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Hetland J, Lundervold AJ, Erga AH. Cognitive impairment as a predictor of long-term psychological distress in patients with polysubstance use disorders: a prospective longitudinal cohort study. BMC Psychiatry 2024; 24:143. [PMID: 38378466 PMCID: PMC10880353 DOI: 10.1186/s12888-024-05600-x] [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: 07/02/2023] [Accepted: 02/08/2024] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND The association between polysubstance use disorder (pSUD), mental illness, and cognitive impairments is well established and linked to negative outcomes in substance use disorder treatment. However, it remains unclear whether cognitive impairment predicts long-term psychological distress among treatment seeking patients with pSUD. This study aimed to investigate the associations and predictive ability of cognitive impairment on psychological distress one and 5 years after treatment initiation. METHODS N = 164 treatment seeking patients with pSUD were sampled at treatment initiation. We examined associations between cognitive impairment according to Montreal Cognitive Assessment® (MoCA®), Wechsler Abbreviated Scale of Intelligence (WASI), and Behaviour Rating Inventory of Executive Function - Adult version (BRIEF-A) administered at treatment initiation and psychological distress defined by the Symptom Check List-90-Revised (SCL-90-R) at treatment initiation, one and five years later. We ran hierarchical logistic regressions to assess the predictive ability of the respective cognitive instruments administered at treatment initiation on psychological distress measured one and five years later including psychological distress at treatment initiation and substance intake at the time-points of the measurements as covariates. RESULTS The main results was that MoCA® and BRIEF-A predicted psychological distress at years one and five, but BRIEF-A lost predictive power when accounting for psychological distress at treatment initiation. WASI predicted psychological distress at year one, but not at year five. CONCLUSIONS Results from MoCA® and WASI was found to be less sensitive to the effect of psychological distress than BRIEF-A. Cognitive impairment at treatment initiation may hold predictive value on later psychological distress, yet its clinical utility is uncertain.
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Affiliation(s)
- Jens Hetland
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway.
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Aleksander H Erga
- Center for Alcohol and Drug Research (KORFOR), Stavanger University Hospital, P.O. Box 8100, N-4068, Stavanger, Norway
- The Norwegian Centre for Movement Disorders, Stavanger University Hospital, Stavanger, Norway
- Institute of Social Sciences, University of Stavanger, Stavanger, Norway
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2
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Fietz J, Pöhlchen D, Brückl TM, Brem AK, Padberg F, Czisch M, Sämann PG, Spoormaker VI. Data-Driven Pupil Response Profiles as Transdiagnostic Readouts for the Detection of Neurocognitive Functioning in Affective and Anxiety Disorders. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023:S2451-9022(23)00149-0. [PMID: 37348604 DOI: 10.1016/j.bpsc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Neurocognitive functioning is a relevant transdiagnostic dimension in psychiatry. As pupil size dynamics track cognitive load during a working memory task, we aimed to explore if this parameter allows identification of psychophysiological subtypes in healthy participants and patients with affective and anxiety disorders. METHODS Our sample consisted of 226 participants who completed the n-back task during simultaneous functional magnetic resonance imaging and pupillometry measurements. We used latent class growth modeling to identify clusters based on pupil size in response to cognitive load. In a second step, these clusters were compared on affective and anxiety symptom levels, performance in neurocognitive tests, and functional magnetic resonance imaging activity. RESULTS The clustering analysis resulted in two distinct pupil response profiles: one with a stepwise increasing pupil size with increasing cognitive load (reactive group) and one with a constant pupil size across conditions (nonreactive group). A larger increase in pupil size was significantly associated with better performance in neurocognitive tests in executive functioning and sustained attention. Statistical maps of parametric modulation of pupil size during the n-back task showed the frontoparietal network in the positive contrast and the default mode network in the negative contrast. The pupil response profile of the reactive group was associated with more thalamic activity, likely reflecting better arousal upregulation and less deactivation of the limbic system. CONCLUSIONS Pupil measurements have the potential to serve as a highly sensitive psychophysiological readout for detection of neurocognitive deficits in the core domain of executive functioning, adding to the development of valid transdiagnostic constructs in psychiatry.
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Affiliation(s)
- Julia Fietz
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Dorothee Pöhlchen
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany; International Max Planck Research School for Translational Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Tanja M Brückl
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Anna-Katharine Brem
- University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland; Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Victor I Spoormaker
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany.
