COMPARATIVE FUNCTIONAL STUDY OF TWO PSYCHIATRIC PATHOLOGIES BY MEANS OF BRAINSPECT TC 99 HMPAO: MAJOR DEPRESSION AND BORDERLINE PERSONALITY DISORDER.
INTRODUCTION
For Eric Kandel (recent Nobel prize in Medicine) (8) in the complex cognitives capacities, the main issue is not any more if the study of the brain localization is useful to understand which are the brain mechanisms by which these functions can be performed. This epistemological approximation orients to the dimensional study of the psychiatric states analyzing the behavior features, emphatizing the study of the brain circuits linked to conduct which act in modular form and facilitation areas of these circuits.
It is known (9) that the monoaminergic neural systems modulate the function of the circuits related to the executive capacity and that these same neurotransmissors have been related to aspects of the neurodevelopment to pathologies (10). A recent publication outstands the changes which occurs in the synapses through the neurodevelopment since the second week of life to a fully grown person (Chart I) and suggests that these changes if abnormal, would be responsible of the pathological states observed in patients. There is no doubt that genetics determines in a great amount, what will happen in the future of the individual(11). Nevertheless, the relation with the environment, and in particular with the most significative figures for a person in his infancy, such as the parents (12) (13) (14), influence the synaptic arquitecture.
GRAPHIC 1
In this same line, transcendental changes are known to occur at the age of 18 years (15), mainly in the II layer of pyramidal cells in the dorsolateral prefrontal cortex, that could be determining the onset of pathologies such as schizophrenia (16) and personality disorders in the early adult life (17).
We have thought necessary in this work to maintain a close assessment of cortical areas and the neurotransmission subjacent, as the study of the latter has started to be successful with Neurospect in patients with neurological psychiatric pathologies (Gilles de la Tourette, Parkinson’ Disease) and could be used in other psychiatric pathologies in the future. This approximation will permit to have an heuristic reading of what happens in the basal areas of the brain in relation to finding of changes in cortical hemodynamia.
In both pathologies presented in this work, there would be alterations (18) (19) mainly in two neurotransmission synaptic systems (See Graphic II), and these are linked to the control of impulses and affective demonstrations (20). The serotonynergic neurotransmission system, distributed throughout the brain and whose functionality has been associated to stability of mood, nociception, control of impulses and regulation of circadian cycles would be deregulated permanently in older depressive patients, who show discouragement, impairment of sleeping habits/vigil and in more advanced cases, decontrol and auto aggressive impulses and a diminution of pain and fear, which facilitates the attempts of suicide.
On the other hand, the inhibition linked to the depressive patients would be determined by the noradrenergic dysfunction.
In the case of borderline patients, the serotonynergic system would be dysfunctional episodically and would present short dystimic periods as intense as the mayor depression. The noradrenergic system also would present a decontrol transforming the impulsive autoaggressive acts in heteroaggressive acts, shown in borderline patients.
An explanatory graphic (II) can help to have a better comprehension.
GRAPHIC 2
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SEROTONINE |
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N O R E P I |
H Y P O R E A C T Y V E |
HIPOREACTIVE Diminished responsiveness to the environmental changes, Self-inflicting aggression which leads to suicidal attempts, Diminution to sensitivity to pain,. Neuroendocrine changes |
HIPERREACTIVE
Inhibitness, obsessive symptoms, Symptoms of body protection. |
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N E P H R I N E |
H Y P E R R E A C T Y V E |
External aggression, high-risk behavior, Search for novelty, Excessive reactivity to environmental changes coupled with impulsive activity. |
Increased reactivity to environment coupled with anxiety symptoms or anxiety traits of personality. |
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MODIFIED DE SIEVER AND FRUCHT
There are numerous papers which permit to point out dysfunction in borderline patients in specific neurotransmission systems and it can be stated that the noradrenaline "turns on the light", shows people the surrounding and invites them to act; while by serotonin, would indicate sometimes "stop", "donīt continue", if you do so you can have disastrous consequences. The depressive patients as well as the borderline patients have difficulties with these two systems.
The third neurotransmission system related to conduct stability (21, 22, 23), is the cholynergic system and borderline patients have demonstrated a clear emotional compromise when using cholynomimetics experimentally (24). Acetylcholine is also associated to cognition (25) and to other important behavioral events (26).
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