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Calancie OG, Parr AC, Brien DC, Coe BC, Booij L, Khalid-Khan S, Munoz DP. Impairment of Visual Fixation and Preparatory Saccade Control in Borderline Personality Disorder with and without co-morbid Attention-Deficit/ Hyperactivity Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2024:S2451-9022(24)00191-5. [PMID: 39032694 DOI: 10.1016/j.bpsc.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/31/2024] [Accepted: 07/04/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is associated with heightened impulsivity, evidenced by increased substance abuse, self-harm and suicide attempts. Addressing impulsivity in individuals with BPD is a therapeutic objective; but its underlying neural basis in this clinical population remains unclear, partly due to its frequent co-morbidity with attention-deficit/hyperactivity disorder (ADHD). METHODS We employed a response inhibition paradigm - the interleaved pro-/anti-saccade task (IPAST) - among adolescents diagnosed with BPD with and without comorbid ADHD (N=25 and N=24, respectively) during concomitant video-based eye-tracking. We quantified various eye movement response parameters reflective of impulsive action during the task, including delay to fixation acquisition, fixation breaks, anticipatory saccades, and direction errors with express saccade (Saccade Reaction Time [SRT]: 90-140 ms) and regular saccade latencies (SRT > 140 ms). RESULTS Individuals with BPD exhibited deficient response preparation, exampled by reduced visual fixation on task cues and greater variability of saccade responses (i.e., SRT and peak velocity). The ADHD/BPD group shared these traits, as well as produced an increased frequency of anticipatory responses and direction errors with express saccade latencies and reduced error correction. CONCLUSIONS Saccadic deficits in BPD and ADHD/BPD stem not from an inability to execute anti-saccades, but rather from an inadequate preparation for the upcoming task set. These distinctions may arise due to abnormal signaling in cortical areas like the frontal eye fields, posterior parietal cortex, and anterior cingulate cortex. Understanding these mechanisms could provide insights into targeted interventions focusing on task set preparation to manage response inhibition deficits in BPD and ADHD/BPD.
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Affiliation(s)
- Olivia G Calancie
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada;; School of Medicine, Queen's University, Kingston, ON, Canada;.
| | - Ashley C Parr
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Don C Brien
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Brian C Coe
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Linda Booij
- Department of Psychiatry, McGill University, Montreal, QC, Canada;; Research Centre and Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sarosh Khalid-Khan
- School of Medicine, Queen's University, Kingston, ON, Canada;; Division of Child and Youth Psychiatry, Department of Psychiatry, School of Medicine, Queen's University, Kingston, ON, Canada
| | - Doug P Munoz
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
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Haque MT, Segreti M, Giuffrida V, Ferraina S, Brunamonti E, Pani P. Attentional spatial cueing of the stop-signal affects the ability to suppress behavioural responses. Exp Brain Res 2024; 242:1429-1438. [PMID: 38652274 PMCID: PMC11108874 DOI: 10.1007/s00221-024-06825-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 03/19/2024] [Indexed: 04/25/2024]
Abstract
The ability to adapt to the environment is linked to the possibility of inhibiting inappropriate behaviours, and this ability can be enhanced by attention. Despite this premise, the scientific literature that assesses how attention can influence inhibition is still limited. This study contributes to this topic by evaluating whether spatial and moving attentional cueing can influence inhibitory control. We employed a task in which subjects viewed a vertical bar on the screen that, from a central position, moved either left or right where two circles were positioned. Subjects were asked to respond by pressing a key when the motion of the bar was interrupted close to the circle (go signal). In about 40% of the trials, following the go signal and after a variable delay, a visual target appeared in either one of the circles, requiring response inhibition (stop signal). In most of the trials the stop signal appeared on the same side as the go signal (valid condition), while in the others, it appeared on the opposite side (invalid condition). We found that spatial and moving cueing facilitates inhibitory control in the valid condition. This facilitation was observed especially for stop signals that appeared within 250ms of the presentation of the go signal, thus suggesting an involvement of exogenous attentional orienting. This work demonstrates that spatial and moving cueing can influence inhibitory control, providing a contribution to the investigation of the relationship between spatial attention and inhibitory control.
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Affiliation(s)
- Md Tanbeer Haque
- Department of Physiology and Pharmacology, Sapienza University, Rome, Italy
| | - Mariella Segreti
- Department of Physiology and Pharmacology, Sapienza University, Rome, Italy
- Behavioral Neuroscience PhD Program, Sapienza University, Rome, Italy
| | - Valentina Giuffrida
- Department of Physiology and Pharmacology, Sapienza University, Rome, Italy
- Behavioral Neuroscience PhD Program, Sapienza University, Rome, Italy
| | - Stefano Ferraina
- Department of Physiology and Pharmacology, Sapienza University, Rome, Italy
| | | | - Pierpaolo Pani
- Department of Physiology and Pharmacology, Sapienza University, Rome, Italy.
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Senkowski D, Ziegler T, Singh M, Heinz A, He J, Silk T, Lorenz RC. Assessing Inhibitory Control Deficits in Adult ADHD: A Systematic Review and Meta-analysis of the Stop-signal Task. Neuropsychol Rev 2024; 34:548-567. [PMID: 37300725 PMCID: PMC11166755 DOI: 10.1007/s11065-023-09592-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 03/21/2023] [Indexed: 06/12/2023]
Abstract
In recent years, there has been an increasing quest in improving our understanding of the neurocognitive deficits underlying adult attention-deficit/hyperactivity disorder (ADHD). Current statistical manuals of psychiatric disorders emphasize inattention and hyperactivity-impulsivity symptoms, but empirical studies have also shown consistent alterations in inhibitory control. To date, there is no established neuropsychological test to assess inhibitory control deficits in adult ADHD. A common paradigm for assessing response inhibition is the stop-signal task (SST). Following PRISMA-selection criteria, our systematic review and meta-analysis integrated the findings of 26 publications with 27 studies examining the SST in adult ADHD. The meta-analysis, which included 883 patients with adult ADHD and 916 control participants, revealed reliable inhibitory control deficits, as expressed in prolonged SST response times, with a moderate effect size g = 0.51 (95% CI: 0.376-0.644, p < 0.0001). The deficits were not moderated by study quality, sample characteristics or clinical parameters, suggesting that they may be a phenotype in this disorder. The analyses of secondary outcome measures revealed greater SST omission errors and reduced go accuracy in patients, indicative of altered sustained attention. However, only few (N < 10) studies were available for these measures. Our meta-analysis suggests that the SST, in conjunction with other tests and questionnaires, could become a valuable tool for assessing inhibitory control deficits in adult ADHD.
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Affiliation(s)
- Daniel Senkowski
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117, Berlin, Germany.
| | - Theresa Ziegler
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117, Berlin, Germany
| | - Mervyn Singh
- Centre for Social and Early Emotional Development (SEED) and School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Andreas Heinz
- Department of Psychiatry and Neurosciences, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität Zu Berlin, Charité Campus Mitte (CCM), Charitéplatz 1, 10117, Berlin, Germany
| | - Jason He
- King's College London, London, WC2R 2LS, UK
| | - Tim Silk
- Centre for Social and Early Emotional Development (SEED) and School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Robert C Lorenz
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany
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4
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Traynor JM, McMain S, Chapman AL, Kuo J, Labrish C, Ruocco AC. Pretreatment cognitive performance is associated with differential self-harm outcomes in 6 v. 12-months of dialectical behavior therapy for borderline personality disorder. Psychol Med 2024; 54:1350-1360. [PMID: 37997387 DOI: 10.1017/s0033291723003197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND Recent findings suggest that brief dialectical behavior therapy (DBT) for borderline personality disorder is effective for reducing self-harm, but it remains unknown which patients are likely to improve in brief v. 12 months of DBT. Research is needed to identify patient characteristics that moderate outcomes. Here, we characterized changes in cognition across brief DBT (DBT-6) v. a standard 12-month course (DBT-12) and examined whether cognition predicted self-harm outcomes in each arm. METHODS In this secondary analysis of 240 participants in the FASTER study (NCT02387736), cognitive measures were administered at pre-treatment, after 6 months, and at 12 months. Self-harm was assessed from pre-treatment to 2-year follow-up. Multilevel models characterized changes in cognition across treatment. Generalized estimating equations examined whether pre-treatment cognitive performance predicted self-harm outcomes in each arm. RESULTS Cognitive performance improved in both arms after 6 months of treatment, with no between-arm differences at 12-months. Pre-treatment inhibitory control was associated with different self-harm outcomes in DBT-6 v. DBT-12. For participants with average inhibitory control, self-harm outcomes were significantly better when assigned to DBT-12, relative to DBT-6, at 9-18 months after initiating treatment. In contrast, participants with poor inhibitory control showed better self-harm outcomes when assigned to brief DBT-6 v. DBT-12, at 12-24 months after initiating treatment. CONCLUSIONS This work represents an initial step toward an improved understanding of patient profiles that are best suited to briefer v. standard 12 months of DBT, but observed effects should be replicated in a waitlist-controlled study to confirm that they were treatment-specific.
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Affiliation(s)
- Jenna M Traynor
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada
- McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Shelley McMain
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | - Janice Kuo
- Department of Psychology, PGSP-Stanford PsyD Consortium, Palo Alto University, Palo Alto, CA, USA
| | - Cathy Labrish
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Anthony C Ruocco
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychology, University of Toronto Scarborough, Toronto, ON, Canada
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5
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Waite EE, DeFontes C, Weiss NH, Karnedy C, Woods SE, Haliczer LA, Dixon-Gordon KL. Borderline personality disorder and multidimensional impulsivity: The roles of positive and negative emotion dysregulation. J Affect Disord 2024; 344:635-643. [PMID: 37832740 DOI: 10.1016/j.jad.2023.10.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/07/2023] [Accepted: 10/08/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Risky, self-destructive impulsivity and emotion dysregulation are core features of borderline personality disorder (BPD). Yet impulsivity is multidimensional and has rarely been comprehensively assessed in BPD. Impulsivity has been linked to negative emotion dysregulation, yet explorations of the role of positive emotion dysregulation have been neglected. The current study attempts to extend existing literature by identifying the pattern of associations of specific domains of impulsivity, using both self-report and behavioral measures in BPD, and the role of both negative and positive emotion dysregulation in this link. METHODS Adults with BPD (n = 48), subthreshold BPD (n = 37), and without BPD (n = 78) completed a diagnostic interview, self-report measures, and multiple behavioral tasks. We examined correlations between primary variables, then examined the role of negative and positive emotion dysregulation in the association between BPD and specific domains of impulsivity. RESULTS Negative emotion dysregulation accounted for the link between BPD and negative urgency, (lack of) premeditation, and (lack of) perseverance, while positive emotion dysregulation accounted for the relation between BPD and sensation seeking. LIMITATIONS Key limitations of this study include using a relatively homogeneous sample and using abbreviated versions of one behavioral task, among others discussed. CONCLUSIONS These findings locate the precise impulsivity impairments in BPD and highlight the differential roles of negative and positive emotion dysregulation. Understanding the impulsivity deficits associated with BPD will further explain the impulsive behaviors associated with this disorder, and the contexts in which they occur, which may streamline clinical treatments.
