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Perroud N, Dayer A, Piguet C, Nallet A, Favre S, Malafosse A, Aubry JM. Childhood maltreatment and methylation of the glucocorticoid receptor gene NR3C1 in bipolar disorder. Br J Psychiatry 2014; 204:30-5. [PMID: 23743517 DOI: 10.1192/bjp.bp.112.120055] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Early-life adversities represent risk factors for the development of bipolar affective disorder and are associated with higher severity of the disorder. This may be the consequence of a sustained alteration of the hypothalamic-pituitary-adrenal (HPA) axis resulting from epigenetic modifications of the gene coding for the glucocorticoid receptor (NR3C1). AIMS To investigate whether severity of childhood maltreatment is associated with increased methylation of the exon 1F NR3C1 promoter in bipolar disorder. METHOD A sample of people with bipolar disorder (n = 99) were assessed for childhood traumatic experiences. The percentage of NR3C1 methylation was measured for each participant. RESULTS The higher the number of trauma events, the higher was the percentage of NR3C1 methylation (β = 0.52, 95% CI 0.46-0.59, P<<0.0001). The severity of each type of maltreatment (sexual, physical and emotional) was also associated with NR3C1 methylation status. CONCLUSIONS Early-life adversities have a sustained effect on the HPA axis through epigenetic processes and this effect may be measured in peripheral blood. This enduring biological impact of early trauma may alter the development of the brain and lead to adult psychopathological disorder.
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Affiliation(s)
- Nader Perroud
- Nader Perroud, MD, Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, and Department of Psychiatry, University of Geneva; Alexandre Dayer, MD, Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, and Departments of Basic Neuroscience and of Psychiatry, University of Geneva; Camille Piguet, MD, Department of Neuroscience, Faculty of Medicine, University of Geneva; Audrey Nallet, MSc, Sophie Favre, PhD, Department of Psychiatry, University of Geneva; Alain Malafosse, MD, PhD, Department of Psychiatry, University of Geneva, and Department of Genetic Medicine and Laboratories, Psychiatric Genetic Unit, University Hospitals of Geneva; Jean-Michel Aubry, MD, Department of Mental Health and Psychiatry, Bipolar Programme, Service of Psychiatric Specialties, University Hospitals of Geneva, Switzerland
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Feliu-Soler A, Soler J, Elices M, Pascual JC, Pérez J, Martín-Blanco A, Santos A, Crespo I, Pérez V, Portella MJ. Differences in attention and impulsivity between borderline personality disorder and bipolar disorder. Psychiatry Res 2013; 210:1307-9. [PMID: 24080255 DOI: 10.1016/j.psychres.2013.09.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 05/29/2013] [Accepted: 09/07/2013] [Indexed: 11/25/2022]
Abstract
This study aims at investigating attention and impulsivity differences between borderline personality disorder and bipolar disorder, as both diseases may share neuropsychological deficits. Differential cognitive outcomes on the Continuous Performance Test-II were observed between disorders, and also when compared to healthy controls.
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Affiliation(s)
- Albert Feliu-Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau. Centro de Investigación Biomédica en Red de Salud Mental (CIBER-SAM), Institut d'Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Universitat Autònoma de Barcelona (UAB), Spain.
