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Arıkan MK, Uysal Ö, Gıca Ş, Orhan Ö, İlhan R, Esmeray MT, Bakay H, Metin B, Pogarell O, Turan Ş. REM parameters in drug-free major depressive disorder: A systematic review and meta-analysis. Sleep Med Rev 2024; 73:101876. [PMID: 37995418 DOI: 10.1016/j.smrv.2023.101876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 11/11/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
Previous studies revealed that rapid eye movement (REM) parameters, such as REM latency (RL) and REM density (RD) could be used as electrophysiological markers of depression. Yet these finding should be re-tested in a comorbid-free and drug-free sample. The present systematic review and meta-analysis was conducted to investigate whether drug-free and comorbid-free patients with unipolar depression differentiate from controls with respect to the RL and RD. The PubMed and Web of Science databases were screened from inception to 23 January 2023 for case-control studies comparing RL and RD of patients with unipolar depression and controls. The primary outcome was the standard mean difference. The data were fitted with a random-effects model. Meta-regressions were conducted to investigate patient characteristics and effect size. Publication bias assessment was checked by Egger's Regression and funnel plot asymmetry. Among 43 articles accepted as eligible, 46 RL and 22 RD measurements were included in the meta-analysis. The results indicated shortened RL and increased RD in the patient group than controls. Neither Egger's regression nor funnel plot asymmetry were significant for publication bias. In conclusion, our results tested within drug-free and comorbid-free samples are in line with the literature.
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Affiliation(s)
| | - Ömer Uysal
- Istanbul University Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Department of Biostatistics, Istanbul, Turkey
| | - Şakir Gıca
- Department of Mental Health and Disease, MERAM School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Özden Orhan
- Kemal Arıkan Psychiatry Clinic, Istanbul, Turkey
| | - Reyhan İlhan
- Kemal Arıkan Psychiatry Clinic, Istanbul, Turkey
| | | | - Hasan Bakay
- Department of Mental Health and Disease, MERAM School of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Barış Metin
- Department of Neurology, Medical Faculty, Uskudar University, Istanbul, Turkey
| | - Oliver Pogarell
- Department of Psychiatry, Division of Clinical Neurophysiology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Şenol Turan
- Istanbul University Cerrahpasa, Department of Psychiatry, Cerrahpasa Medical School, Istanbul, Turkey
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2
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Boland C, Jalihal V, Organ C, Oak K, McLean B, Laugharne R, Woldman W, Beck R, Shankar R. EEG Markers in Emotionally Unstable Personality Disorder-A Possible Outcome Measure for Neurofeedback: A Narrative Review. Clin EEG Neurosci 2021; 52:254-273. [PMID: 32635758 DOI: 10.1177/1550059420937948] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objectives. There is growing evidence for the use of biofeedback (BF) in affective disorders, dissocial personality disorder, and in children with histories of abuse. Electroencephalogram (EEG) markers could be used as neurofeedback in emotionally unstable personality disorder (EUPD) management especially for those at high risk of suicide when emotionally aroused. This narrative review investigates the evidence for EEG markers in EUPD. Methods. PRISMA guidelines were used to conduct a narrative review. A structured search method was developed and implemented in collaboration with an information specialist. Studies were identified via 3 electronic database searches of MEDLINE, Embase, and PsycINFO. A predesigned inclusion/exclusion criterion was applied to selected papers. A thematic analysis approach with 5 criteria was used. Results. From an initial long list of 5250 papers, 229 studies were identified and screened, of which 44 met at least 3 of the predesigned inclusion criteria. No research to date investigates EEG-based neurofeedback in EUPD. A number of different EEG biomarkers are identified but there is poor consistency between studies. Conclusions. The findings heterogeneity may be due to the disorder complexity and the variable EEG related parameters studied. An alternative explanation may be that there are a number of different neuromarkers, which could be clustered together with clinical symptomatology, to give new subdomains. Quantitative EEGs in particular may be helpful to identify more specific abnormalities. EEG standardization of neurofeedback protocols based on specific EEG abnormalities detected may facilitate targeted use of neurofeedback as an intervention in EUPD.
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Affiliation(s)
- Cailín Boland
- Saint James's Hospital, Dublin, Ireland.,8809Trinity College Dublin, Dublin, Ireland
| | | | | | - Katy Oak
- 8028Royal Cornwall Hospitals Trust, Truro, UK
| | | | - Richard Laugharne
- 7491Cornwall Partnership NHS Foundation Trust, Truro, UK.,151756Exeter Medical School, Exeter, UK
| | | | - Randy Beck
- Institute of Functional Neuroscience, Perth, Western Australia, Australia
| | - Rohit Shankar
- 7491Cornwall Partnership NHS Foundation Trust, Truro, UK.,151756Exeter Medical School, Exeter, UK
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3
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Vanek J, Prasko J, Ociskova M, Hodny F, Holubova M, Minarikova K, Slepecky M, Nesnidal V. Insomnia in Patients with Borderline Personality Disorder. Nat Sci Sleep 2021; 13:239-250. [PMID: 33654445 PMCID: PMC7910080 DOI: 10.2147/nss.s295030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Both sleep disorders and BPD are prevalent in the population, and one is often a comorbidity of the other. This narrative review aims to assess contemporary literature and scientific databases to provide the current state of knowledge about sleep disorders in patients with borderline personality disorder (BPD) and clinical suggestions for managing sleep disorders in BPD patients and future research direction. METHODS Articles were acquired via PubMed and Web of Science, and papers published between January 1980 and October 2020 were extracted. Authors made a series of literature searches using the keywords: Sleep problems, Insomnia, Nightmares, Obstructive sleep apnea, Borderline personality disorder. The inclusion criteria were: published in peer-reviewed journals; studies in humans; or reviews on the related topic; English language. The exclusion criteria were: abstracts from conferences; commentaries; subjects younger than 18 years. After an inspection of the full texts, 42 papers from 101 were selected. Secondary documents from the reference lists of the primary designated papers were searched, assessed for suitability, and included. In total, 71 papers were included in the review process. RESULTS Sleep disturbance is common among patients with BPD. Nevertheless, the number of investigations is limited, and the prevalence differs between 5-45%. Studies assessing objective changes in sleep architecture in BPD show inconsistent results. Some of them identify REM sleep changes and a decrease in slow-wave sleep, while other studies found no objective sleep architecture changes. There is also a higher prevalence of nightmares in patients with BPD. Untreated insomnia can worsen BPD symptoms via interference with emotional regulation. BPD itself seems to influence the subjective quality of sleep significantly. Proper diagnosis and treatment of sleep disorders in patients with BPD could lead to better results in therapy. Psychotherapeutic approaches can improve both sleep disorders and BPD symptoms. CONCLUSION Recognising and managing sleep disorders in patients with BPD may help alleviate the disorder's symptoms. Treatment of people with BPD may be more effective if the treatment plan explicitly addresses sleep problems. Further research is needed to reach reliable conclusions.