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Affiliation(s)
- Elinor E Waite
- Department of Psychological and Brain Science, University of Massachusetts Amherst, United States
| | - Clara DeFontes
- Department of Psychological and Brain Science, University of Massachusetts Amherst, United States
| | - Nicole H Weiss
- Department of Psychological and Brain Science, University of Massachusetts Amherst, United States; Department of Psychology, University of Rhode Island, United States
| | - Colten Karnedy
- Department of Psychological and Brain Science, University of Massachusetts Amherst, United States
| | - Sherry E Woods
- Department of Psychological and Brain Science, University of Massachusetts Amherst, United States
| | - Lauren A Haliczer
- Department of Psychological and Brain Science, University of Massachusetts Amherst, United States
| | - Katherine L Dixon-Gordon
- Department of Psychological and Brain Science, University of Massachusetts Amherst, United States.
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Calancie OG, Parr AC, Brien DC, Huang J, Pitigoi IC, Coe BC, Booij L, Khalid-Khan S, Munoz DP. Motor synchronization and impulsivity in pediatric borderline personality disorder with and without attention-deficit hyperactivity disorder: an eye-tracking study of saccade, blink and pupil behavior. Front Neurosci 2023; 17:1179765. [PMID: 37425020 PMCID: PMC10323365 DOI: 10.3389/fnins.2023.1179765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Shifting motor actions from reflexively reacting to an environmental stimulus to predicting it allows for smooth synchronization of behavior with the outside world. This shift relies on the identification of patterns within the stimulus - knowing when a stimulus is predictable and when it is not - and launching motor actions accordingly. Failure to identify predictable stimuli results in movement delays whereas failure to recognize unpredictable stimuli results in early movements with incomplete information that can result in errors. Here we used a metronome task, combined with video-based eye-tracking, to quantify temporal predictive learning and performance to regularly paced visual targets at 5 different interstimulus intervals (ISIs). We compared these results to the random task where the timing of the target was randomized at each target step. We completed these tasks in female pediatric psychiatry patients (age range: 11-18 years) with borderline personality disorder (BPD) symptoms, with (n = 22) and without (n = 23) a comorbid attention-deficit hyperactivity disorder (ADHD) diagnosis, against controls (n = 35). Compared to controls, BPD and ADHD/BPD cohorts showed no differences in their predictive saccade performance to metronome targets, however, when targets were random ADHD/BPD participants made significantly more anticipatory saccades (i.e., guesses of target arrival). The ADHD/BPD group also significantly increased their blink rate and pupil size when initiating movements to predictable versus unpredictable targets, likely a reflection of increased neural effort for motor synchronization. BPD and ADHD/BPD groups showed increased sympathetic tone evidenced by larger pupil sizes than controls. Together, these results support normal temporal motor prediction in BPD with and without ADHD, reduced response inhibition in BPD with comorbid ADHD, and increased pupil sizes in BPD patients. Further these results emphasize the importance of controlling for comorbid ADHD when querying BPD pathology.
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Affiliation(s)
- Olivia G. Calancie
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Ashley C. Parr
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Don C. Brien
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Jeff Huang
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Isabell C. Pitigoi
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Brian C. Coe
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Linda Booij
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Research Centre and Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sarosh Khalid-Khan
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Divison of Child and Youth Psychiatry, Department of Psychiatry, School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Douglas P. Munoz
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
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Ahlberg R, Du Rietz E, Ahnemark E, Andersson LM, Werner-Kiechle T, Lichtenstein P, Larsson H, Garcia-Argibay M. Real-life instability in ADHD from young to middle adulthood: a nationwide register-based study of social and occupational problems. BMC Psychiatry 2023; 23:336. [PMID: 37173664 PMCID: PMC10176742 DOI: 10.1186/s12888-023-04713-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/23/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Studies using self-reports indicate that individuals with ADHD are at increased risk for functional impairments in social and occupational settings, but evidence around real-life instability remains limited. It is furthermore unclear if these functional impairments in ADHD differ across sex and across the adult lifespan. METHOD A longitudinal observational cohort design of 3,448,440 individuals was used to study the associations between ADHD and residential moves, relational instability and job shifting using data from Swedish national registers. Data were stratified on sex and age (18-29 years, 30-39 years, and 40-52 years at start of follow up). RESULTS 31,081 individuals (17,088 males; 13,993 females) in the total cohort had an ADHD-diagnosis. Individuals with ADHD had an increased incidence rate ratio (IRR) of residential moves (IRR 2.35 [95% CI, 2.32-2.37]), relational instability (IRR = 1.07 [95% CI, 1.06-1.08]) and job shifting (IRR = 1.03 [95% CI, 1.02-1.04]). These associations tended to increase with increasing age. The strongest associations were found in the oldest group (40-52 years at start of follow). Women with ADHD in all three age groups had a higher rate of relational instability compared to men with ADHD. CONCLUSION Both men and women with a diagnosis of ADHD present with an increased risk of real-life instability in different domains and this behavioral pattern was not limited to young adulthood but also existed well into older adulthood. It is therefore important to have a lifespan perspective on ADHD for individuals, relatives, and the health care sector.
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Affiliation(s)
- Rickard Ahlberg
- School of Medical Sciences, Örebro University, Örebro, 701 82, Sweden.
| | - E Du Rietz
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - E Ahnemark
- Department of Neuropsychiatry, Region Stockholm, Stockholm, Sweden
| | | | - T Werner-Kiechle
- Global Medical Affairs, Shire International GmbH, Zug, Switzerland
| | - P Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - H Larsson
- School of Medical Sciences, Örebro University, Örebro, 701 82, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - M Garcia-Argibay
- School of Medical Sciences, Örebro University, Örebro, 701 82, Sweden
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Developmental predictors of young adult borderline personality disorder: a prospective, longitudinal study of females with and without childhood ADHD. BMC Psychiatry 2023; 23:106. [PMID: 36793031 PMCID: PMC9930262 DOI: 10.1186/s12888-023-04515-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/02/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Research on the precursors of borderline personality disorder (BPD) reveals numerous child and adolescent risk factors, with impulsivity and trauma among the most salient. Yet few prospective longitudinal studies have examined pathways to BPD, particularly with inclusion of multiple risk domains. METHODS We examined theory-informed predictors of young-adult BPD (a) diagnosis and (b) dimensional features from childhood and late adolescence via a diverse (47% non-white) sample of females with (n = 140) and without (n = 88) carefully diagnosed childhood attention-deficit hyperactivity disorder (ADHD). RESULTS After adjustment for key covariates, low levels of objectively measured executive functioning in childhood predicted young adult BPD diagnostic status, as did a cumulative history of childhood adverse experiences/trauma. Additionally, both childhood hyperactivity/impulsivity and childhood adverse experiences/trauma predicted young adult BPD dimensional features. Regarding late-adolescent predictors, no significant predictors emerged regarding BPD diagnosis, but internalizing and externalizing symptoms were each significant predictors of BPD dimensional features. Exploratory moderator analyses revealed that predictions to BPD dimensional features from low executive functioning were heightened in the presence of low socioeconomic status. CONCLUSIONS Given our sample size, caution is needed when drawing implications. Possible future directions include focus on preventive interventions in populations with enhanced risk for BPD, particularly those focused on improving executive functioning skills and reducing risk for trauma (and its manifestations). Replication is required, as are sensitive measures of early emotional invalidation and extensions to male samples.
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Smit D, Trevino L, Mohamed SMH, Enriquez-Geppert S. Theta power and functional connectivity as neurophysiological markers of executive functions in individuals with cognitive complaints in daily life. Biol Psychol 2023; 178:108503. [PMID: 36681295 DOI: 10.1016/j.biopsycho.2023.108503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023]
Abstract
Impairments in executive functions (EFs) are common across psychological disorders. Research into the neural oscillations underlying EFs has the potential to help understand these impairments and contribute to the development of interventions. The aim of this study is to assess theta power and functional theta connectivity in the sensor space of the regions of the superordinate network for the core EFs: conflict monitoring, response inhibition, set-shifting, and working memory updating. We recruited adults with self-reported everyday EFs complaints and formed two groups: one with attention deficit hyperactivity disorder (ADHD) (n=27) and another without any diagnosis (n=22), and compared them to controls (n=21) on the Stroop, Stop-signal, Switching, and N-back task using EEG. Power and functional connectivity analyses were conducted for four regions of interest: frontal-midline, frontolateral left and right, and parietal region. For all four EFs, the groups showed a dynamical increase in theta power over time in the four regions of interest, as well as in functional theta connectivity between these regions. Group differences were found especially for conflict monitoring, with differences in theta power in the frontal-midline and frontolateral right region. These neural markers are also associated with behavioural performance and complaints in daily life. For set-shifting, group differences were less pronounced and for response inhibition and working memory updating no group differences were observed.
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Affiliation(s)
- Diede Smit
- Department of Clinical and Developmental Neuropsychology, University of Groningen, the Netherlands; Research School of Behavioural and Cognitive Neurosciences, University of Groningen, the Netherlands
| | - Lorena Trevino
- Department of Clinical and Developmental Neuropsychology, University of Groningen, the Netherlands
| | - Saleh M H Mohamed
- Department of Clinical and Developmental Neuropsychology, University of Groningen, the Netherlands
| | - Stefanie Enriquez-Geppert
- Department of Clinical and Developmental Neuropsychology, University of Groningen, the Netherlands; Department of Biomedical Sciences of Cells & Systems, University Medical Center Groningen, the Netherlands.
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10
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Does identity disturbance contribute to inhibition in borderline personality? A preliminary report. Encephale 2022:S0013-7006(22)00109-9. [DOI: 10.1016/j.encep.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 11/19/2022]
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11
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Pan N, Wang S, Qin K, Li L, Chen Y, Zhang X, Lai H, Suo X, Long Y, Yu Y, Ji S, Radua J, Sweeney JA, Gong Q. Common and Distinct Neural Patterns of Attention-Deficit/Hyperactivity Disorder and Borderline Personality Disorder: A Multimodal Functional and Structural Meta-analysis. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022:S2451-9022(22)00147-1. [PMID: 35714858 DOI: 10.1016/j.bpsc.2022.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have partially overlapping symptom profiles and are highly comorbid in adults. However, whether the behavioral similarities correspond to shared neurobiological substrates is not known. METHODS An overlapping meta-analysis of 58 ADHD and 66 BPD whole-brain articles incorporating observations from 3401 adult patients and 3238 healthy participants was performed by seed-based d mapping. Brain maps were subjected to meta-analytic connectivity modeling and data-driven functional decoding analyses to identify associated neural circuit alterations and relations to behavioral dimensions. RESULTS Both groups exhibited hypoactivated abnormalities in the left inferior parietal lobule, and altered clusters of the bilateral superior temporal gyrus were disjunctive in ADHD and BPD. No overlapping structural abnormalities were found. Multimodal alterations of ADHD were located in the right putamen and of BPD in the left orbitofrontal cortex. CONCLUSIONS The transdiagnostic neural bases of ADHD and BPD in temporoparietal circuitry may underlie overlapping problems of behavioral control, while disorder-specific substrates in frontostriatal circuitry may account for their distinguishing features in motor and emotion domains, respectively.
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Affiliation(s)
- Nanfang Pan
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Song Wang
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China.
| | - Kun Qin
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Lei Li
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Ying Chen
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xun Zhang
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Han Lai
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Xueling Suo
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yajing Long
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Yifan Yu
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Shiyu Ji
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital of Sichuan University, Chengdu, China; Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu, China
| | - Joaquim Radua
- Imaging of Mood- and Anxiety-Related Disorders Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - John A Sweeney
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Department of Psychiatry, University of Cincinnati, Cincinnati, Ohio
| | - Qiyong Gong
- Huaxi MR Research Center, Department of Radiology, West China Hospital of Sichuan University, Chengdu, China; Department of Radiology, West China Xiamen Hospital of Sichuan University, Xiamen, China.
