White matter network alterations in patients with depersonalization/derealization disorder - PubMed (original) (raw)
White matter network alterations in patients with depersonalization/derealization disorder
Anika Sierk et al. J Psychiatry Neurosci. 2018 Aug.
Abstract
Background: Depersonalization/derealization disorder (DPD) is a chronic and distressing condition characterized by detachment from oneself and/or the external world. Neuroimaging studies have associated DPD with structural and functional alterations in a variety of distinct brain regions. Such local neuronal changes might be mediated by altered interregional white matter connections. However, to our knowledge, no research on network characteristics in this patient population exists to date.
Methods: We explored the structural connectome in 23 individuals with DPD and 23 matched, healthy controls by applying graph theory to diffusion tensor imaging data. Mean interregional fractional anisotropy (FA) was used to define the network weights. Group differences were assessed using network-based statistics and a link-based controlling procedure.
Results: Our main finding refers to lower FA values within left temporal and right temporoparietal regions in individuals with DPD than in healthy controls when using a link-based controlling procedure. These links were also associated with dissociative symptom severity and could not be explained by anxiety or depression scores. Using network-based statistics, no significant results emerged. However, we found a trend for 1 subnetwork that may support the model of frontolimbic dysbalance suggested to underlie DPD symptomatology.
Limitations: To ensure ecological validity, patients with certain comorbidities or psychotropic medication were included in the study. Confirmatory replications are necessary to corroborate the results of this explorative investigation.
Conclusion: In patients with DPD, the structural connectivity between brain regions crucial for multimodal integration and emotion regulation may be altered. Aberrations in fibre tract communication seem to be not solely a secondary effect of local grey matter volume loss, but may present a primary pathophysiology in patients with DPD.
Conflict of interest statement
Competing interests: J.-P. declares personal fees from BIOTRONIK SE & Co. KG, outside the submitted work. No other competing interests declared.
Figures
Fig. 1
Flowchart of the preprocessing pipeline using FreeSurfer (
https://surfer.nmr.mgh.harvard.edu
) and ExploreDTI (
). CSD = constrained spherical deconvolution; EPI = echo-planar imaging.
Fig. 2
Visualization of the trend found in the group comparison when using network-based statistics. At an initial-link threshold of _p_lt = 0.005, a subnetwork was identified for which patients with depersonalization/derealization disorder (DPD) displayed lower fractional anisotropy (FA) (blue edges) as well as higher FA (red edges) than healthy controls (_p_FWE = 0.08). Patients showed relatively lower FA values between the left caudate, brainstem and the right amygdala, and higher FA between the left superior frontal gyrus, right medial frontal cortex and the right amygdala. FWE = family-wise error.
Fig. 3
Visualization of the 2 most outstanding results of the group comparison when using a link-based controlling procedure. First, (A) patients with depersonalization/derealization disorder (DPD) showed significantly lower fractional anisotropy (FA) between the right middle temporal gyrus and the right supramarginal gyrus. (B) The FA values within this connection were negatively correlated with dissociative symptom scores across groups, as measured by the CDS-30. Second, (C) relative to controls, patients with DPD showed significantly lower FA values between the left temporal pole and the left superior temporal gyrus. (D) Dissociative symptom severity correlated negatively with FA values of this connection. CDS = Cambridge Depersonalization Scale; FDR = false discovery rate; MTG = middle temporal gyrus; SMG = supramarginal gyrus; STG = superior temporal gyrus.
References
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