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Affiliation(s)
- Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic
| | - Kamila Minarikova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Vlastimil Nesnidal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
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McGowan N, Goodwin G, Bilderbeck A, Saunders K. Actigraphic patterns, impulsivity and mood instability in bipolar disorder, borderline personality disorder and healthy controls. Acta Psychiatr Scand 2020; 141:374-384. [PMID: 31916240 PMCID: PMC7216871 DOI: 10.1111/acps.13148] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/02/2020] [Accepted: 01/05/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To differentiate the relation between the structure and timing of rest-activity patterns and symptoms of impulsivity and mood instability in bipolar disorder (BD), borderline personality disorder (BPD) and healthy controls (HC). METHODS Eighty-seven participants (31 BD, 21 BPD and 35 HC) underwent actigraph monitoring for 28 days as part of the Automated Monitoring of Symptom Severity (AMoSS) study. Impulsivity was assessed at study entry using the BIS-11. Mood instability was subsequently longitudinally monitored using the digital Mood Zoom questionnaire. RESULTS BPD participants show several robust and significant correlations between non-parametric circadian rest-activity variables and worsened symptoms. Impulsivity was associated with low interdaily stability (r = -0.663) and weak amplitude (r = -0.616). Mood instability was associated with low interdaily stability (r = -0.773), greater rhythm fragmentation (r = 0.662), weak amplitude (r = -0.694) and later onset of daily activity (r = 0.553). These associations were not present for BD or HCs. Classification analysis using actigraphic measures determined that later L5 onset reliably distinguished BPD from BD and HC but did not sufficiently discriminate between BD and HC. CONCLUSIONS Rest-activity pattern disturbance indicative of perturbed sleep and circadian function is an important predictor of symptom severity in BPD. This appears to validate the greater subjective complaints of BPD individuals that are sometimes regarded as exaggerated by clinicians. We suggest that treatment strategies directed towards improving sleep and circadian entrainment may in the future be investigated in BPD.
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Affiliation(s)
- N.M. McGowan
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - G.M. Goodwin
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK
| | | | - K.E.A. Saunders
- Department of PsychiatryUniversity of OxfordOxfordUK,Oxford Health NHS Foundation TrustWarneford HospitalOxfordUK,NIHR Oxford Health Biomedical Research CentreOxfordUK
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5
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Weibel S, Jermann F, Weiner L, Nicastro R, Ardu S, Pham E, Hasler R, Dayer A, Prada P, Perroud N. Insomnia in adult attention-deficit/hyperactivity disorder: A comparison with borderline personality disorder population in a clinical setting and control participants. Compr Psychiatry 2017; 76:119-128. [PMID: 28501733 DOI: 10.1016/j.comppsych.2017.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 03/29/2017] [Accepted: 04/28/2017] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Many adults with attention-deficit/hyperactivity disorder (ADHD) report sleeping difficulties. The relationship between sleep and ADHD is poorly understood, and shows discrepancies between subjective and objective measures. In order to determine the specificity of sleep-associated symptoms in ADHD, subjective sleep assessments among ADHD adult patients were compared with control subjects and with individuals suffering from borderline personality disorder (BPD). METHODS 129 outpatients with ADHD, 70 with BPD (including 17 patients with BPD and ADHD comorbidity), and 65 control participants were assessed for sleep quality, insomnia, and sleepiness, using the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). RESULTS ADHD- and BPD-sufferers achieved higher insomnia and lower sleep quality scores than control subjects. Clinical groups did not differ in terms of sleep quality, although insomnia was more severe among BPD patients. Depression scores explained most of sleep symptoms, but even when controlling for depression, ADHD sufferers showed higher sleep latency. Inattentive symptoms were associated with somnolence, while hyperactive/impulsive symptoms were associated with insomnia and lower sleep efficiency. CONCLUSION Sleep-related symptoms associated with ADHD were partly explained by non-specific factors, especially depression symptoms. In a dimensional perspective, hyperactive and inattentive symptoms were associated with specific sleep symptoms.
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Affiliation(s)
- Sébastien Weibel
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland.