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12
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Ditrich I, Philipsen A, Matthies S. Borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD) revisited - a review-update on common grounds and subtle distinctions. Borderline Personal Disord Emot Dysregul 2021; 8:22. [PMID: 34229766 PMCID: PMC8261991 DOI: 10.1186/s40479-021-00162-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overlap in symptom domains particularly in the field of impulsivity and emotional dysregulation in attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) have stimulated further research activities since our last review from 2014. MAIN BODY Disentangling features of impulsivity in ADHD and BPD revealed that impulsivity is a feature of both disorders with patients suffering from both ADHD and BPD having highest impulsivity ratings. BPD individuals have more problems using context cues for inhibiting responses and their impulsivity is stress-dependent, whereas ADHD patients have more motor impulsivity and therefore difficulties interrupting ongoing responses. For emotion regulation difficulties the ranking order ranges from ADHD to BPD to the comorbid condition, again with the patients suffering from both, ADHD and BPD, having the most pronounced emotion regulation problems. Environmental influences namely adverse childhood events were shown to be linked to both ADHD and BPD. Traumatic experiences seem independently linked to impulsivity features. Thus, some authors point to the risk of misdiagnosis during childhood and the necessity to screen for traumatic experiences in both patient groups. Genetic research confirmed genetic overlap of BPD with bipolar disorder (BD) and schizophrenic disorders, as well as genetic overlap of BD and ADHD. A population-based study confirmed the high co-occurrence and familial co-aggregation of ADHD and BPD. Interesting questions in the field of gene-environment-interactions are currently dealt with by genetic and epigenetic research. Few studies have investigated treatment strategies for the comorbid condition, though the issue is highly important for the management of patients suffering from both disorders and presenting with the highest symptom scores. CONCLUSION Research on the different impulsivity features might point to a necessity of disorder-specific treatment strategies in the field of impulse control. Future research is needed to base treatment decisions for the comorbid condition on an evidence basis.
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Affiliation(s)
- Ismene Ditrich
- Department of Psychiatry and Psychotherapy, Medical Center -Faculty of Medicine, University of Freiburg, Hauptstr. 5, D-79104, Freiburg, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Medical Center, University of Bonn, Bonn, Germany
| | - Swantje Matthies
- Department of Psychiatry and Psychotherapy, Medical Center -Faculty of Medicine, University of Freiburg, Hauptstr. 5, D-79104, Freiburg, Germany.
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13
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Coll-Martín T, Carretero-Dios H, Lupiáñez J. Attentional networks, vigilance, and distraction as a function of attention-deficit/hyperactivity disorder symptoms in an adult community sample. Br J Psychol 2021; 112:1053-1079. [PMID: 34089269 DOI: 10.1111/bjop.12513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/09/2021] [Indexed: 01/29/2023]
Abstract
Attentional difficulties are a core axis in attention-deficit/hyperactivity disorder (ADHD). However, establishing a consistent and detailed pattern of these neurocognitive alterations has not been an easy endeavour. Based on a dimensional approach to ADHD, the present study aims at comprehensively characterizing three key attentional domains: the three attentional networks (alerting, orienting, and executive attention), two components of vigilance (executive and arousal vigilance), and distraction. To do so, we modified a single, fine-grained task (the ANTI-Vea) by adding irrelevant distractors. One hundred and twenty undergraduates completed three self-reports of ADHD symptoms in childhood and adulthood and performed the ANTI-Vea. Despite the low reliability of some ANTI-Vea indexes, the task worked successfully. While ADHD symptoms in childhood were related to alerting network and arousal vigilance, symptoms in adulthood were linked to executive vigilance. No association between ADHD symptom severity and executive attention and distraction was found. In general, our hypotheses about the relationships between ADHD symptoms and attentional processes were partially supported. We discuss our findings according to ADHD theories and attention measurement.
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Affiliation(s)
- Tao Coll-Martín
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Spain.,Department of Behavioral Sciences Methodology, University of Granada, Spain
| | - Hugo Carretero-Dios
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Spain.,Department of Behavioral Sciences Methodology, University of Granada, Spain
| | - Juan Lupiáñez
- Mind, Brain, and Behavior Research Center (CIMCYC), University of Granada, Spain.,Department of Experimental Psychology, University of Granada, Spain
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14
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Onandia-Hinchado I, Pardo-Palenzuela N, Diaz-Orueta U. Cognitive characterization of adult attention deficit hyperactivity disorder by domains: a systematic review. J Neural Transm (Vienna) 2021; 128:893-937. [PMID: 33620582 DOI: 10.1007/s00702-021-02302-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023]
Abstract
Attention deficit hyperactivity disorder (ADHD) is reportedly the most frequent neurodevelopmental disorder diagnosed during childhood, and it is recognized as a common condition in adulthood. We review the evidence to help identify cognitive domains associated to deficits in adult ADHD. A systematic review with narrative synthesis was performed, assessing studies on adult ADHD, neuropsychology and research on involved cognitive domains in adults 18+ years old with an established diagnosis of ADHD, in seven electronic databases (PubMed, PsychInfo, WebOfScience, Embase, Scopus, OvidSPMedline, and Teseo), and Worldcat and OpenGrey grey literature databases. 93 studies were included for this review, encompassing findings from a total 5574 adults diagnosed only with ADHD, medication-naïve or non-medicated at the moment of the assessment and 4880 healthy controls. Adults diagnosed with ADHD may show, when compared to healthy controls, a cognitive profile characterized by deficits across all attention modalities, processing speed, executive function (mainly working memory and inhibition with emphasis on reward delay and interference control), verbal memory, reading skills, social cognition and arithmetic abilities. A cognitive characterization of adult ADHD by domains is established beyond the sole consideration of attention and executive function problems. Along with these, verbal memory, language (mainly reading), social cognition and arithmetic abilities may also contribute to a more comprehensive characterization of the cognitive profile in adult ADHD.
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Affiliation(s)
| | | | - Unai Diaz-Orueta
- Department of Psychology, Maynooth University, Room 3.11, John Hume Building, North Campus, Maynooth, Co. Kildare, Ireland.
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15
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Linhartová P, Širůček J, Ejova A, Barteček R, Theiner P, Kašpárek T. Dimensions of Impulsivity in Healthy People, Patients with Borderline Personality Disorder, and Patients with Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2021; 25:584-595. [PMID: 30628513 DOI: 10.1177/1087054718822121] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective: Impulsivity, observed in patients with various psychiatric disorders, is a heterogeneous construct with different behavioral manifestations. Through confirmatory factor analysis (CFA), this study tests hypotheses about relationships between dimensions of impulsivity measured using personality questionnaires and behavioral tests. Method: The study included 200 healthy people, 40 patients with borderline personality disorder, and 26 patients with attention-deficit/hyperactivity disorder (ADHD) who underwent a comprehensive impulsivity test battery including the Barratt Impulsiveness Scale (BIS), UPPS-P Impulsive Behavior Scale, a Go-NoGo task, a stop-signal task, and a delay discounting task. Results: A CFA model comprising three self-reported and three behavioral latent variables reached a good fit. Both patient groups scored higher in the self-reported dimensions and impulsive choice; only the ADHD patients displayed impaired waiting and stopping impulsivity. Conclusions: Using the developed CFA model, it is possible to describe relations between impulsivity dimensions and show different impulsivity patterns in patient populations.
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Affiliation(s)
- Pavla Linhartová
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
| | | | | | - Richard Barteček
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
| | - Pavel Theiner
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
| | - Tomáš Kašpárek
- Masaryk University, Brno, Czech Republic.,University Hospital Brno, Czech Republic
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16
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Attention Networks in ADHD Adults after Working Memory Training with a Dual n-Back Task. Brain Sci 2020; 10:brainsci10100715. [PMID: 33050115 PMCID: PMC7600375 DOI: 10.3390/brainsci10100715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/21/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023] Open
Abstract
Patients affected by Attention-Deficit/Hyperactivity Disorder (ADHD) are characterized by impaired executive functioning and/or attention deficits. Our study aim is to determine whether the outcomes measured by the Attention Network Task (ANT), i.e., the reaction times (RTs) to specific target and cue conditions and alerting, orienting, and conflict (or executive control) effects are affected by cognitive training with a Dual n-back task. We considered three groups of young adult participants: ADHD patients without medication (ADHD), ADHD with medication (MADHD), and age/education-matched controls. Working memory training consisted of a daily practice of 20 blocks of Dual n-back task (approximately 30 min per day) for 20 days within one month. Participants of each group were randomly assigned into two subgroups, the first one with an adaptive mode of difficulty (adaptive training), while the second was blocked at the level 1 during the whole training phase (1-back task, baseline training). Alerting and orienting effects were not modified by working memory training. The dimensional analysis showed that after baseline training, the lesser the severity of the hyperactive-impulsive symptoms, the larger the improvement of reaction times on trials with high executive control/conflict demand (i.e., what is called Conflict Effect), irrespective of the participants’ group. In the categorical analysis, we observed the improvement in such Conflict Effect after the adaptive training in adult ADHD patients irrespective of their medication, but not in controls. The ex-Gaussian analysis of RT and RT variability showed that the improvement in the Conflict Effect correlated with a decrease in the proportion of extreme slow responses. The Dual n-back task in the adaptive mode offers as a promising candidate for a cognitive remediation of adult ADHD patients without pharmaceutical medication.
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17
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Linhartová P, Látalová A, Barteček R, Širůček J, Theiner P, Ejova A, Hlavatá P, Kóša B, Jeřábková B, Bareš M, Kašpárek T. Impulsivity in patients with borderline personality disorder: a comprehensive profile compared with healthy people and patients with ADHD. Psychol Med 2020; 50:1829-1838. [PMID: 31439062 DOI: 10.1017/s0033291719001892] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Impulsivity is a core symptom of borderline personality disorder (BPD). Impulsivity is a heterogeneous concept, and a comprehensive evaluation of impulsivity dimensions is lacking in the literature. Moreover, it is unclear whether BPD patients manifest impaired cognitive functioning that might be associated with impulsivity in another patient group, such as ADHD, a frequent comorbidity of BPD. METHODS We tested 39 patients with BPD without major psychiatric comorbidities and ADHD, 25 patients with ADHD, and 55 healthy controls (HC) using a test battery consisting of a self-report measure of impulsivity (UPPS-P questionnaire), behavioral measures of impulsivity - impulsive action (Go/NoGo task, stop signal task) and impulsive choice (delay discounting task, Iowa gambling task), and standardized measures of attention (d2 test), working memory (digit span), and executive functioning (Tower of London). RESULTS Patients with BPD and ADHD, as compared with HC, manifested increased self-reported impulsivity except sensation seeking and increased impulsive choice; patients with ADHD but not BPD showed increased impulsive action and deficits in cognitive functioning. Negative urgency was increased in BPD as compared to both HC and ADHD groups and correlated with BPD severity. CONCLUSIONS Patients with BPD without ADHD comorbidity had increased self-reported impulsivity and impulsive choice, but intact impulsive action and cognitive functioning. Controlling for ADHD comorbidity in BPD samples is necessary. Negative urgency is the most diagnostically specific impulsivity dimension in BPD.
