title: Neural correlates of self-injurious behavior in Prader-Willi syndrome.
abstract: Individuals with Prader-Willi syndrome (PWS), a genetic disorder caused by mutations to the q11-13 region on chromosome 15, commonly show severe skin-picking behaviors that can cause open wounds and sores on the body. To our knowledge, however, no studies have examined the potential neural mechanisms underlying these behaviors. Seventeen individuals with PWS, aged 6-25 years, who showed severe skin-picking behaviors, were recruited and scanned on a 3T scanner. We used functional magnetic resonance imaging (fMRI) while episodes of skin picking were recorded on an MRI-safe video camera. Three participants displayed skin picking continuously throughout the scan, three participants did not display skin picking, and the data for one participant evidenced significant B0 inhomogeneity that could not be corrected. The data for the remaining 10 participants (six male, four female) who displayed a sufficient number of picking and nonpicking episodes were subjected to fMRI analysis. Results showed that regions involved in interoceptive, motor, attention, and somatosensory processing were activated during episodes of skin-picking behavior compared with nonpicking episodes. Scores obtained on the Self-Injury Trauma scale were significantly negatively correlated with mean activation within the right insula and left precentral gyrus. These data indicate that itch and pain processes appear to underlie skin-picking behaviors in PWS, suggesting that interoceptive disturbance may contribute to the severity and maintenance of abnormal skin-picking behaviors in PWS. Implications for treatments are discussed.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, California.
authors.forename: Megan
authors.initials: M
authors.lastname: Klabunde
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, California.
authors.forename: Manish
authors.initials: M
authors.lastname: Saggar
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, California.
authors.forename: Kristin M
authors.initials: KM
authors.lastname: Hustyi
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, California.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Hammond
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, California.
authors.forename: Allan L
authors.initials: AL
authors.lastname: Reiss
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, California.
authors.forename: Scott S
authors.initials: SS
authors.lastname: Hall
mesh_terms: D000293:Adolescent; D000328:Adult; D001288:Attention; D001931:Brain Mapping; D002648:Child; D003192:Compulsive Behavior; D005260:Female; D019416:Head Movements; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009068:Movement; D059906:Neuroimaging; D011218:Prader-Willi Syndrome / Q000235:genetics / Q000503:physiopathology* / Q000523:psychology; D016728:Self-Injurious Behavior / Q000503:physiopathology* / Q000523:psychology; D012677:Sensation; D012867:Skin; D055815:Young Adult
keywords: developmental disability; functional magnetic resonance imaging; genetic disorder; interoception; repetitive behavior