| | - Françoise Jermann
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Luisa Weiner
- Department of Psychiatry, Mental Health and Addictology, University Hospital of Strasbourg, Strasbourg, France
| | - Rosetta Nicastro
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Stefano Ardu
- Department of Cariology and Endodontology, Treatment Plan Unit and Division of Operative Dentistry, Dental School, University of Geneva, Geneva, Switzerland
| | - Eleonore Pham
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Paco Prada
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Service of psychiatric specialties, Department of mental Health and Psychiatry, University Hospital of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
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6
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The sleep phenotype of Borderline Personality Disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev 2017; 73:48-67. [DOI: 10.1016/j.neubiorev.2016.12.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 11/22/2016] [Accepted: 12/09/2016] [Indexed: 12/30/2022]
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7
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Baglioni C, Nanovska S, Regen W, Spiegelhalder K, Feige B, Nissen C, Reynolds CF, Riemann D. Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychol Bull 2016; 142:969-990. [PMID: 27416139 PMCID: PMC5110386 DOI: 10.1037/bul0000053] [Citation(s) in RCA: 535] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Investigating sleep in mental disorders has the potential to reveal both disorder-specific and transdiagnostic psychophysiological mechanisms. This meta-analysis aimed at determining the polysomnographic (PSG) characteristics of several mental disorders. Relevant studies were searched through standard strategies. Controlled PSG studies evaluating sleep in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, attention-deficit-hyperactivity disorder (ADHD), and schizophrenia were included. PSG variables of sleep continuity, depth, and architecture, as well as rapid-eye movement (REM) sleep were considered. Calculations were performed with the "Comprehensive Meta-Analysis" and "R" software. Using random effects modeling, for each disorder and each variable, a separate meta-analysis was conducted if at least 3 studies were available for calculation of effect sizes as standardized means (Hedges' g). Sources of variability, that is, sex, age, and mental disorders comorbidity, were evaluated in subgroup analyses. Sleep alterations were evidenced in all disorders, with the exception of ADHD and seasonal affective disorders. Sleep continuity problems were observed in most mental disorders. Sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders. Comorbidity was associated with enhanced REM sleep pressure and more inhibition of sleep depth. No sleep parameter was exclusively altered in 1 condition; however, no 2 conditions shared the same PSG profile. Sleep continuity disturbances imply a transdiagnostic imbalance in the arousal system likely representing a basic dimension of mental health. Sleep depth and REM variables might play a key role in psychiatric comorbidity processes. Constellations of sleep alterations may define distinct disorders better than alterations in 1 single variable. (PsycINFO Database Record
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Affiliation(s)
- Chiara Baglioni
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Svetoslava Nanovska
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Wolfram Regen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Bernd Feige
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Christoph Nissen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | | | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
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8
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Huỳnh C, Guilé JM, Breton JJ, Godbout R. Sleep-Wake Patterns of Adolescents with Borderline Personality Disorder and Bipolar Disorder. Child Psychiatry Hum Dev 2016; 47:202-14. [PMID: 26003420 DOI: 10.1007/s10578-015-0557-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Sleep-wake patterns are rarely examined in adolescents with borderline personality disorder (BPD) or bipolar disorder (BD). Within a developmental perspective, this study explores the sleep-wake cycle of adolescents aged 12-17 years with BPD or BD and healthy controls (HC) during periods with and without entrainment by school/work schedules. Eighteen euthymic BPD, six euthymic BD, and 20 HC adolescents wore wrist actigraphy during nine consecutive days to assess sleep-wake patterns. During school/work days, BPD adolescents spent more time awake when they were in bed compared to HC and BD adolescents (p = 0.039). On schedule-free days, BPD and BD youths spent more time in bed compared to HC adolescents (p = 0.015). BPD adolescents woke up over 1 h later compared to HC (p = 0.003). Total sleep time was more variable between nights in BPD adolescents compared to the HC group (p = 0.031). Future research should explore if sleep-wake pattern disruptions are a cause or a consequence of BPD symptomatology in adolescents. Addressing sleep-wake pattern during clinical assessment and treatment of BPD adolescents may potentially reduce their symptoms; this therapeutic effect still needs to be evaluated.
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Affiliation(s)
- Christophe Huỳnh
- Sleep Laboratory and Clinic, Rivière-des-Prairies Hospital, 7070 Boul. Perras, Montréal, QC, H1E 1A4, Canada
- Mood Disorders Clinic and Research Branch, Rivière-des-Prairies Hospital, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
- Research Centre, Rivière-des-Prairies Hospital and Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Jean-Marc Guilé
- Mood Disorders Clinic and Research Branch, Rivière-des-Prairies Hospital, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Jean-Jacques Breton
- Mood Disorders Clinic and Research Branch, Rivière-des-Prairies Hospital, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
- Research Centre, Rivière-des-Prairies Hospital and Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | - Roger Godbout
- Sleep Laboratory and Clinic, Rivière-des-Prairies Hospital, 7070 Boul. Perras, Montréal, QC, H1E 1A4, Canada.
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada.
- Research Centre, Rivière-des-Prairies Hospital and Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada.
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9
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Weinhold SL, Göder R, Pabst A, Scharff AL, Schauer M, Baier PC, Aldenhoff J, Elbert T, Seeck-Hirschner M. Sleep recordings in individuals with borderline personality disorder before and after trauma therapy. J Neural Transm (Vienna) 2016; 124:99-107. [PMID: 26970970 DOI: 10.1007/s00702-016-1536-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 02/26/2016] [Indexed: 10/22/2022]
Abstract
Most individuals diagnosed with borderline personality disorder (BPD) have been exposed to severe and traumatic stressors and thus frequently present with symptoms of a posttraumatic stress disorder (PTSD). Severe sleep disturbances often accompany these complex cases, but changes of sleep parameters during therapy and the impact of sleep on treatment response have barely been studied. Narrative Exposure Therapy (NET) is an evidence-based approach for the treatment of trauma-related psychological disorders. To investigate the effect of NET on sleep in patients with BPD and comorbid PTSD, we screened 45 inpatients and outpatients who met the inclusion criteria of both diagnoses according to DSM-IV and who had a minimum of 2 weeks' stable medication. Patients were allocated to NET (N = 13) or treatment as usual (TAU; N = 8) in blocks. Polysomnographies and psychological questionares were performed before, directly and 6 months after the last therapy session. The aim of this pilot study was to investigate the effectiveness of trauma therapy by NET on sleep quantity (total sleep time) and sleep continuity (sleep efficiency and awakenings) in patients with comorbid BPD and PTSD. Participants of the NET group compared with those who received TAU showed an increased reduction in sleep latency from baseline to the end of therapy and a reduction in arousals over time. Patients with longer pre-treatment total sleep time and pre-treatment REM sleep duration showed a better outcome of NET with respect to PTSD symptoms. NET seems not lead to a change in sleep for the worse during therapy and seems to improve sleep as good as treatment as usual. Furthermore, our results provide evidence of an influence of sleep structure at baseline on treatment success later on.
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Affiliation(s)
- Sara Lena Weinhold
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Robert Göder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany.
| | - Astrid Pabst
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Anna-Lena Scharff
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Maggie Schauer
- Department of Psychology, University of Konstanz, Constance, Germany
| | - Paul Christian Baier
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Josef Aldenhoff
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-University Kiel, Niemannsweg 147, 24105, Kiel, Germany
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Constance, Germany
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10
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Skrzypińska D, Szmigielska B. Dream-reality confusion in borderline personality disorder: a theoretical analysis. Front Psychol 2015; 6:1393. [PMID: 26441768 PMCID: PMC4569816 DOI: 10.3389/fpsyg.2015.01393] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022] Open
Abstract
This paper presents an analysis of dream-reality confusion (DRC) in relation to the characteristics of borderline personality disorder (BPD), based on research findings and theoretical considerations. It is hypothesized that people with BPD are more likely to experience DRC compared to people in non-clinical population. Several variables related to this hypothesis were identified through a theoretical analysis of the scientific literature. Sleep disturbances: problems with sleep are found in 15–95.5% of people with BPD (Hafizi, 2013), and unstable sleep and wake cycles, which occur in BPD (Fleischer et al., 2012), are linked to DRC. Dissociation: nearly two-thirds of people with BPD experience dissociative symptoms (Korzekwa and Pain, 2009) and dissociative symptoms are correlated with a fantasy proneness; both dissociative symptoms and fantasy proneness are related to DRC (Giesbrecht and Merckelbach, 2006). Negative dream content: People with BPD have nightmares more often than other people (Semiz et al., 2008); dreams that are more likely to be confused with reality tend to be more realistic and unpleasant, and are reflected in waking behavior (Rassin et al., 2001). Cognitive disturbances: Many BPD patients experience various cognitive disturbances, including problems with reality testing (Fiqueierdo, 2006; Mosquera et al., 2011), which can foster DRC. Thin boundaries: People with thin boundaries are more prone to DRC than people with thick boundaries, and people with BPD tend to have thin boundaries (Hartmann, 2011). The theoretical analysis on the basis of these findings suggests that people who suffer from BPD may be more susceptible to confusing dream content with actual waking events.