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Affiliation(s)
- Pavla Linhartová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Adéla Látalová
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Richard Barteček
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Širůček
- Faculty of Social Studies, Institute for Research on Children, Youth and Family, Masaryk University, Brno, Czech Republic
| | - Pavel Theiner
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Anastasia Ejova
- Faculty of Science, School of Psychology, University of Auckland, Auckland, New Zealand
| | - Pavlína Hlavatá
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Behavioral and Social Neuroscience Research Group, CEITEC - Central European Institute of Technology, Masaryk University, Brno, Czech Republic
| | - Barbora Kóša
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Barbora Jeřábková
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martin Bareš
- First Department of Neurology, St. Anne's Hospital and Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, Faculty of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Tomáš Kašpárek
- Department of Psychiatry, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
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18
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Nasri B, Castenfors M, Fredlund P, Ginsberg Y, Lindefors N, Kaldo V. Group Treatment for Adults With ADHD Based on a Novel Combination of Cognitive and Dialectical Behavior Interventions: A Feasibility Study. J Atten Disord 2020; 24:904-917. [PMID: 28178870 DOI: 10.1177/1087054717690231] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives: To evaluate feasibility and preliminary effects of a new group treatment manual for adults with ADHD and to explore adherence to treatment and its relation to outcome. Method: Eighteen adults with ADHD recruited from neuropsychiatric units in Stockholm underwent a 14-week program including combined cognitive and dialectical behavior therapy. Assessments were made at baseline, posttreatment, and follow-up, at one and six months after treatment end. Primary outcome measure was the Adult ADHD Self Report Scale version 1.1. Results/Conclusion: ADHD symptoms significantly decreased (d = 1.29) and remained stable for 6 months. Measures of depression, perceived stress, and anxiety were also significantly reduced. Attendance and patient satisfaction was high. Use, comprehension, and perceived benefit of treatment components varied from medium to high. Total use of treatment components was, in general, positively correlated with favorable outcome. The current combination of treatment components may be a valuable addition to available treatments in psychiatric care.
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Affiliation(s)
- Berkeh Nasri
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Huddinge hospital, Stockholm, Sweden
| | | | - Peggy Fredlund
- Stockholm Health Care Services, Stockholm County Council, Huddinge hospital, Stockholm, Sweden
| | - Ylva Ginsberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Huddinge hospital, Stockholm, Sweden
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Huddinge hospital, Stockholm, Sweden
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm County Council, Huddinge hospital, Stockholm, Sweden
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19
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Hallett N. To what extent should expert psychiatric witnesses comment on criminal culpability? MEDICINE, SCIENCE, AND THE LAW 2020; 60:67-74. [PMID: 31483744 DOI: 10.1177/0025802419872844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Following the Court of Appeal case of R v Edwards in England and Wales, there has been increasing pressure for expert psychiatric witnesses to comment explicitly on how a defendant’s mental disorder affects their culpability. Culpability is the degree to which a person can be held morally or legally responsible for their conduct, but defining culpability has proved difficult. Mental disorder does not translate easily into degrees of legal culpability. Although psychiatric evidence will often be central to such cases, the determination of culpability is a matter for the court, and experts should not comment on it explicitly. Nevertheless, certain areas of psychiatry may have a bearing on culpability, and ways in which experts may comment on these are suggested. Given the pressure on judges to determine culpability, experts need to be honest about the limits of medical science to answer legal questions and the professional necessity to remain within their area of expertise.
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20
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Calvo N, Lara B, Serrat L, Pérez-Rodríguez V, Andión Ò, Ramos-Quiroga JA, Ferrer M. The role of environmental influences in the complex relationship between borderline personality disorder and attention-deficit/hyperactivity disorder: review of recent findings. Borderline Personal Disord Emot Dysregul 2020; 7:2. [PMID: 31921426 PMCID: PMC6945629 DOI: 10.1186/s40479-019-0118-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 12/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent years, the existence of possible developmental pathways from childhood Attention-Deficit/Hyperactivity Disorder (ADHD) to adult Borderline Personality Disorder (BPD) has been suggested. The existence of common genetic factors has been described but there is little evidence on the role of environmental factors in the possible transition from one disorder to another throughout life. The main goal of this work is to review the literature about the existing evidence on childhood traumas as factors that mediate the risk of developing BPD in children with ADHD. METHODS A literature search was conducted using PubMed, Science Direct and PsychInfo databases. Criteria included studies of BPD and ADHD relationships and childhood traumas as environmental influences from epidemiological or clinical samples. RESULTS The review only identified 4 studies that matched the search criteria. All studies retrospectively analyzed childhood traumas, and adult patients with BPD, with or without comorbid ADHD, were the most frequently mentioned. The analyzed evidence reinforces the relationship between the number of childhood traumas and higher clinical severity. Three of these analyzed studies describe an increased the risk of children with ADHD who report emotional and sexual traumatic experiences to develop BPD in adulthood. CONCLUSIONS The experience of traumatic childhood events, especially those of an emotional type, may have a mediating effect of an increased risk of developing adult BPD in childhood ADHD patients. However, to consider them as risk factors, more studies, and especially longitudinal studies, are necessary to clarify the probable transactional process between the two disorders. Evidence from these studies may be helpful to develop early intervention programs to reduce the functional impairment associated with the two disorders.
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Affiliation(s)
- Natalia Calvo
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,2Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
| | - Benjamin Lara
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Laia Serrat
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Violeta Pérez-Rodríguez
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Òscar Andión
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Josep A Ramos-Quiroga
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,2Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
| | - Marc Ferrer
- 1BPD Program, Psychiatry Department, Hospital Universitary Vall d'Hebron, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain.,2Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,3Psychiatry, Mental Health and Addictions Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
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21
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Rosas R, Espinoza V, Porflitt F, Ceric F. Executive Functions Can Be Improved in Preschoolers Through Systematic Playing in Educational Settings: Evidence From a Longitudinal Study. Front Psychol 2019; 10:2024. [PMID: 31551874 PMCID: PMC6734167 DOI: 10.3389/fpsyg.2019.02024] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 08/19/2019] [Indexed: 11/13/2022] Open
Abstract
This study aimed to test the impact of play on the development of executive functions (EFs) in preschoolers. Thirty-two games were designed to be collectively played in groups by 70 children, in their regular classes. The games were specifically designed to promote the development of the three components of EFs: inhibition (behavioral or cognitive), working memory, and cognitive flexibility. The games focused on each function were of three types: playground games, expression games, and classroom games. Sixty 45 min play sessions were held on consecutive days for 3 months, always in the first period. The sessions were guided by two members of the research team, assisted by the four teachers of the participating classes. The intervention was carried out in two highly socially vulnerable schools in the city of Santiago de Chile. Four classes were studied in total: two experimental groups and two controls. The classes were selected using a questionnaire on teacher-student interaction quality and an age homogeneity criterion. EFs were evaluated using the Hearts and Flowers task at three points: before the intervention (T1), immediately after the end of the intervention (T2), and 8 months after the end of the intervention (T3). The results show a significant difference in the growth of EFs by comparing the experimental and control groups (p = 0.04) between T1 and T3. They also reveal a strong correlation between EFs measures at T1 and mathematics performance at T3. These results are discussed within the context of the guidelines proposed by Diamond and Ling (2016) and Barnett (2011) regarding what an EFs promotion program needs to be considered effective and high quality. The program presented in this study meets most of the requisites mentioned by the authors, which proves that following these guidelines guarantees a high probability of success.
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Affiliation(s)
- Ricardo Rosas
- Escuela de Psicología Centro de Justicia Educacional, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Victoria Espinoza
- Escuela de Psicología Centro de Justicia Educacional, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Felipe Porflitt
- Facultad de Educación, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Ceric
- Facultad de Psicología, Universidad del Desarrollo, Santiago, Chile
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22
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Evren C, Evren B, Dalbudak E, Topcu M, Kutlu N. Relationships of Internet addiction and Internet gaming disorder symptom severities with probable attention deficit/hyperactivity disorder, aggression and negative affect among university students. ACTA ACUST UNITED AC 2019; 11:413-421. [PMID: 31062235 DOI: 10.1007/s12402-019-00305-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2019] [Accepted: 04/30/2019] [Indexed: 12/11/2022]
Abstract
The aim of the present study was to evaluate relationships of Internet addiction (IA) and Internet gaming disorder (IGD) symptom severities with probable attention deficit/hyperactivity disorder (ADHD) and aggression among university students, while controlling the effects of anxiety and depressive symptoms. The study was conducted with online survey among 1509 volunteered university students in Ankara who regularly use the Internet, among whom we conducted analyses related with IA. Among these students, 987 of them, who play video games, were included in the analyses related with IGD. Correlation analyses revealed that the severities of the scale scores were mildly correlated with each other both among students who regularly use the Internet and students who play video games. Probable ADHD was associated with the severity of IA symptoms, together with depression and aggression, particularly physical aggression and hostility, in ANCOVA analyses. Similarly probable ADHD was also associated with the severity of IGD symptoms, together with depression and aggression, particularly physical aggression, anger and hostility, in ANCOVA analyses. These findings suggest that the presence of probable ADHD is related with both severity of IA and IGD symptoms, together with aggression and depression.
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Affiliation(s)
- Cuneyt Evren
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey.
| | - Bilge Evren
- Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
| | | | - Merve Topcu
- Department of Psychology, Çankaya University, Ankara, Turkey
| | - Nilay Kutlu
- Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
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Gagnon J, Aldebert J, Saleh G, Kim WS. The Modulating Role of Self-Referential Stimuli and Processes in the Effect of Stress and Negative Emotion on Inhibition Processes in Borderline Personality Disorder: Proposition of a Model to Integrate the Self-Concept and Inhibition Processes. Brain Sci 2019; 9:E77. [PMID: 30935039 PMCID: PMC6523515 DOI: 10.3390/brainsci9040077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 03/18/2019] [Accepted: 03/27/2019] [Indexed: 12/28/2022] Open
Abstract
Impulsivity is an important clinical and diagnostic feature of borderline personality disorder (BPD). Even though it has been reported that BPD individuals' inhibition performance is significantly reduced in the context of negative emotion or stress, this literature shows mixed results, raising questions about the possible role played by other factors. Winter (2016) proposed that negative emotion stimuli can be more disruptive for BPD individuals' attention control performance because they induce higher distractibility self-referential processes. This article aimed to systematically review the literature regarding the effect of stress and negative emotions on three main inhibition processes-prepotent response inhibition, resistance to distractor interference, and resistance to proactive interference-in BPD and to verify the putative modulating role of self-referential stimuli and processes on these inhibition processes. All English and French experimental studies published until August 2018 were searched in PsychINFO and PubMED databases. The following keywords were used: "borderline* AND inhibit* OR interference* OR forget* OR task* AND emotion* OR stress* OR affect*". A total of 1215 articles were included in the study. After full text revision, twenty-six papers were selected for review. The results of this review indicate that when stimuli or procedures involve self-reference stimuli or processes, BPD individuals' performance seems to be more disrupted in all three inhibition processes. A model based on Winter's and Kernberg's models is proposed with the aim of integrating the self-concept with inhibition processes in BPD.
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Affiliation(s)
- Jean Gagnon
- Department of Psychology, University of Montreal, Montreal, QC H3C 3J7, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC H2H 2N8, Canada.
- Laboratoire d'Électrophysiologie en Neuroscience Sociale (LENS), Department of Psychology, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Joséphine Aldebert
- Department of Psychology, University of Montreal, Montreal, QC H3C 3J7, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC H2H 2N8, Canada.
- Laboratoire d'Électrophysiologie en Neuroscience Sociale (LENS), Department of Psychology, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Gasser Saleh
- Department of Psychology, University of Montreal, Montreal, QC H3C 3J7, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC H2H 2N8, Canada.