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Malhi GS, Tanious M, Fritz K, Coulston CM, Bargh DM, Phan KL, Calhoun V, Das P. Differential engagement of the fronto-limbic network during emotion processing distinguishes bipolar and borderline personality disorder. Mol Psychiatry 2013; 18:1247-8. [PMID: 23439484 PMCID: PMC4429860 DOI: 10.1038/mp.2013.22] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- G S Malhi
- 1] CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, NSW, Australia [2] Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia [3] Advanced Research and Clinical Highfield Imaging (ARCHI), University of Sydney, Sydney, NSW, Australia
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Beatson JA, Rao S. Depression and borderline personality disorder. Med J Aust 2013; 199:S24-7. [DOI: 10.5694/mja12.10474] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 08/16/2012] [Indexed: 12/13/2022]
Affiliation(s)
| | - Sathya Rao
- Spectrum, The Personality Disorder Service for Victoria, Melbourne, VIC
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Malhi GS, Bargh DM, Kuiper S, Coulston CM, Das P. Modeling bipolar disorder suicidality. Bipolar Disord 2013; 15:559-74. [PMID: 23848394 DOI: 10.1111/bdi.12093] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 02/07/2013] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To review the psychosocial, neuropsychological, and neurobiological evidence regarding suicide and bipolar disorder (BD), to enable the development of an integrated model that facilitates understanding, and to provide a useful framework for future research. METHODS A two-stage literature review was conducted. First, an electronic literature search was performed using key words (e.g., bipolar disorder, suicide risk, and neuroimaging) and standard databases (e.g., MEDLINE). Second, theoretical suicide models were reviewed, and their evidence base and relevance to BD were evaluated in order to determine a guiding theoretical framework for contextualizing suicide in BD. RESULTS Although accumulating clinical, cognitive, and neurobiological correlates of suicide have been identified in BD, extant research has been largely atheoretical. The Cry of Pain (CoP) and an adapted version of the model, the Schematic Appraisals Model of Suicide (SAMS), provide a useful schema for examining vulnerability to suicide in BD, by taking into account biopsychosocial determinants of suicidality. In combination, these also provide a model within which the neural correlates of suicide can be integrated. CONCLUSIONS The proposed Bipolar Suicidality Model (BSM) highlights the psychosocial precursors to suicidality in BD, while recognizing the key role of cognitive deficits and underlying functional neurobiological abnormalities. It usefully integrates our knowledge, and provides a novel perspective that is intended to meaningfully inform future research initiatives, and can lead to a better understanding of suicidality in bipolar disorder. Ultimately, it is hoped that it will facilitate the development of targeted interventions that diminish the risk of suicide in bipolar disorder.
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Affiliation(s)
- Gin S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, NSW, Australia.
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Larsson S, Aas M, Klungsøyr O, Agartz I, Mork E, Steen NE, Barrett EA, Lagerberg TV, Røssberg JI, Melle I, Andreassen OA, Lorentzen S. Patterns of childhood adverse events are associated with clinical characteristics of bipolar disorder. BMC Psychiatry 2013; 13:97. [PMID: 23522391 PMCID: PMC3637635 DOI: 10.1186/1471-244x-13-97] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 03/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies in bipolar disorder investigating childhood trauma and clinical presentations of the illness have mainly focused on physical and sexual abuse. Our aim was to explore further the relationship between childhood trauma and disease characteristics in bipolar disorder to determine which clinical characteristics were most strongly associated with childhood trauma total score, as well as subtypes of adverse childhood events, including physical, sexual, emotional abuse and neglect. METHODS 141 Patients with bipolar disorder were consecutively recruited, and disease history and clinical characteristics were assessed. History of childhood abuse was obtained using the Childhood Trauma Questionnaire (CTQ). Statistical methods used were factor analysis, Poisson and linear regression, and generalized additive modeling (GAM). RESULTS The factor analysis of CTQ identified three factors: emotional abuse/neglect, sexual abuse and physical abuse. There were significant associations between CTQ total score and earlier onset of illness, reduced level of psychosocial functioning (GAF; Global Assessment of Functioning) and decreased number of hospitalization, which mainly were due to the factor emotional abuse/neglect. Physical abuse was significantly associated with lower GAF scores, and increased number of mood episodes, as well as self-harm. Sexual abuse was significantly associated with increased number of mood episodes. For mood episodes and self-harm the associations were characterized by great variance and fluctuations. CONCLUSIONS Our results suggest that childhood trauma is associated with a more severe course of bipolar illness. Further, childhood abuse (physical and sexual), as well as emotional abuse and neglect were significantly associated with accelerating staging process of bipolar disorder. By using specific trauma factors (physical abuse, sexual abuse and emotional abuse/neglect) the associations become both more precise, and diverse.