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Affiliation(s)
- Dagna Skrzypińska
- Unit of Sleep Psychology, Institute of Psychology, Jagiellonian University Krakow, Poland
| | - Barbara Szmigielska
- Unit of Sleep Psychology, Institute of Psychology, Jagiellonian University Krakow, Poland
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Oltmanns JR, Oltmanns TF. Borderline Personality Pathology, Polysomnography, and Self-Reported Sleep Problems: A Review. CURRENT SLEEP MEDICINE REPORTS 2015. [DOI: 10.1007/s40675-015-0011-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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12
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Oltmanns JR, Weinstein Y, Oltmanns TF. Borderline personality pathology and insomnia symptoms in community-dwelling older adults. Personal Ment Health 2014; 8:178-87. [PMID: 24574136 PMCID: PMC4365934 DOI: 10.1002/pmh.1259] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 01/28/2014] [Accepted: 01/29/2014] [Indexed: 11/09/2022]
Abstract
Prior research has associated BPD with sleep problems, but the relationship has been explored primarily in small clinical samples of younger adults. Findings from our lab have demonstrated that borderline symptoms remain present in later middle age and are associated with several negative life outcomes. A representative community sample of older adults (N = 633, Mage = 62.3) was obtained from the St Louis area, and interviewer-reports, self-reports, and informant-reports of personality pathology were completed along with an insomnia symptoms questionnaire. Cross-sectional analyses revealed that symptoms from all 10 DSM-IV personality disorders were significantly correlated with insomnia symptoms. However, after statistically controlling for major depression, body-mass index, race and gender, only borderline personality pathology remained significantly associated with insomnia symptoms. Our results demonstrate that in addition to other negative health outcomes, borderline personality pathology is uniquely associated with sleep problems in later middle-aged adults in the community.
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Affiliation(s)
- Joshua R Oltmanns
- Department of Psychology, Washington University in St. Louis, St. Louis, MO, United States
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13
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Hafizi S. Sleep and borderline personality disorder: a review. Asian J Psychiatr 2013; 6:452-9. [PMID: 24309854 DOI: 10.1016/j.ajp.2013.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 06/24/2013] [Accepted: 06/28/2013] [Indexed: 12/17/2022]
Abstract
Sleep problems are very common among psychiatric patients. Borderline personality disorder, as a common and severe mental disorder, is associated with different types of sleep disturbances, such as disturbances of sleep continuity, altered REM sleep regulation and nightmares. These disturbances are the result of interaction of the personality traits, concomitant and comorbid diseases and environmental factors. Despite the high prevalence of sleep related disorders in BPD patients, this aspect of BPD is still neglected in clinical and research settings. To date there has been little agreement on sleep characteristics of BPD among different studies, and presence of some uncontrolled confounding factors, make interpretation of the results difficult. However, it seems that appropriate diagnosis and treatment of sleep disorders in BPD patients might lead to better outcome. This article aimed to review the current literature of sleep studies in BPD. Some recommendations and suggestions were made for future researches in this field.
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Affiliation(s)
- Sina Hafizi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Simor P, Horváth K. Altered sleep in Borderline Personality Disorder in relation to the core dimensions of psychopathology. Scand J Psychol 2013; 54:300-12. [PMID: 23574575 DOI: 10.1111/sjop.12048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 01/19/2013] [Indexed: 11/29/2022]
Abstract
The aim of the study was to review the literature regarding sleep disturbances in Borderline Personality Disorder (BPD) and to relate the reported sleep alterations to the underlying core dimensions of BPD pathology. We present a qualitative and theoretical review regarding the empirical studies that investigated objective and subjective sleep quality in BPD and in different psychiatric conditions showing high co-morbidity with this disorder. We show that disturbed sleep including sleep fragmentation, alterations in Slow Wave Sleep and REM sleep, and dysphoric dreaming are prevalent symptoms in BPD. We provide a framework relating the specific sleep alterations to the core dimensions of BPD pathology in order to clarify the inconsistencies of the different findings. The specific sleep disturbances in BPD seem to be related to different dimensions of psychopathological functioning and may have detrimental consequences on waking affect and cognition. Investigating disturbed sleep in BPD in relation to waking symptoms and underlying neural functioning would shed more light on the nature of this complex disorder. Moreover, a stronger emphasis on sleep disturbances would enrich the treatment protocols of BPD.
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Affiliation(s)
- Péter Simor
- Department of Cognitive Sciences, Budapest University of Technology and Economics, Budapest, Hungary.
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15
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Schredl M, Paul F, Reinhard I, Ebner-Priemer UW, Schmahl C, Bohus M. Sleep and dreaming in patients with borderline personality disorder: a polysomnographic study. Psychiatry Res 2012; 200:430-6. [PMID: 22657954 DOI: 10.1016/j.psychres.2012.04.036] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 04/26/2012] [Accepted: 04/29/2012] [Indexed: 10/28/2022]
Abstract
Previous research has demonstrated disturbances in sleep continuity in subjects with borderline personality disorders (BPD). Moreover, depression-like sleep abnormalities like reduced REM latency have been found in BPD subjects, even without comorbid major depression disorder. Yet it is still unknown what the effect is of co-morbid posttraumatic stress disorder on sleep continuity and dream content in BPD patients group. The present study compared 27 unmedicated female BPD subjects and healthy controls. The patients exhibited increased sleep fragmentation, increased REM density, and reduced REM latency. The findings were independent from co-morbid posttraumatic stress response (PTSD), which was present in 33% of the patient sample. Negatively toned dreams obtained by REM awakenings and nightmares were also reported more often by the patients-also irrespective of co-morbid PTSD-whereas dreams of specific BPD behavior, like self-mutilation, were rare. Taking these finding into account, one might productively investigate whether the sleep abnormalities improve during successful treatment of BPD and whether efficient methods for treating nightmares can be beneficial for this patient group.
