提高我们对 BPD 最常用处方药在处理情绪任务期间对脑功能的潜在影响的理解。

方法

对 PubMed、Scopus 和 Web of Science 的 fMRI 研究进行了搜索，探索抗精神病药、抗抑郁药和情绪稳定剂对 BPD 情绪任务处理过程中大脑活动的影响。

结果

总体而言，研究表明，在处理情绪任务期间，药物治疗对 BPD 患者的大脑活动和连通性影响很小或没有影响。

限制

样本量小、观察性设计、女性比例升高、同时使用精神兴奋剂、抗胆碱能药和阿片类药物替代治疗以及合并症的高发生率限制了本综述的结论。

结论

药物治疗似乎对 BPD 患者在情绪任务期间的大脑活动/连通性影响较小，最终表明 BPD 患者的大脑缺陷似乎不受药物的影响。这可能是由于 BPD 的脑功能特异性以及 BPD 与其他常见精神疾病之间的药理学方案和治疗依从性的差异。