- Laboratoire d'Électrophysiologie en Neuroscience Sociale (LENS), Department of Psychology, University of Montreal, Montreal, QC H3C 3J7, Canada.
| | - Wan Seo Kim
- Department of Psychology, University of Montreal, Montreal, QC H3C 3J7, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, QC H2H 2N8, Canada.
- Laboratoire d'Électrophysiologie en Neuroscience Sociale (LENS), Department of Psychology, University of Montreal, Montreal, QC H3C 3J7, Canada.
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Albert J, López-Martín S, Arza R, Palomares N, Hoyos S, Carretié L, Díaz-Marsá M, Carrasco JL. Response inhibition in borderline personality disorder: Neural and behavioral correlates. Biol Psychol 2019; 143:32-40. [PMID: 30772405 DOI: 10.1016/j.biopsycho.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/18/2018] [Accepted: 02/09/2019] [Indexed: 11/16/2022]
Abstract
Although response inhibition is thought to be important in borderline personality disorder (BPD), little is known about its neurophysiological basis. This study aimed to provide insight into this issue by capitalizaing on the high temporal resolution of electroencephalography and information provided by source localization methods. To this end, twenty unmedicated patients with BPD and 20 healthy control subjects performed a modified go/no-go task designed to better isolate the brain activity specifically associated with response inhibition. Event-related potentials (ERP) were measured and further analyzed at the scalp and source levels. Patients with BPD made more commission errors (failed inhibitions) than control subjects. Scalp ERP data showed that both groups displayed greater frontocentral P3 amplitude for no-go (response inhbition) than for go trials (response execution). However, source reconstruction data revealed that patients with BPD activated posterior parietal regions (precuneus) to inhibit their responses, whereas controls activated prefrontal regions (presupplementary motor area, preSMA). This dissociation was supported by a significant Region (precuneus, preSMA) x Trial Type (no-go, go) x Group (BPD, control) interaction. These findings extend our understanding of the neurophysiological basis of abnormal response inhibition in BPD, suggesting that patients with BPD recruit different brain regions for inhibiting prepotent responses compared to controls. Future research in larger, medication-naïve samples of patients with BPD is required to confirm and extend these findings.
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Affiliation(s)
- Jacobo Albert
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain; Instituto Pluridisciplinar, Universidad Complutense de Madrid, Madrid, Spain.
| | - Sara López-Martín
- Centro Neuromottiva, Madrid, Spain; Universidad Rey Juan Carlos, Madrid, Spain
| | - Rocío Arza
- Hospital Clínico San Carlos, Cibersam, Madrid, Spain
| | | | - Sandra Hoyos
- Universidad Católica del Uruguay, Montevideo, Uruguay
| | - Luis Carretié
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
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25
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Impulsivity and its association with childhood trauma experiences across bipolar disorder, attention deficit hyperactivity disorder and borderline personality disorder. J Affect Disord 2019; 244:33-41. [PMID: 30336349 DOI: 10.1016/j.jad.2018.07.060] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/22/2018] [Accepted: 07/22/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Impulsivity is a core feature of the attention-deficit/hyperactivity disorder (ADHD) and is one of the DSM-V diagnostic criteria for borderline personality disorder (BPD). Impulsivity is also present in bipolar disorder (BD). Impulsivity has been linked to adverse behavior (suicidality,…) and to traumatic childhood experiences. Our study explored impulsivity in BPD, BD, ADHD and healthy controls (CTRL) and investigated the impact of early trauma on impulsivity. METHODS 744 patients with BD (n = 276), BPD (n = 168), ADHD (n = 173) or a combination (BPD_BD, n = 29; BPD_ADHD, n = 94, BD_BPD_ADHD n = 13) and 47 controls were included. All subjects were completed the Baratt Impulsivity Scale (BIS-10) and the Childhood Trauma Questionnaire (CTQ). RESULTS BD reported the same levels of impulsiveness as CTRL. When BPD and BD are co-morbid, impulsivity increased to reach the level of BPD. Impulsiveness was significantly associated to traumatic childhood event for BD and CTRL, not for BPD and AHDH. LIMITATIONS Impulsivity was assessed on the basis of a self-report questionnaire and not by the mean of an objective measure such as a neuropsychological test. Moreover, we don't know what treatment our pathological subjects were receiving. But, ADHD and BPD, despite the probable treatment, were more impulsive than healthy CTRLs who did not take medications. CONCLUSIONS Impulsivity is probably not a feature of BD but is associated with the presence of traumatic childhood experiences, especially for euthymic patients, unlike BPD and ADHD. So, it seems essential to assess the presence of early trauma to reduce the impulsivity and improve the evolution of BD.
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26
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Schulze L, Grove M, Tamm S, Renneberg B, Roepke S. Effects of transcranial direct current stimulation on the cognitive control of negative stimuli in borderline personality disorder. Sci Rep 2019; 9:332. [PMID: 30674987 PMCID: PMC6344572 DOI: 10.1038/s41598-018-37315-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 12/05/2018] [Indexed: 11/16/2022] Open
Abstract
Borderline personality disorder (BPD) is characterized by impairments in the cognitive control of negative information. These impairments in cognitive control are presumably due to blunted activity of the dorsolateral prefrontal cortex (dlPFC) along with enhanced activations of the limbic system. However, the impact of an excitatory stimulation of the dlPFC still needs to be elucidated. In the present study, we therefore assigned 50 patients with BPD and 50 healthy controls to receive either anodal or sham stimulation of the right dlPFC in a double-blind, randomized, between-subjects design. Participants performed a delayed working memory task with a distracter period during which a grey background screen, or neutral, or negative stimuli were presented. This experimental paradigm was first evaluated in a pilot study with 18 patients with BPD and 19 healthy controls. In both studies, patients with BPD showed an impairment of cognitive control when negative distracters were presented in the delay period of a working memory task. However, excitatory stimulation of the right dlPFC did not ameliorate cognitive control of negative stimuli in BPD, which raises questions about the specific role of the right dlPFC for the understanding of BPD psychopathology. Methodological limitations are discussed.
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Affiliation(s)
- Lars Schulze
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany.
| | - Maren Grove
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - Sascha Tamm
- Experimental and Cognitive Neuropsychology, Freie Universität Berlin, Berlin, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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27
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Weiner L, Perroud N, Weibel S. Attention Deficit Hyperactivity Disorder And Borderline Personality Disorder In Adults: A Review Of Their Links And Risks. Neuropsychiatr Dis Treat 2019; 15:3115-3129. [PMID: 31806978 PMCID: PMC6850677 DOI: 10.2147/ndt.s192871] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022] Open
Abstract
Attention deficit hyperactivity disorder (ADHD) and borderline personality disorder (BPD) are particularly common disorders, that are highly comorbid in adult populations. The symptomatic overlap between adult ADHD and BPD includes impulsivity, emotional dysregulation and interpersonal impairment, which makes the differential diagnosis difficult. Our review aims at focusing on recent data on the comorbid ADHD+BPD form, as well as the risk factors involved in the emergence of the two disorders. While adult ADHD and BPD share some genetic and temperamental risk factors, adult ADHD is characterized by more severe trait-impulsivity compared to non-comorbid BPD; BPD patients display more severe trait-emotion regulation symptoms compared to non-comorbid ADHD. Patients with the comorbid ADHD+BPD form have severe symptoms in both dimensions. Early-life exposure to adverse events is a shared risk factor for the development of ADHD and BPD, but type and timing of adversity seem to play a differential role in the development of BPD and ADHD symptoms. Age of onset used to be a discriminative diagnostic criterion between ADHD, an early-onset neurodevelopmental disorder, and BPD, a late-onset psychological disorder. However, this distinction has been recently called into question, increasing the need for more research aiming at delineating the disorders from a developmental and clinical standpoint. Clinicians should carefully consider the comorbidity, and consider ADHD and BPD dimensionally, in order to provide more effective patient management. This might improve early preventive interventions, and treatment for comorbid conditions in adulthood.
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Affiliation(s)
- Luisa Weiner
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Laboratoire De Psychologie Des Cognitions, University of Strasbourg, Strasbourg, France
| | - Nader Perroud
- Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.,Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France.,Inserm U1114, Strasbourg, France
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28
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Schote AB, A. L. Sayk C, Pabst K, Meier JK, Frings C, Meyer J. Sex, ADHD symptoms, and CHRNA5
genotype influence reaction time but not response inhibition. J Neurosci Res 2018; 97:215-224. [DOI: 10.1002/jnr.24342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 09/18/2018] [Accepted: 09/26/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Andrea B. Schote
- Department of Neurobehavioral Genetics; Institute of Psychobiology, University of Trier; Trier Germany
| | - Clara A. L. Sayk
- Department of Neurobehavioral Genetics; Institute of Psychobiology, University of Trier; Trier Germany
| | - Kathrin Pabst
- Department of Neurobehavioral Genetics; Institute of Psychobiology, University of Trier; Trier Germany
| | - Jacqueline K. Meier
- Department of Neurobehavioral Genetics; Institute of Psychobiology, University of Trier; Trier Germany
| | - Christian Frings
- Department of Cognitive Psychology; University of Trier; Trier Germany
| | - Jobst Meyer
- Department of Neurobehavioral Genetics; Institute of Psychobiology, University of Trier; Trier Germany
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29
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Ernst M, Mohr HM, Schött M, Rickmeyer C, Fischmann T, Leuzinger-Bohleber M, Weiß H, Grabhorn R. The effects of social exclusion on response inhibition in borderline personality disorder and major depression. Psychiatry Res 2018; 262:333-339. [PMID: 28363497 DOI: 10.1016/j.psychres.2017.03.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 02/17/2017] [Accepted: 03/20/2017] [Indexed: 01/08/2023]
Abstract
It is a prevalent notion that borderline personality disorder (BPD) is characterized by deficits in executive functions (EF) like inhibition. Yet experimental studies yield inconsistent results. However, despite emotional dysregulation being a core feature of BPD, most paradigms did not control for emotional state or comorbid mental disorders. In the present study, subjects with BPD and comorbid MDD (BPD+MDD), with major depression (MDD) and healthy controls (HC) partook in a social exclusion paradigm combined with an inhibition task. We expected inhibition to be more strongly impaired in BPD+MDD than in depression and HC when experiencing negative emotions. Respecting inhibition, depressed patients performed best while (BPD+MDD) patients performed worst. Surprisingly, MDD & HC participants' performance improved during social exclusion, but this was not the case for BPD+MDD. Inhibition deficits were correlated with childhood trauma. These results challenge the hypothesis that an induction of negative emotion results in inferior inhibition in (BPD+MDD). Instead, patients with (BPD+MDD) seem to suffer from a more general inhibitory dysfunction. Importantly, (BPD+MDD) patients were not able to improve their performance during social exclusion like HC and MDD patients did. These findings need to be investigated further, particularly regarding the efficiency of neural networks regulating inhibition and effects of trauma.