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16
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Sleep disturbances and circadian CLOCK genes in borderline personality disorder. J Neural Transm (Vienna) 2012; 119:1105-10. [DOI: 10.1007/s00702-012-0860-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 06/29/2012] [Indexed: 01/03/2023]
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17
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Bassett D. Borderline personality disorder and bipolar affective disorder. Spectra or spectre? A review. Aust N Z J Psychiatry 2012; 46:327-39. [PMID: 22508593 DOI: 10.1177/0004867411435289] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Bipolar affective disorder and borderline personality disorder have long been considered to have significant similarities and comorbidity. This review endeavours to clarify the similarities and differences between these disorders, with an effort to determine whether they reflect different forms of the same illness or separate illness clusters. METHOD The published literature relating to bipolar affective disorders, borderline personality disorders, and related areas of knowledge was reviewed using searches of several electronic databases (AMED, CINHAL, Embase, Ovid, ProQuest, MEDLINE, Web of Science, ScienceDirect) and published texts. These findings were combined with the personal clinical experience of the author, and information gathered from colleagues, to create a review of this topic. RESULTS Bipolar affective disorders and borderline personality disorders differ with respect to sense of self, disruption of relationships, family history of bipolar disorders, the benefits of medications, the extent of cognitive deficits, the form of affective dysregulation and mood cycling, the incidence of suicide and suicide attempts, the form of psychotic episodes, the incidence of early sexual abuse but not early trauma in general, the loss of brain substance, alterations in cortical activity, glucocorticoid receptor sensitivity, and mitochondrial dysfunction. They are similar with respect to non-specific features of affective dysregulation, the incidence of atypical depressive features, the incidence of self-mutilation, the incidence of transporter polymorphisms, possible genetic linkages, overall reduction in limbic modulation, reduction in the size of hippocampi and amygdala, and the incidence of sleep disruption. CONCLUSIONS This review concludes that bipolar affective disorders and borderline personality disorder are separate disorders, but have significant elements in common.
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Affiliation(s)
- Darryl Bassett
- School of Medicine, University of Notre Dame, Fremantle Australia.
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18
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Huynh C, Guilé JM, Godbout R. Études polysomnographiques du sommeil dans le trouble de personnalité limite chez l’adulte. Presse Med 2012; 41:e63-75. [DOI: 10.1016/j.lpm.2011.06.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/10/2011] [Indexed: 10/17/2022] Open
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Sansone RA, Edwards HC, Forbis JS. Sleep quality in borderline personality disorder: a cross-sectional study. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12. [PMID: 21274357 DOI: 10.4088/pcc.09m00919bro] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Accepted: 12/28/2009] [Indexed: 10/19/2022]
Abstract
OBJECTIVE In this study, relationships between sleep quality and borderline personality disorder were examined using 2 self-report measures. METHOD Using a cross-sectional design in a sample of convenience of internal medicine outpatients, we surveyed men and women (N=76), aged 18 years or older, who were seeking nonemergent medical care during the period January 2009 to September 2009. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and borderline personality was assessed with 2 measures: the borderline personality scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). RESULTS The global PSQI score was statistically significantly associated with scores on the PDQ-4 (P < .01), the SHI (P < .01), and the combination PDQ-4 and SHI (P < .01). With regard to the components of the PSQI, subjective sleep quality (P < .05), sleep duration (P < .05), and daytime dysfunction (P < .01) were all statistically significantly associated with scores on the PDQ-4, and sleep latency was statistically significantly associated with the combined PDQ-4 and SHI (P < .05). CONCLUSIONS Individuals with borderline personality symptomatology demonstrate a poorer overall quality of sleep than those without these symptoms.
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Affiliation(s)
- Randy A Sansone
- Department of Psychiatry and Internal Medicine, Wright State University School of Medicine, Dayton.
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De la Fuente JM, Bengoetxea E, Navarro F, Bobes J, Alarcón RD. Interconnection between biological abnormalities in borderline personality disorder: use of the Bayesian networks model. Psychiatry Res 2011; 186:315-9. [PMID: 20858567 DOI: 10.1016/j.psychres.2010.08.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2010] [Revised: 08/24/2010] [Accepted: 08/26/2010] [Indexed: 11/26/2022]
Abstract
There is agreement in that strengthening the sets of neurobiological data would reinforce the diagnostic objectivity of many psychiatric entities. This article attempts to use this approach in borderline personality disorder (BPD). Assuming that most of the biological findings in BPD reflect common underlying pathophysiological processes we hypothesized that most of the data involved in the findings would be statistically interconnected and interdependent, indicating biological consistency for this diagnosis. Prospectively obtained data on scalp and sleep electroencephalography (EEG), clinical neurologic soft signs, the dexamethasone suppression and thyrotropin-releasing hormone stimulation tests of 20 consecutive BPD patients were used to generate a Bayesian network model, an artificial intelligence paradigm that visually illustrates eventual associations (or inter-dependencies) between otherwise seemingly unrelated variables. The Bayesian network model identified relationships among most of the variables. EEG and TSH were the variables that influence most of the others, especially sleep parameters. Neurological soft signs were linked with EEG, TSH, and sleep parameters. The results suggest the possibility of using objective neurobiological variables to strengthen the validity of future diagnostic criteria and nosological characterization of BPD.
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Ottoni GL, Lorenzi TM, Lara DR. Association of temperament with subjective sleep patterns. J Affect Disord 2011; 128:120-7. [PMID: 20584550 DOI: 10.1016/j.jad.2010.06.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 04/26/2010] [Accepted: 06/03/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Emotional and cognitive functioning have been involved in insomnia etiology, and sleep disturbances are closely related to psychiatric disorders and personality traits. This study investigates the association of temperament with subjective sleep parameters. METHODS In this web-survey, 5129 subjects (25.3% males) completed the Combined Emotional and Affective Temperament Scale (CEATS), which assesses emotional (fear, anger, drive and control) and affective (e.g. cyclothymic, hyperthymic) temperaments. Subjects also answered questions regarding subjective sleep parameters, psychiatric diagnosis, psychotropic medication intake and cigarette smoking. RESULTS As control scores decreased, the later were the bed and the wake up time. Total sleep time was weakly associated with emotional temperaments. The higher the score of anger and the lower the score of control, the higher was the sleep-onset latency. As the anger score increased and the drive, fear and control scores decreased, the higher the number of nightly awakenings. The higher the drive and the control and the lower the anger scores, the better the sleep quality. For affective temperaments, depressives, labiles (related to ADHD) and cyclothymics (related to bipolar II disorders) go to bed and wake up later and have a worse profile regarding other sleep parameters. Hyperthymics and euthymics showed favorable sleep profiles. LIMITATIONS Sample included a significant number of subjects with psychiatric diseases and on psychotropic medication. CONCLUSION Dysregulated emotional activation (expressed as higher anger, and lower control and drive), as well as depressive, labile and cyclothymic affective temperaments were related to more dysfunctional sleep patterns.