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Affiliation(s)
- Sara Larsson
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Monica Aas
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Klungsøyr
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Erlend Mork
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nils Eiel Steen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elizabeth A Barrett
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Jan Ivar Røssberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Steinar Lorentzen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, Clinic of Health and Addiction, University of Oslo, 1039, Blindern, Oslo, N-0315, Norway
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Empathy and social problem solving in alcohol dependence, mood disorders and selected personality disorders. Neurosci Biobehav Rev 2013; 37:448-70. [DOI: 10.1016/j.neubiorev.2013.01.024] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 01/18/2013] [Accepted: 01/28/2013] [Indexed: 12/30/2022]
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Abstract
PURPOSE OF REVIEW This review summarizes recent neurocognitive research to better delineate the nosology, prognostication and cause underlying borderline personality disorder (BPD). RECENT FINDINGS BPD had marked clinical heterogeneity with high comorbidity. Executive dysfunction in this disorder was linked to suicidality and treatment adherence, and may serve as an endophenotype. BPD was also characterized by cognitive distortions such as risky decision-making, deficient feedback processing, dichotomous thinking, jumping to conclusion, monocausal attribution and paranoid cognitive style. Social cognition deficits recently described in BPD include altered social inference and emotional empathy, hypermentalization, poorer facial emotional recognition and facial expressions. In electrophysiological studies, BPD was found to have predominantly right hemispheric deficit in high-order cortical inhibition. Reduced left orbitofrontal activity by visual evoked potential and magnetoencephalography correlated with depressive symptoms and functional deterioration. Brain structures implicated in BPD include the hippocampus, dorsolateral prefrontal cortex and anterior cingulate cortex. Abnormal anatomy and functioning of frontolimbic circuitry appear to correlate with cognitive deficits. SUMMARY Frontolimbic structural and functional abnormalities underlie the broad array of cognitive abnormalities in BPD. Further research should espouse broader considerations of effects of comorbidity and clinical heterogeneity, and include community samples and, possibly, longitudinal designs.
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Sjåstad HN, Gråwe RW, Egeland J. Affective disorders among patients with borderline personality disorder. PLoS One 2012; 7:e50930. [PMID: 23236411 PMCID: PMC3516502 DOI: 10.1371/journal.pone.0050930] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 10/26/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The high co-occurrence between borderline personality disorder and affective disorders has led many to believe that borderline personality disorder should be considered as part of an affective spectrum. The aim of the present study was to examine whether the prevalence of affective disorders are higher for patients with borderline personality disorder than for patients with other personality disorders. METHODS In a national cross-sectional study of patients receiving mental health treatment in Norway (N = 36 773), we determined whether psychiatric outpatients with borderline personality disorder (N = 1 043) had a higher prevalence of affective disorder in general, and whether they had an increased prevalence of depression, bipolar disorder or dysthymia specifically. They were compared to patients with paranoid, schizoid, dissocial, histrionic, obsessive-compulsive, avoidant, dependent, or unspecified personality disorder, as well as an aggregated group of patients with personality disorders other than the borderline type (N = 2 636). Odds ratios were computed for the borderline personality disorder group comparing it to the mixed sample of other personality disorders. Diagnostic assessments were conducted in routine clinical practice. RESULTS More subjects with borderline personality disorder suffered from unipolar than bipolar disorders. Nevertheless, borderline personality disorder had a lower rate of depression and dysthymia than several other personality disorder groups, whereas the rate of bipolar disorder tended to be higher. Odds ratios showed 34% lower risk for unipolar depression, 70% lower risk for dysthymia and 66% higher risk for bipolar disorder in patients with borderline personality disorder compared to the aggregated group of other personality disorders. CONCLUSIONS The results suggest that borderline personality disorder has a stronger association with affective disorders in the bipolar spectrum than disorders in the unipolar spectrum. This association may reflect an etiological relationship or diagnostic overlapping criteria.
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Affiliation(s)
- Hege Nordem Sjåstad
- Division of Mental Health and Addiction, Vestfold Hospital Trust, Tønsberg, Norway.
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Affiliation(s)
- Sandy Kuiper
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Genevieve Curran
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Gin S Malhi
- CADE Clinic, Department of Psychiatry, Royal North Shore Hospital, Sydney, Australia
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia
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Malhi GS. A 'conflict' of interests. Aust N Z J Psychiatry 2012; 46:491-2. [PMID: 22679199 DOI: 10.1177/0004867412446711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gin S Malhi
- Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, Australia.
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