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Affiliation(s)
| | - Harald M Mohr
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University Hospital, Frankfurt, Germany.
| | | | - Constanze Rickmeyer
- Sigmund-Freud-Institut, Frankfurt, Germany; Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University Hospital, Frankfurt, Germany
| | | | | | - Heinz Weiß
- Sigmund-Freud-Institut, Frankfurt, Germany
| | - Ralph Grabhorn
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University Hospital, Frankfurt, Germany
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30
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31
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Willis F, Kuniss S, Kleindienst N, Lis S, Naoum J, Jungkunz M, Neukel C, Bohus M, Treede R, Baumgärtner U, Schmahl C. Stress reactivity and pain-mediated stress regulation in remitted patients with borderline personality disorder. Brain Behav 2018; 8:e00909. [PMID: 29484266 PMCID: PMC5822574 DOI: 10.1002/brb3.909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 11/22/2017] [Accepted: 12/03/2017] [Indexed: 11/28/2022] Open
Abstract
Objective Patients with borderline personality disorder (BPD) use nonsuicidal self-injury (NSSI) to cope with states of elevated inner tension. It is unclear to what extent remitted BPD patients experience these states and whether the experience of pain still regulates emotion. The purpose of this study was the investigation of baseline stress levels, stress reactivity, and pain-mediated stress regulation in remitted BPD patients. Method Subjective and objective stress parameters were assessed in 30 remitted BPD patients, 30 current BPD patients, and 30 healthy controls. After stress induction, a non-nociceptive tactile stimulus, a tissue-injuring, or a noninvasive pain stimulus was applied to the right volar forearm. Results Baseline stress levels of remitted BPD patients lie in between the stress levels of current BPD patients and healthy controls. Urge for NSSI increased significantly more in current than remitted BPD patients. The experience of pain led to a greater decrease of arousal in current compared to remitted BPD patients and healthy controls. Conclusions States of increased tension still seem to appear in remitted BPD patients. The role of pain-mediated stress regulation appears to be reduced in remitted patients.
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Affiliation(s)
- Franziska Willis
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Department of General, Visceral and Transplantation SurgeryUniversity Hospital HeidelbergHeidelbergGermany
| | - Sarah Kuniss
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Stefanie Lis
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Janina Naoum
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Martin Jungkunz
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
| | - Corinne Neukel
- Department of Psychosocial MedicineUniversity of HeidelbergHeidelbergGermany
| | - Martin Bohus
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Faculty of HealthUniversity of AntwerpAntwerpBelgium
| | - Rolf‐Detlef Treede
- Department of Neurophysiology, Centre of Biomedicine and Medical Technology MannheimMedical Faculty MannheimHeidelberg UniversityMannheimGermany
| | - Ulf Baumgärtner
- Department of Neurophysiology, Centre of Biomedicine and Medical Technology MannheimMedical Faculty MannheimHeidelberg UniversityMannheimGermany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and PsychotherapyMedical Faculty MannheimCentral Institute of Mental HealthUniversity of HeidelbergMannheimGermany
- Department of Psychiatry, Schulich School of Medicine and DentistryWestern UniversityLondonONCanada
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Weibel S, Nicastro R, Prada P, Cole P, Rüfenacht E, Pham E, Dayer A, Perroud N. Screening for attention-deficit/hyperactivity disorder in borderline personality disorder. J Affect Disord 2018; 226:85-91. [PMID: 28964997 DOI: 10.1016/j.jad.2017.09.027] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/21/2017] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND A valid screening instrument is needed to detect attention-deficit/hyperactivity disorder (ADHD) in treatment-seeking borderline personality disorder (BPD) patients. We aimed to test the performance of the widely-used Adult ADHD Self-Report Scale v1.1 screener (ASRS-v1.1). METHODS 317 BPD subjects were systematically assessed for comorbid ADHD and completed the ASRS-v1.1. 79 BPD patients also completed the Wender Utah Rating Scale (WURS-25). RESULTS The prevalence of adult ADHD was of 32.4%. The overall positive predictive value of the ASRS-v1.1 was of 38.5%, the negative predictive value 77.0%, the sensitivity 72.8%, and the specificity 43.9%. Combining WURS-25 and ASRS-v1.1 improved sensitivity to 81.8% and specificity to 59.6%. LIMITATIONS Cross-sectional study on treatment-seeking patients. CONCLUSIONS We found a high prevalence of ADHD using structured interviews. The ASRS-v1.1 was not a sensitive screener for identifying possible ADHD cases in a BPD population, with a high number of false positives. When combined with the WURS-25, it offered improved screening.
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Affiliation(s)
- Sébastien Weibel
- Department of Psychiatry, University Hospital of Strasbourg, Strasbourg, France; Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland.
| | - Rosetta Nicastro
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Paco Prada
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Pierre Cole
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eva Rüfenacht
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Eléonore Pham
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
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33
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LeGris J. Rapid emotional response and disadvantageous Iowa gambling task performance in women with borderline personality disorder. Borderline Personal Disord Emot Dysregul 2018; 5:16. [PMID: 30237891 PMCID: PMC6139153 DOI: 10.1186/s40479-018-0092-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/29/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Adults with Borderline Personality Disorder (BPD) manifest poor performance on tasks of decision making which may be congruent with their decisional and interpersonal conflicts in real life. Poor decision making is often assumed to be due to impulsive behaviour or weak inhibitory control despite inconsistent evidences of these relationships, leaving questions about the specific nature of these decisional deficits. Decision making in BPD may be compromised by different domains of impulsivity, affective dysregulatory processes or unknown co-morbid ADHD which is considered a developmental precursor to BPD. FINDINGS Iowa Gambling Task (IGT) decision making, 2 tasks of inhibitory control and a self report of ADHD symptoms consisting of 9 subscales were administered to 41 BPD women and 41 healthy controls. No group differences in inhibitory control were present. Net decision making performance and all ADHD subscale ratings differed significantly among BPD women and healthy controls. BPD women did not meet the threshold indicative of moderate to severe ADHD. Three subscales of attention, behaviour/ disorganized and emotive were significantly associated with poor IGT performance in 26 women with BPD. Of these 3 variables, the emotive subscale, representing a rapid emotional response, was the only significant predictor contributing 49% to the variance in poor DM. CONCLUSIONS This is the 1st evidence of an emotive type of impulsivity, representing a type of affective instability that is linked to poor IGT DM in BPD. Findings support the Somatic Marker Hypothesis of IGT DM and may reflect the affective dysregulation that characterizes the disorder.
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Affiliation(s)
- Jeannette LeGris
- 1Faculty of Health Sciences, School of Nursing, McMaster University, Ontario, Hamilton Canada.,2Deparment of Psychiatry and Behavioural Neuroscience, McMaster University, Ontario, Hamilton Canada
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34
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Abstract
BackgroundAttention deficit hyperactivity disorder (ADHD) is a common disorder in childhood, which progresses to adulthood in about a fifth of cases. For various reasons, adult ADHD is a disorder not comprehensively assessed by psychiatrists, not least because the biological underpinnings are only recently being unmasked.AimsThis selective review targets psychiatrists without a background in neuroscience and aims to describe the neurobiological basis of ADHD.MethodsIn total, 40 articles from a PubMed search were selected for inclusion based on sample population and methodology (neuroimaging studies). Studies focussing on adult participants were selected preferentially for inclusion. Seminal articles relevant to childhood populations were included for the purpose of understanding general concepts around ADHD.ResultsThe neuropathology of ADHD is not rooted in a single anatomical area, but in multiple parallel and intersecting pathways, which have demonstrated impaired functional connectivity in ADHD brains. Dysfunction in executive function, reward processing, attention networks and default networks play major roles in the neuropathology of this condition. Biological findings vary between individuals, with some showing greater dysfunction at cortical levels and others at subcortical levels, which is in keeping with its clinical heterogeneity.ConclusionImproved symptomatology in adulthood is linked to a number of factors. Maturation of the prefrontal cortex in early adulthood contributes to symptom attenuation in many cases, meaning that individuals with cortical dysfunction are more likely to grow out of symptoms, whereas individuals with subcortical dysfunction may be less likely to do so. There is emerging evidence for a similar but distinct disorder arising de novo in adulthood.
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35
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Ferrer M, Andión Ó, Calvo N, Ramos-Quiroga JA, Prat M, Corrales M, Casas M. Differences in the association between childhood trauma history and borderline personality disorder or attention deficit/hyperactivity disorder diagnoses in adulthood. Eur Arch Psychiatry Clin Neurosci 2017; 267:541-549. [PMID: 27658669 DOI: 10.1007/s00406-016-0733-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 09/09/2016] [Indexed: 12/01/2022]
Abstract
Common environmental etiological factors between borderline personality disorder (BPD) and attention deficit/hyperactivity disorder (ADHD) have not been fully studied. The main aim of this study was to investigate the relationship between childhood trauma histories, assessed by the Childhood Trauma Questionnaire-Short Form (CTQ-SF), with adult BPD, ADHD or BPD-ADHD diagnoses. Comorbid BPD-ADHD patients exhibited significantly higher clinical severity and higher scores in the Total Neglect Scale, compared to BPD and ADHD patients, and only a marginal difference was observed for Sexual Abuse when BPD and ADHD patients were compared. Physical Trauma Scales were associated with ADHD diagnosis, whereas Emotional Abuse and Sexual Abuse Scales were associated with BPD or BPD-ADHD diagnoses. The study findings support the association between experiencing traumatic events in childhood and a higher clinical severity of BPD in adulthood. Furthermore, physical trauma history in childhood could be associated with the persistence of ADHD in adulthood and emotional or sexual abuse with later development of BPD or comorbid BPD-ADHD. Whereas experiencing childhood traumas is associated with later development of more general psychopathology, our study supports that a specific type of traumatic event could increase the risk for the consolidation of a concrete psychiatric disorder in the trajectory from childhood to adulthood of vulnerable subjects.
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Affiliation(s)
- Marc Ferrer
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain. .,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain. .,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain.
| | - Óscar Andión
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Natalia Calvo
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
| | - Josep A Ramos-Quiroga
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mònica Prat
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
| | - Montserrat Corrales
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel Casas
- BPD Program, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Psychiatry Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.,Psychiatry and Legal Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.,Grup TLP Barcelona (BPD Barcelona Group), Barcelona, Spain
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Abstract
PURPOSE OF REVIEW Impulsivity is a multifaceted construct and an important personality trait in various mental health conditions. Among personality disorders (PDs), especially cluster B PDs are affected. The aims of this review are to summarize the relevant findings of the past 3 years concerning impulsivity in cluster B PDs and to identify those subcomponents of self-reported impulsivity and experimentally measured impulse control that are most affected in these disorders. RECENT FINDINGS All studies referred to antisocial (ASPD) or borderline PD (BPD), and none were found for narcissistic or histrionic PD. In ASPD as well as BPD, self-report scales primarily revealed heightened impulsivity compared to healthy controls. In experimental tasks, ASPD patients showed impairments in response inhibition, while fewer deficits were found in delay discounting. BPD patients showed specific impairments in delay discounting and proactive interference, while response inhibition was less affected. However, after inducing high levels of stress, deficits in response inhibition could also be observed in BPD patients. Furthermore, negative affect led to altered brain activation patterns in BPD patients during impulse control tasks, but no behavioral impairments were found. As proposed by the DSM-5 alternative model for personality disorders, heightened impulsivity is a core personality trait in BPD and ASPD, which is in line with current research findings. However, different components of experimentally measured impulse control are affected in BPD and ASPD, and impulsivity occurring in negative emotional states or increased distress seems to be specific for BPD. Future research could be focused on measures that assess impulsive behaviors on a momentary basis as this is a promising approach especially for further ecological validation and transfer into clinical practice.