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Affiliation(s)
- Gustavo L Ottoni
- Departamento de Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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22
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Marissen MAE, Meuleman L, Franken IHA. Altered emotional information processing in borderline personality disorder: an electrophysiological study. Psychiatry Res 2010; 181:226-32. [PMID: 20153144 DOI: 10.1016/j.pscychresns.2009.10.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 08/05/2009] [Accepted: 10/16/2009] [Indexed: 10/19/2022]
Abstract
Emotional dysregulation is one of the key symptoms of patients with borderline personality disorder (BPD). In the present study it is hypothesized that borderline patients display a cortical hyper-responsivity to emotional stimuli compared with a healthy control group. Further, we aimed to examine whether BPD patients were able to suppress stimuli with negative emotional valence as well as healthy control participants could. This is the first study addressing the electrophysiological processing of emotional stimuli in BPD. The electrophysiological response to emotional information was studied among 30 BPD patients and compared with the response in 30 normal controls using event-related potentials (ERPs). Participants were shown pictures selected from the International Affective Picture System with neutral, positive, and negative valence. After performing an attentional task, the participants were asked to perform a reappraisal task. The assignment was to consciously suppress emotions that might occur after viewing pictures with an unpleasant content. Borderline patients displayed larger late positive potentials (LPP) to pictures with an unpleasant valence as compared with the control group, indicating an enhanced elaborative processing of unpleasant stimuli. However, they did not differ on the reappraisal task. Borderline patients show an enhanced emotional cortical reactivity to unpleasant stimuli as compared with a control group. This suggests an emotional dysfunctioning in BPD patients. This feature might be an important focus in the treatment of BPD.
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Affiliation(s)
- Marlies A E Marissen
- Centre for Personality Disorders, PsyQ, The Hague, The Netherlands; Erasmus University Rotterdam, Institute of Psychology, Rotterdam, The Netherlands.
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Harty L, Duckworth R, Thompson A, Stuewig J, Tangney JP. Are inmates' subjective sleep problems associated with borderline personality, psychopathy, and antisocial personality independent of depression and substance dependence? THE JOURNAL OF FORENSIC PSYCHIATRY & PSYCHOLOGY 2010; 21:23-39. [PMID: 20198127 PMCID: PMC2830015 DOI: 10.1080/14789940903194095] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Previous research investigating the relationship between Borderline Personality Disorder (BPD) and sleep problems, independent of depression, has been conducted on small atypical samples with mixed results. This study extends the literature by utilizing a much larger sample and by statistically controlling for depression and substance dependence. Subjective reports of sleep problems were obtained from 513 jail inmates (70% male) incarcerated on felony charges. Symptoms of BPD were significantly associated with sleep problems even when controlling for depression. Thus, sleep problems associated with BPD cannot be attributed simply to co-morbid symptoms of depression and substance dependence was ruled out as proximal causes for this relationship. Symptoms of depression, but not Antisocial Personality features, were related to sleep problems independent of substance dependence. Treatment of individuals with BPD may be more effective if sleep problems are explicitly addressed in the treatment plan.
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Plante DT, Zanarini MC, Frankenburg FR, Fitzmaurice GM. Sedative-hypnotic use in patients with borderline personality disorder and axis II comparison subjects. J Pers Disord 2009; 23:563-71. [PMID: 20001175 PMCID: PMC3222941 DOI: 10.1521/pedi.2009.23.6.563] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sleep disturbance is a common, yet poorly understood, phenomenon in borderline personality disorder (BPD). We examined the use of sedative-hypnotic medication in BPD, as part of a larger naturalistic study. In comparison to other personality disorder (OPD) comparison subjects, a significantly higher percentage of BPD subjects than OPD subjects used both as needed (prn) and standing medications to help them sleep. Specifically, over the course of the study, BPD subjects were approximately 4 times more likely to have used prn (OR = 4.27, 95% CI: 2.22-8.22) and standing sleeping medications (OR = 3.81, 95% CI: 1.88-7.72). When adjusted for differences in depression, anxiety, and age among BPD and OPD subjects, BPD subjects were approximately 3 times more likely to have used prn (adjusted OR = 3.38, 95% CI: 1.73-6.61) and standing sleeping medications (adjusted OR = 2.81, 95% CI: 1.33-5.95). These results indicate that sedative-hypnotic use is greater among BPD than OPD subjects. They also confirm clinical observations that subjective sleep disturbance is a significant problem in BPD.
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Affiliation(s)
- David T. Plante
- Division of Sleep Medicine, Harvard Medicial School, Boston, MA,Department of Medicine, Brigham and Women’s Hospital, Boston, MA
| | - Mary C. Zanarini
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Frances R. Frankenburg
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA,Edith Nourse Rogers Memorial Veterans Hospital Bedford, Massachusetts
| | - Garrett M. Fitzmaurice
- Department of Psychiatry, Harvard Medical School, Boston, MA,Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA,Department of Biostatistics, Harvard School of Public Health, Boston, MA
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Elst LTV, Groffmann M, Ebert D, Schulze-Bonhage A. Amygdala volume loss in patients with dysphoric disorder of epilepsy. Epilepsy Behav 2009; 16:105-12. [PMID: 19616480 DOI: 10.1016/j.yebeh.2009.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Revised: 06/02/2009] [Accepted: 06/07/2009] [Indexed: 10/20/2022]
Abstract
A categorical approach to the study of amygdala volumes in specific neuropsychiatric disorders leads to contradictory findings. In an alternative dimensional approach, we tested the hypothesis that amygdala volume loss represents specific dimensions of affective syndromes in patients with epilepsy. One hundred sixty patients with chronic therapy-refractory epilepsy were carefully diagnosed for psychiatric symptoms. Fifty-three patients without any lifetime psychopathology (n=24), with dysphoric disorder of epilepsy (n=12), or with major depressive disorder (n=17) were included. Amygdala and hippocampal volumes were measured using established protocols. Amygdala volumes were significantly reduced in patients with dysphoric disorder of epilepsy and correlated significantly with core symptoms of dysphoric disorder of epilepsy, that is, emotional instability, dysphoria, irritability, and aggression. Our finding supports a dimensional concept of the meaning of brain alterations and validates the clinical concept of dysphoric disorder of epilepsy.
