Comparative Functional Study of Two Psychiatric Pathologies by means of BrainSPECT Tc 99 HMPAO: Major Depression and Borderline Personality Disorder.

COMPARATIVE FUNCTIONAL STUDY OF TWO PSYCHIATRIC PATHOLOGIES BY MEANS OF BRAINSPECT TC 99 HMPAO: MAJOR DEPRESSION AND BORDERLINE PERSONALITY DISORDER.

SUMMARY

In the D.S.M. IV, classification system of the American Psychiatric Association (1), which is the most used document in investigation and communication in psychiatry, it is stated that the Depressive Disorder affects between 5 and 9% in women and 2 – 3% of men, while border line personality disorder, correspond to 2% of the general population. Both pathological disorders share dimensions of regulation of affection and control of impulses (2).

In these pathologies there are important impaired functions in at least three common systems of neurotransmission with behavioral features such as the cholinergic system, noradrenergic system and serotoninergic systems (3).

In this paper an intracomparisson of brain blood flow is reported of a group of patients with Mayor Depression and Borderline Personality, in basal conditions versus activation conditions with the Wisconsin Test, as well an intercomparisson between the results of both pathologies are reported.

In this work brain blood flow is quantified by SPECT Tc99m HMPAO evaluating the compromise in areas of the brain cortex, which are part of the three brain separate circuits (4) such as the frontal orbit circuit, the anterior cyngulate and the dorsolateral prefrontal circuit, with its afferences and efferences (5).

In the analysis of results we can see a compromise shared in structures linked to motivation, where the anterior cyngulate stands out, while the hipofuncionality induced by the Wisconsin test in borderline patients (P< 0.00005 to the right and< 0.0003 to the left) is more marked than in depressive patients ( P< 0.002 to the right and < 0.003 to the left).

The same happens in the area 32 of Brodmann (part of the limbic system), and the area 25 mentioned by Damasio (6) as the area of the "anhedonia" where the compromise exists in both pathologies.

There is only in borderline patients a significative compromise of the dorsolateral prefrontal area or executive area induced by the stress of the Wisconsin test. In the other hand in the depressive patients it was detected a more than 50%, more extensive hypoperfusion in the frontal orbit area related to emotions and this is evident (7) in basal conditions as well as with stimulation.