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Cackowski S, Krause-Utz A, Van Eijk J, Klohr K, Daffner S, Sobanski E, Ende G. Anger and aggression in borderline personality disorder and attention deficit hyperactivity disorder - does stress matter? Borderline Personal Disord Emot Dysregul 2017; 4:6. [PMID: 28331620 PMCID: PMC5356413 DOI: 10.1186/s40479-017-0057-5] [Citation(s) in RCA: 12] [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: 11/25/2016] [Accepted: 03/10/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The impact of stress on anger and aggression in Borderline Personality Disorder (BPD) and Attention Deficit Hyperactivity Disorder (ADHD) has not been thoroughly investigated. The goal of this study was to investigate different aspects of anger and aggression in patients with these disorders. METHODS Twenty-nine unmedicated female BPD patients, 28 ADHD patients and 30 healthy controls (HC) completed self-reports measuring trait anger, aggression and emotion regulation capacities. A modified version of the Point Subtraction Aggression Paradigm and a state anger measurement were applied under resting and stress conditions. Stress was induced by the Mannheim Multicomponent Stress Test (MMST). RESULTS Both patient groups scored significantly higher on all self-report measures compared to HCs. Compared to ADHD patients, BPD patients reported higher trait aggression and hostility, a stronger tendency to express anger when provoked and to direct anger inwardly. Furthermore, BPD patients exhibited higher state anger than HCs and ADHD patients under both conditions and showed a stress-dependent anger increase. At the behavioral level, no significant effects were found. In BPD patients, aggression and anger were positively correlated with emotion regulation deficits. CONCLUSIONS Our findings suggest a significant impact of stress on self-perceived state anger in BPD patients but not on aggressive behavior towards others in females with BPD or ADHD. However, it appears to be pronounced inwardly directed anger which is of clinical importance in BPD patients.
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Affiliation(s)
- Sylvia Cackowski
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, J5, D-68159 Mannheim, Germany
| | - Annegret Krause-Utz
- Department of Clinical Psychology, Faculty of Social and Behavioural Science, Leiden University, Leiden, The Netherlands
| | - Julia Van Eijk
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Katrin Klohr
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, J5, D-68159 Mannheim, Germany
| | - Stephanie Daffner
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim/Heidelberg University, J5, D-68159 Mannheim, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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Lee S, Choi JW, Kim KM, Kim JW, Kim S, Kang T, Kim JI, Lee YS, Kim B, Han DH, Cheong JH, Lee SI, Hyun GJ, Kim BN. The Guideline of Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder: Developed by ADHD Translational Research Center. Soa Chongsonyon Chongsin Uihak 2016. [DOI: 10.5765/jkacap.2016.27.4.236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Sumin Lee
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Won Choi
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Min Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Jun Won Kim
- Department of Psychiatry, Catholic University of Daegu School of Medicine, Daegu, Korea
| | - Sooyeon Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | | | - Johanna Inhyang Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
| | - Young Sik Lee
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Bongseog Kim
- Department of Psychiatry, Sanggye Paik Hospital, School of Medicine, Inje University, Seoul, Korea
| | - Doug Hyun Han
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Jae Hoon Cheong
- Uimyung Research Institute for Neuroscience, Sahmyook University, Seoul, Korea
| | - Soyoung Irene Lee
- Department of Psychiatry, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Korea
| | - Gi Jung Hyun
- Department of Psychiatry, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, Seoul, Korea
| | - Bung-Nyun Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
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Krause-Utz A, Cackowski S, Daffner S, Sobanski E, Plichta MM, Bohus M, Ende G, Schmahl C. Delay discounting and response disinhibition under acute experimental stress in women with borderline personality disorder and adult attention deficit hyperactivity disorder. Psychol Med 2016; 46:3137-3149. [PMID: 27572473 DOI: 10.1017/s0033291716001677] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Impulsivity is a core feature of borderline personality disorder (BPD) and attention deficit hyperactivity disorder (ADHD). In BPD, impulsive behavior primarily occurs under acute stress; impulse control deficits under non-stress conditions may be partly related to co-morbid ADHD. We aimed to investigate whether acute experimental stress has an impact on self-reported impulsivity, response inhibition (action withholding, action cancelation) and delay discounting in BPD compared to ADHD. METHOD Thirty female BPD patients, 28 female ADHD patients (excluding patients with co-morbid BPD and ADHD), and 30 female healthy controls (HC) completed self-reports and behavioral measures of impulsivity (IMT, assessing action withholding; GoStop, measuring action cancelation, Delay Discounting Task) under baseline conditions and after an experimental stress induction (Mannheim Multicomponent Stress Test). RESULTS Both patient groups reported higher impulsivity than HC, ADHD reported higher trait impulsivity than BPD. On the IMT, ADHD showed significant action-withholding deficits under both conditions, while BPD performed significantly worse than HC under stress. In BPD but not ADHD and HC, action-withholding deficits (IMT) were significantly increased under stress compared to baseline, while no group/stress effects were found for action cancelation (GoStop). Delay discounting was significantly more pronounced in BPD than in HC (no stress effect was found). CONCLUSIONS In BPD, behavioral deficits in action withholding (but not in action cancelation) appear to be influenced by acute experimental stress. Delay discounting seems to be a general feature of BPD, independent of co-morbid ADHD and acute stress, possibly underlying typical expressions of behavioral impulsivity in the disorder.
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Affiliation(s)
- A Krause-Utz
- Department of Psychosomatic Medicine and Psychotherapy,Central Institute of Mental Health,Mannheim,Germany
| | - S Cackowski
- Department of Psychosomatic Medicine and Psychotherapy,Central Institute of Mental Health,Mannheim,Germany
| | - S Daffner
- Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
| | - Esther Sobanski
- Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
| | | | - M Bohus
- Department of Psychosomatic Medicine and Psychotherapy,Central Institute of Mental Health,Mannheim,Germany
| | - G Ende
- Medical Faculty Mannheim,Heidelberg University,Mannheim,Germany
| | - C Schmahl
- Department of Psychosomatic Medicine and Psychotherapy,Central Institute of Mental Health,Mannheim,Germany
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40
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Kaess M, Parzer P, Koenig J, Resch F, Brunner R. Dual-task performance under acute stress in female adolescents with borderline personality disorder. Eur Child Adolesc Psychiatry 2016; 25:1027-35. [PMID: 26852226 DOI: 10.1007/s00787-016-0824-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/20/2016] [Indexed: 01/10/2023]
Abstract
Research to elucidate early alterations of higher cognitive processes in adolescents with BPD is rare. This study investigated differences in dual-task performance in adolescents with BPD during stress and non-stress conditions. The study sample comprised 30 female adolescents with BPD and 34 healthy controls. The impact of stress on dual-task performance was measured using a standardized stressor. Self-reports of distress and measures of heart rate (HR) were obtained to measure stress reactivity. There were no group differences in task performance. Under stress conditions, the performance on the auditory task decreased in both groups but without significant group differences. Healthy controls showed an increase of mean HR after stress induction compared to no change in the BPD group. The finding of attenuated HR response to acute stress in adolescent patients with BPD may contradict current theories that the affective hyperresponsivity in BPD is based on a biologically determined mechanism.
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Affiliation(s)
- Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.,Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Julian Koenig
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Franz Resch
- Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Section for Disorders of Personality Development, Department of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany. .,Clinic for Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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41
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Koerting J, Pukrop R, Klein P, Ritter K, Knowles M, Banzhaf A, Gentschow L, Vater A, Heuser I, Colla M, Roepke S. Comparing Dimensional Models Assessing Personality Traits and Personality Pathology Among Adult ADHD and Borderline Personality Disorder. J Atten Disord 2016. [PMID: 23190611 DOI: 10.1177/1087054712464391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This pilot study was a comparison of dimensional models assessing personality traits and personality pathology in a clinical sample of adults diagnosed with ADHD and adults diagnosed with borderline personality disorder (BPD), and a nonclinical control sample of healthy adults. METHOD Personality traits were assessed using the NEO-Personality Inventory-Revised (NEO-PI-R) and dimensional personality pathology with the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). RESULTS Adults with ADHD and BPD produced higher Emotional Dysregulation/Neuroticism and Dissocial Behavior scores than controls. For the Extraversion/Inhibitedness scale, adults with BPD produced significantly lower scores than adults with ADHD and controls. On the Conscientiousness/Compulsivity domains, Conscientiousness scores were lower for both disorders, whereas low Compulsivity values were specific to adult ADHD. CONCLUSION Our results suggest that patients with adult ADHD and BPD have distinguishable profiles of personality traits and personality pathology.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Stefan Roepke
- Charité-Universitätsmedizin Berlin, Germany Freie Universität Berlin, Germany
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42
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Cassiello-Robbins C, Barlow DH. Anger: The unrecognized emotion in emotional disorders. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/cpsp.12139] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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43
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McClure G, Hawes DJ, Dadds MR. Borderline personality disorder and neuropsychological measures of executive function: A systematic review. Personal Ment Health 2016; 10:43-57. [PMID: 26381859 DOI: 10.1002/pmh.1320] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 07/27/2015] [Accepted: 08/20/2015] [Indexed: 11/06/2022]
Abstract
The notion that neurocognitive deficits may be core to the development of borderline personality disorder (BPD) has received considerable attention in recent years, with growing evidence pointing to cognitive deficits in executive function (EF). A relationship between EF and BPD has long been suggested by evidence of high comorbidity between BPD and disorders characterized by poor EF (e.g. attention-deficit/hyperactivity disorder); however, despite a marked increase in studies of EF and BPD in recent years, the precise nature of this relationship remains unclear. We provide a systematic review of this emerging evidence base, with respect to (1) studies of participants diagnosed with BPD in which EF has been indexed in isolation from broader cognitive processes; (2) the specific domains of EF that have been most robustly associated with BPD; and (3) whether deficits in EF are uniquely associated with BPD, independent of comorbid psychopathology. Key directions for future research are discussed with respect to strategies for measuring EF and the need for research designs that control for phenotypic overlap between BPD and related forms of psychopathology.
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Affiliation(s)
- Georgia McClure
- School of Psychology, University of Sydney, Sydney, Australia
| | - David J Hawes
- School of Psychology, University of Sydney, Sydney, Australia
| | - Mark R Dadds
- School of Psychology, University of New South Wales, Sydney, Australia
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44
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Soler J, Elices M, Pascual JC, Martín-Blanco A, Feliu-Soler A, Carmona C, Portella MJ. Effects of mindfulness training on different components of impulsivity in borderline personality disorder: results from a pilot randomized study. Borderline Personal Disord Emot Dysregul 2016; 3:1. [PMID: 26759718 PMCID: PMC4709962 DOI: 10.1186/s40479-015-0035-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 12/27/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Impulsivity is considered a core characteristic of borderline personality disorder (BPD). Previous research on the effects of mindfulness training (MT) has shown that it might modify impulsivity-related aspects of BPD. Therefore, the aim of this study was to investigate the impact of MT on various facets of impulsivity in BPD patients. METHODS Subjects with BPD diagnosis (n = 64) were randomly assigned to 10 weeks of MT (n = 32) or interpersonal effectiveness skills training (IE; n = 32). All participants were assessed pre- and post-intervention with a self-reported measure of impulsivity and five behavioral neuropsychological tasks to evaluate response inhibition, tolerance for delay rewards, and time perception. RESULTS An interaction effect of time × group was only observed for some of the behavioral paradigms used. Participants in the MT group improved their ability to delay gratification and showed changes in time perception, consistent with a decrease in impulsivity. No differences were observed between treatments in terms of trait impulsivity and response inhibition. CONCLUSIONS Mindfulness training might improve some aspects of impulsivity but not others. Further study is warranted to better determine the effects of mindfulness training on the components of impulsivity. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02397031.