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26
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Lindberg N, Tani P, Putkonen H, Sailas E, Takala P, Eronen M, Virkkunen M. Female impulsive aggression: a sleep research perspective. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2009; 32:39-42. [PMID: 19095304 DOI: 10.1016/j.ijlp.2008.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The rate of violent crimes among girls and women appears to be increasing. One in every five female prisoners has been reported to have antisocial personality disorder. However, it has been quite unclear whether the impulsive, aggressive behaviour among women is affected by the same biological mechanisms as among men. Psychiatric sleep research has attempted to identify diagnostically sensitive and specific sleep patterns associated with particular disorders. Most psychiatric disorders are typically characterized by a severe sleep disturbance associated with decreased amounts of slow wave sleep (SWS), the physiologically significant, refreshing part of sleep. Among men with antisocial behaviour with severe aggression, on the contrary, increased SWS has been reported, reflecting either specific brain pathology or a delay in the normal development of human sleep patterns. In our preliminary study among medication-free, detoxified female homicidal offenders with antisocial personality disorder, the same profound abnormality in sleep architecture was found. From the perspective of sleep research, the biological correlates of severe impulsive aggression seem to share similar features in both sexes.
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Schmidt RE, Gay P, Van der Linden M. Facets of impulsivity are differentially linked to insomnia: evidence from an exploratory study. Behav Sleep Med 2008; 6:178-92. [PMID: 18629688 DOI: 10.1080/15402000802162570] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study investigated the association between insomnia and four facets of impulsivity as distinguished by Whiteside and Lynam (2001): urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking. A sample of 233 university students completed the UPPS Impulsive Behavior Scale, the Insomnia Severity Index, and a short questionnaire on sleep-related mentation. Correlational analyses revealed that urgency was related to insomnia severity and insomnia-related impairments in daytime functioning, and that lack of perseverance was related to insomnia-related impairments in daytime functioning. Follow-up analyses showed that the frequency of disturbing thoughts and visions during the pre-sleep period partially mediated the relation between urgency and sleep-initiation problems, and that the frequency of disturbing dreams and nightmares partially mediated the relation between urgency and sleep-maintenance problems. These findings suggest that the facets of impulsivity are differentially linked to insomnia and that urgency is associated with sleep-interfering nighttime mentation.
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Affiliation(s)
- Ralph E Schmidt
- Cognitive Psychopathology and Neuropsychology Unit, Department of Psychology and Swiss Center for Affective Sciences, University of Geneva, Switzerland.
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28
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Hornung OP, Regen F, Warnstedt C, Anghelescu I, Danker-Hopfe H, Heuser I, Lammers CH. Declarative and procedural memory consolidation during sleep in patients with borderline personality disorder. J Psychiatr Res 2008; 42:653-8. [PMID: 17706671 DOI: 10.1016/j.jpsychires.2007.07.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2007] [Revised: 07/05/2007] [Accepted: 07/05/2007] [Indexed: 11/28/2022]
Abstract
Borderline personality disorder (BPD) is characterized by changes in subjective and objective measures of sleep quality. As recent findings point to the importance of sleep in memory consolidation, sleep-related memory consolidation was investigated in 15 female BPD patients (mean age 26.1+/-6.1 years) and 15 female healthy controls (mean age 25.6+/-6.8 years). Before and after the study night, declarative and procedural memory performance was tested by a paired associate list and a mirror tracing task. Subjective sleep quality was assessed by a sleep questionnaire, objective sleep quality was measured by a portable sleep recording device. During the study night the restorative value of sleep was significantly reduced in BPD patients (p<0.001), while objective sleep quality showed a trend for longer REM sleep duration (p=0.054). No significant differences were found regarding overnight performance improvement in the declarative and procedural memory tasks. Present findings suggest that declarative and procedural memory consolidation during sleep is intact in BPD patients.
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Affiliation(s)
- Orla P Hornung
- Department of Psychiatry and Psychotherapy, Charité-University Medicine Berlin, Campus Benjamin Franklin, Eschenallee 3, 14050 Berlin, Germany.
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29
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Acheson A, Richards JB, de Wit H. Effects of sleep deprivation on impulsive behaviors in men and women. Physiol Behav 2007; 91:579-87. [PMID: 17477941 DOI: 10.1016/j.physbeh.2007.03.020] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2006] [Revised: 02/21/2007] [Accepted: 03/26/2007] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to examine the effects of sleep deprivation on impulsive behavior. Patients with impulse control disorders often report sleep problems, and sleep deprivation even in healthy individuals impairs cognition, decision-making, and perhaps impulse control. To characterize the effects of sleep loss on specific forms of impulsive behavior, we tested the effects of overnight, monitored sleep deprivation on measures of impulsivity and cognition in healthy volunteers. Ten men and ten women completed two 24 h sessions in random order, in which they were either allowed to sleep normally or remained awake all night. At 8:30 am and 6:15 pm on the day after sleep or no sleep, participants were tested on the Balloon Analogue Risk Task (BART), the Experiential Discounting Task, the Adjusting Amount Delay and Probability Discounting Task, and the Stop Task. Participants also completed mood questionnaires and the Automated Neuropsychological Assessment Matrix (ANAM) throughout the course of the day. Sleep deprivation did not affect most of the measures of impulsive behavior. However, on the BART, sleep deprivation decreased risk taking in women, but not men. Sleep deprivation produced expected increases in subjective fatigue, and impaired performance on measures of attention and cognitive efficiency on the ANAM. The results indicate that sleep deprivation does not specifically increase impulsive behaviors but may differentially affect risk taking in men and women.
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Affiliation(s)
- Ashley Acheson
- Research Imaging Center, University of Texas Health Science Center at San Antonio, TX, USA
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30
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Lindberg N, Tani P, Sailas E, Putkonen H, Takala P, Urrila AS, Eronen M, Virkkunen M. Sleep architecture in homicidal women with antisocial personality disorder--a preliminary study. Psychiatry Res 2006; 145:67-73. [PMID: 17070601 DOI: 10.1016/j.psychres.2005.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Revised: 04/18/2005] [Accepted: 10/27/2005] [Indexed: 10/24/2022]
Abstract
The aim of the present study was to characterize sleep in severely violent women with antisocial personality disorder (ASP) as the primary diagnosis. Participants for this preliminary study were three drug-free female offenders ordered to undergo a forensic mental examination in a maximum security state mental hospital after committing homicide or attempted homicide. Ten healthy age- and gender-matched controls consisted of hospital staff with no history of physical violence. The most striking finding was the increased amount of slow wave sleep, particularly the deepest sleep stage, S4, in women with ASP. This finding is in agreement with previously reported results in habitually violent male criminals with ASP. Severe female aggression seems to be associated with profound changes in sleep architecture. Whether this reflects specific brain pathology, or a delay in the normal development of sleep patterns in the course of aging, needs to be clarified. From the perspective of sleep research, the biological correlates of severe impulsive violence seem to be similar in both sexes.
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Affiliation(s)
- Nina Lindberg
- Institute of Biomedicine, Department of Physiology, University of Helsinki, Helsinki, Finland.
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De la Fuente JM, Bobes J, Morlán I, Bascarán MT, Vizuete C, Linkowski P, Mendlewicz J. Is the biological nature of depressive symptoms in borderline patients without concomitant Axis I pathology idiosyncratic? Sleep EEG comparison with recurrent brief, major depression and control subjects. Psychiatry Res 2004; 129:65-73. [PMID: 15572186 DOI: 10.1016/j.psychres.2004.05.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2003] [Revised: 01/19/2004] [Accepted: 05/17/2004] [Indexed: 10/26/2022]
Abstract
The relationship between borderline personality disorder (BPD) and the affective disorders is controversial, and we have previously compared BPD and major depression (MD) with endocrinological measures and sleep electroencephalography (S-EEG). We have also compared BPD, MD and recurrent brief depression (RBD) using endocrine tests. We have proposed that depressive symptoms in BPD might have a biological substrate that is distinct from those in depressive illness without comorbid BPD. BPD has been proposed to overlap with RBD, which has been found to share perturbed biological substrates with MD, but we have not found the same biological pattern in BPD. When endocrinological data in BPD, MD and RBD were compared, we did not find evidence of biological linkage between BPD and RBD. To clarify the biological nature of depressive symptoms in BPD, we examined S-EEG characteristics in BPD, RBD, MD and controls. Among 20 BPD patients, 12 were also diagnosed as having clinical RBD. BPD patients showed differences in sleep continuity and especially in sleep architecture compared with RBD, MD and controls. BPD with or without clinical RBD did not show significant differences in any parameter. BPD with or without clinical RBD had less slow sleep activity not only than MD but also than non-borderline RBD patients. We propose that although BPD patients can have concomitant MD, they often exhibit a specific BPD-associated affective syndrome that is different from both MD and non-borderline RBD in the quality and duration of symptoms and the biological substrate.
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Affiliation(s)
- José Manuel De la Fuente
- Department of Psychiatry, Erasme Hospital, Free University of Brussels, 808 route de Lennik, B-1070 Brussels, Belgium.
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Lindberg N, Tani P, Appelberg B, Stenberg D, Naukkarinen H, Rimón R, Porkka-Heiskanen T, Virkkunen M. Sleep among habitually violent offenders with antisocial personality disorder. Neuropsychobiology 2003; 47:198-205. [PMID: 12824743 DOI: 10.1159/000071215] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of the present study was to characterize the subjective and objective sleep and sleep quality in habitually violent offenders with DSM-IV diagnosis of antisocial personality disorder using a sleep questionnaire, actigraphy, polysomnography and power spectral analysis. Subjects for the study were 19 drug-free males (mean age +/- SEM 30.7 +/- 2.58 years) recruited from a forensic psychiatric examination in a special ward of a university psychiatric hospital. The most striking finding was the high amount of slow-wave sleep, particularly the deepest S4 stage (17% as compared with 6% in healthy controls), in males with antisocial personality disorder. Moreover, in the spectral power analysis, both the delta and the theta power were significantly elevated. Whether this increase in persons with antisocial personality disorder reflects a specific brain pathology, or a delay in the normal development of sleep patterns in the course of ageing needs to be clarified with further experiments.
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Affiliation(s)
- Nina Lindberg
- Institute of Biomedicine, Department of Psychiatry, Biomedicum Helsinki, PO Box 63, University of Helsinki, FL-00014 Helsinki, Finland.
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Lindberg N, Tani P, Appelberg B, Naukkarinen H, Rimón R, Porkka-Heiskanen T, Virkkunen M. Human impulsive aggression: a sleep research perspective. J Psychiatr Res 2003; 37:313-24. [PMID: 12765854 DOI: 10.1016/s0022-3956(03)00041-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Impulsive aggression is commonly associated with personality disorders, in particular antisocial and borderline personality disorders as well as with conduct disorder and intermittent explosive disorder. The relationship between impulsive aggression and testosterone is well established in many studies. One of the aims of this study was to characterize the relationship between earlier-mentioned different categorical psychiatric diagnosis describing human impulsive aggression and sleep using polysomnography and spectral power analysis. Another aim was to study the relationship between serum testosterone and sleep in persons with severe aggressive behaviour. Subjects for the study were 16 males charged with highly violent offences and ordered for a pretrial forensic psychiatric examination. The antisocials with borderline personality disorder comorbidity had significantly more awakenings and lower sleep efficiency compared with the subjects with only antisocial personality disorder. The subjects with severe conduct disorder in childhood anamnesis had higher amount of S4 sleep and higher relative theta and delta power in this sleep stage compared with males with only mild or moderate conduct disorder. The same kind of sleep architecture was associated with intermittent explosive disorder. In subgroups with higher serum testosterone levels also the amount of S4 sleep and the relative theta and delta power in this sleep stage were increased. The study gives further support to the growing evidence of brain dysfunction predisposing to severe aggressive behaviour and strengthens the view that there are different subpopulations of individuals with antisocial personality varying in impulsiveness. The differences in impulsiveness are reflected in sleep architecture as well.
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Affiliation(s)
- Nina Lindberg
- Department of Psychiatry, University of Helsinki, Helsinki, Finland.
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Garma L. Insomnias associated with psychiatric disorders. Sleep 2003. [DOI: 10.1007/978-1-4615-0217-3_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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