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Affiliation(s)
- Joaquim Soler
- />Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- />Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Barcelona, Spain
- />Departament de Psicologia Clínica i de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matilde Elices
- />Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- />Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Barcelona, Spain
- />Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
- />Programa de Cognición, Instituto de Fundamentos y Métodos en Psicología. Facultad de Psicología, Universidad de la República, Montevideo, Uruguay
| | - Juan C. Pascual
- />Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- />Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Barcelona, Spain
- />Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ana Martín-Blanco
- />Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- />Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Barcelona, Spain
- />Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Albert Feliu-Soler
- />Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- />Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Barcelona, Spain
- />Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Carmona
- />Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- />Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Maria J. Portella
- />Servei de Psiquiatria, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- />Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut d’Investigació Biomèdica - Sant Pau (IIB-Sant Pau), Barcelona, Spain
- />Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
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Ende G, Cackowski S, Van Eijk J, Sack M, Demirakca T, Kleindienst N, Bohus M, Sobanski E, Krause-Utz A, Schmahl C. Impulsivity and Aggression in Female BPD and ADHD Patients: Association with ACC Glutamate and GABA Concentrations. Neuropsychopharmacology 2016; 41:410-8. [PMID: 26040503 PMCID: PMC5130117 DOI: 10.1038/npp.2015.153] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 04/29/2015] [Accepted: 05/15/2015] [Indexed: 11/09/2022]
Abstract
Borderline personality disorder (BPD) and attention-deficit-hyperactivity disorder (ADHD) are both characterized by high impulsivity and difficulties in controlling anger and aggression. In BPD, comorbid ADHD may further increase impulsivity. For both disorders, altered MR spectroscopy levels of the neurotransmitters glutamate and GABA as well as some correlations with impulsivity were previously reported. The objective of this study was to investigate the neurotransmitters glutamate and GABA in relation to impulsivity and aggression as expressed in the anterior cingulate cortex (ACC) in groups of female patients with BPD and ADHD, respectively. Associations of glutamate and GABA levels with further BPD (symptom severity) and ADHD aspects (hyperactivity and inattention) were exploratively evaluated. 1H MR spectra were acquired at 3T to determine glutamate to total creatine ratios (Glu/tCr) and GABA levels from the ACC in a BPD group (n=26), an ADHD group (n=22), and a healthy control (HC) group (n=30); all participants were females. Both patient groups showed higher scores on self-reported impulsivity, anger, and aggression compared with HCs. ACC GABA levels were significantly lower in ADHD than HC. Although measures of impulsivity were positively related to glutamate and negatively to GABA, for aggression only a negative correlation with GABA could be demonstrated. These data provide human in vivo evidence for the role of ACC Glu/tCr and GABA in impulsivity and aggression. If distinct associations of Glu/tCr and GABA for BPD and ADHD can be confirmed in future studies, this might yield implications for more specific pharmacological treatments.
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Affiliation(s)
- Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany,Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, J5, Mannheim D-68159, Germany. Tel: +49 621 1703 2971; Fax: +49 621 1703 702971; E-mail:
| | - Sylvia Cackowski
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Julia Van Eijk
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Markus Sack
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Traute Demirakca
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Esther Sobanski
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Annegret Krause-Utz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
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van Eijk J, Sebastian A, Krause-Utz A, Cackowski S, Demirakca T, Biedermann SV, Lieb K, Bohus M, Schmahl C, Ende G, Tüscher O. Women with borderline personality disorder do not show altered BOLD responses during response inhibition. Psychiatry Res 2015; 234:378-89. [PMID: 26483213 DOI: 10.1016/j.pscychresns.2015.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/29/2015] [Accepted: 09/24/2015] [Indexed: 01/18/2023]
Abstract
Impulsivity is central to borderline personality disorder (BPD). Response inhibition, addressing the ability to suppress or stop actions, is one aspect of behavioral impulse control which is frequently used to assess impulsivity. BPD patients display deficits in response inhibition under stress condition or negative emotions. We assessed whether response inhibition and its neural underpinnings are impaired in BPD when tested in an emotionally neutral setting and when co-morbid attention-deficit/hyperactivity disorder (ADHD) is excluded. To this end, we studied response inhibition in unmedicated BPD patients and healthy controls (HC) in two independent samples using functional magnetic resonance imaging during Simon-, Go/nogo-, and Stopsignal tasks. BPD patients and HC did not differ significantly in their performance in the Go/nogo and the Stopsignal tasks. Response interference in the Simon task was increased in BPD patients in one sample, but this could not be replicated in the second sample. In both samples, no significant differences in brain activation patterns during any of the tasks were present while the neural impulse control network was robustly activated during the inhibition tasks in both groups. Our results provide evidence that under emotionally neutral conditions response inhibition is not impaired in patients with BPD without co-occurring ADHD.
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Affiliation(s)
- Julia van Eijk
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Alexandra Sebastian
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz Germany.
| | - Annegret Krause-Utz
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany; Clinical Psychology, Institute of Psychology, Faculty of Social and Behavioral Science, Leiden University, Leiden, The Netherlands
| | - Sylvia Cackowski
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Traute Demirakca
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Sarah V Biedermann
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Klaus Lieb
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz Germany
| | - Martin Bohus
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Gabriele Ende
- Department of Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Germany
| | - Oliver Tüscher
- Emotion Regulation and Impulse Control Group, Focus Program Translational Neuroscience, Department of Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University, Mainz Germany; Departments of Neurology and Psychiatry, Albert-Ludwigs-University Medical Center, Freiburg, Germany
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Vega D, Vilà-Balló A, Soto À, Amengual J, Ribas J, Torrubia R, Rodríguez-Fornells A, Marco-Pallarés J. Preserved Error-Monitoring in Borderline Personality Disorder Patients with and without Non-Suicidal Self-Injury Behaviors. PLoS One 2015; 10:e0143994. [PMID: 26636971 PMCID: PMC4670111 DOI: 10.1371/journal.pone.0143994] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 10/13/2015] [Indexed: 11/18/2022] Open
Abstract
Background The presence of non-suicidal self-injury acts in Borderline Personality Disorder (BPD) is very prevalent. These behaviors are a public health concern and have become a poorly understood phenomenon in the community. It has been proposed that the commission of non-suicidal self-injury might be related to a failure in the brain network regulating executive functions. Previous studies have shown that BPD patients present an impairment in their capacity to monitor actions and conflicts associated with the performance of certain actions, which suppose an important aspect of cognitive control. Method We used Event Related Potentials to examine the behavioral and electrophysiological indexes associated with the error monitoring in two BPD outpatients groups (17 patients each) differentiated according to the presence or absence of non-suicidal self-injury behaviors. We also examined 17 age- and intelligence- matched healthy control participants. Results The three groups did not show significant differences in event-related potentials associated with errors (Error-Related Negativity and Pe) nor in theta power increase following errors. Conclusions This is the first study investigating the behavioral and electrophysiological error monitoring indexes in BPD patients characterized by their history of non-suicidal self-injury behaviors. Our results show that error monitoring is preserved in BPD patients and suggest that non-suicidal self-injury acts are not related to a dysfunction in the cognitive control mechanisms.
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Affiliation(s)
- Daniel Vega
- Department of Psychiatry and Mental Health, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain
- Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Adrià Vilà-Balló
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Àngel Soto
- Department of Psychiatry and Mental Health, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain
| | - Julià Amengual
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Joan Ribas
- Department of Psychiatry and Mental Health, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain
| | - Rafael Torrubia
- Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Antoni Rodríguez-Fornells
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Basic Psychology-Campus Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Josep Marco-Pallarés
- Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Basic Psychology-Campus Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain
- Institut de Recerca en Cervell, Cognició i Conducta, IR3C, University of Barcelona, Barcelona, Spain
- * E-mail:
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O'Malley GK, McHugh L, Mac Giollabhui N, Bramham J. Characterizing adult attention-deficit/hyperactivity-disorder and comorbid borderline personality disorder: ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors. Eur Psychiatry 2015; 31:29-36. [PMID: 26657598 DOI: 10.1016/j.eurpsy.2015.09.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/22/2015] [Accepted: 09/25/2015] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To characterize adults with comorbid attention-deficit/hyperactivity-disorder (ADHD) and borderline personality disorder (BPD) with regard to ADHD symptoms, psychopathology, cognitive functioning and psychosocial factors. METHOD A between-group design compared a group of individuals diagnosed with ADHD (n=40) with a group diagnosed with BPD and who also met the criteria for ADHD (ADHD+BPD) (n=20). RESULTS Significant differences were observed for both childhood and current impulsivity symptoms, whereby ADHD+BPD exhibited increased impulsivity; no differences on self-report and cognitive measures of impulsivity were reported. The ADHD+BPD group scored significantly higher on measures of depression, anxiety and numerous other axis I and II conditions. The ADHD+BPD group scored significantly lower on most measures of intellectual functioning and attention, however largely not on those relating to response inhibition. Furthermore, group differences were observed for psychosocial factors, including education, substance use and criminal record. CONCLUSION Comorbid ADHD and BPD is characterized by more symptoms of impulsivity, additional psychopathology, comparatively lower intellectual and attentional functioning and increased psychosocial difficulties.
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Affiliation(s)
- G K O'Malley
- School of Psychology, University College Dublin (UCD), Dublin, Ireland
| | - L McHugh
- School of Psychology, University College Dublin (UCD), Dublin, Ireland
| | - N Mac Giollabhui
- School of Psychology, University College Dublin (UCD), Dublin, Ireland
| | - J Bramham
- School of Psychology, University College Dublin (UCD), Dublin, Ireland.
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Alderson RM, Patros CHG, Tarle SJ, Hudec KL, Kasper LJ, Lea SE. [Formula: see text]Working memory and behavioral inhibition in boys with ADHD: An experimental examination of competing models. Child Neuropsychol 2015; 23:255-272. [PMID: 26563880 DOI: 10.1080/09297049.2015.1105207] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Working memory (WM) and behavioral inhibition impairments have garnered significant attention as candidate core features, endophenotypes, and/or associated neurocognitive deficits of attention-deficit/hyperactivity disorder (ADHD). The relationship between ADHD-related WM and inhibition deficits remains relatively unclear, however, with inferences about the constructs' directional relationship stemming predominantly from correlational research. The current study utilized a dual-task paradigm to experimentally examine the relationship between ADHD-related WM and behavioral inhibition deficits. A total of 31 boys (15 ADHD and 16 typically developing [TD]) aged 8-12 years completed WM (1-back and 2-back), behavioral inhibition (stop-signal task [SST]), and dual-condition (1-back/SST and 2-back/SST) experimental tasks. Children with ADHD exhibited significant, large-magnitude WM deficits for the 1-back condition but were not significantly different from children in the TD group for the 2-back, 1-back/SST, and 2-back/SST conditions. Children with ADHD also exhibited significant inhibition deficits for the SST, 1-back/SST, and 2-back/SST conditions, but the within-group effect was not significant. The findings suggest that ADHD-related stop-signal demands are upstream, or compete for, resources involved in controlled-focused attention and/or other central executive (CE), WM processes.
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Affiliation(s)
- R Matt Alderson
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Connor H G Patros
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Stephanie J Tarle
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Kristen L Hudec
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Lisa J Kasper
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
| | - Sarah E Lea
- a Department of Psychology , Oklahoma State University , Stillwater , OK , USA
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Clinical, neuropsychological and structural convergences and divergences between Attention Deficit/Hyperactivity Disorder and Borderline Personality Disorder: A systematic review. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015. [DOI: 10.1016/j.paid.2015.06.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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