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3
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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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The Role of Cognitive Deficits in Borderline Personality Disorder with Early Traumas: A Mediation Analysis. J Clin Med 2023; 12:jcm12030787. [PMID: 36769436 PMCID: PMC9917894 DOI: 10.3390/jcm12030787] [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: 12/07/2022] [Revised: 01/13/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
(1) Background: although studies of cognitive functions are still limited in borderline personality disorder (BPD), the initial evidence suggested that BPD patients have deficits of executive functions and social cognition. In addition, patients who report physical and psychic traumatic experiences in childhood and adolescence show considerable neurocognitive impairment and severe BPD symptoms. The present study has a twofold aim: (1) to evaluate the differences in neurocognitive performances between BPD patients and healthy controls and (2) to verify in the BPD patients group whether neurocognitive deficits have the role of mediating the effect of early traumas on BPD psychopathology. (2) Methods: 69 subjects were enrolled: 38 outpatients with a diagnosis of BPD (DSM-5) and 31 healthy controls. BPD patients were tested with the Borderline Personality Disorder Severity Index (BPDSI), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). All subjects were evaluated with the Iowa Gambling task (IGT), the Berg card sorting test (BCST), the Tower of London task (ToL), and the Reading-the-mind-in-the-eyes-test (RMET). Statistical analysis was performed with the analysis of variance to compare the cognitive performances between BPD patients and controls. A mediation analysis was conducted with the Sobel Test in the BPD patients group. The significance level was p ≤ 0.05. (3) Results: significant differences between the two groups were found for several parameters of all the cognitive tests examined: BCST, IGT, ToL, and RMET. Mediation analysis with the Sobel test demonstrated that the percentage of correct answers in the BCST (BCSTc) and the RMET score significantly mediated the relation between the CTQ total score and BPDSI total score. (4) Conclusions: BPD patients showed an impairment of the following executive functions: set shifting, decision making, planning and problem solving, and social cognition abilities, in comparison with controls. Our results suggested that the effect of early trauma on BPD psychopathology was mediated by a deficit in two cognitive domains: cognitive flexibility and social cognition.
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5
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Dufresne L, Meilleur D, Gingras N, Di Meglio G, Pesant C, Taddeo D, Nadeau PO, Bélanger R, Lavoie E, Thibault I, Agostino H, Stheneur C, Frappier JY, Bédard A, Bégin C. Personality heterogeneity in adolescents with anorexia nervosa: a factor-mixture analysis. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-022-04216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Abstract
BACKGROUND A number of recent investigations have focused on the neurobiology of obsessive-compulsive personality disorder (OCPD). However, there have been few reviews of this literature with no detailed model proposed. We therefore undertook a systematic review of these investigations, aiming to map the available evidence and investigate whether it is possible to formulate a detailed model of the neurobiology of OCPD. METHODS OCPD can be considered from both categorical and dimensional perspectives. An electronic search was therefore conducted using terms that would address not only OCPD as a category, but also related constructs, such as perfectionism, that would capture research on neuropsychology, neuroimaging, neurochemistry, and neurogenetics. RESULTS A total of 1059 articles were retrieved, with 87 ultimately selected for abstract screening, resulting in a final selection of 49 articles focusing on neurobiological investigations relevant to OCPD. Impaired executive function and cognitive inflexibility are common neuropsychological traits in this condition, and suggest that obsessive-compulsive disorder (OCD) and OCPD may lie on a continuum. However, neuroimaging studies in OCPD indicate the involvement of specific neurocircuitry, including the precuneus and amygdala, and so suggest that OCD and OCPD may have important differences. Although OCPD has a heritable component, we found no well-powered genetic studies of OCPD. CONCLUSION Although knowledge in this area has advanced, there are insufficient data on which to base a comprehensive model of the neurobiology of OCPD. Given the clinical importance of OCPD, further work to understand the mechanisms that underpin this condition is warranted.
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Folesani F, Belvederi Murri M, Biancosino B, Costa S, Zerbinati L, Caruso R, Nanni MG, Toffanin T, Ferrara M, Purdon SE, Grassi L. The screen for cognitive impairment in psychiatry in patients with borderline personality disorder. Personal Ment Health 2022; 16:279-289. [PMID: 35146968 PMCID: PMC9788074 DOI: 10.1002/pmh.1539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 01/12/2022] [Accepted: 01/23/2022] [Indexed: 12/30/2022]
Abstract
Cognitive deficits are common in borderline personality disorder (BPD) and appear to be associated with psychopathology, functioning and outcome. The availability of a cognitive screening instrument could be of use in clinical settings in order to assess neurocognition in BPD patients. The Screen for Cognitive Impairment for Psychiatry (SCIP) proved to be reliable in different psychiatric populations, but it has not yet been validated in personality disorders. The purpose of this study is therefore to evaluate its psychometric properties in a sample of 58 BPD patients. The SCIP was validated against the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) and the Trail Making Test A and B (TMT A and B). The receiver operator curve analysis displayed an acceptable convergent validity (total score AUC: 0.78, 95% CI: 0.70-0.86; Se: 75%, Sp: 72%). A cut-off total score of 80 identified 81% of patients as cognitively impaired. The exploratory factor analysis displayed a one-factor solution explaining 55.8% of the total variance. The SCIP displayed adequate psychometric properties in BPD and could be integrated in the routine clinical assessment to provide a preliminary evaluation of cognitive features for BPD.
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Affiliation(s)
- Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Bruno Biancosino
- Department of Mental Health and Addictive Disorders, Health Trust Ferrara, Ferrara, Italy
| | - Silvia Costa
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Tommaso Toffanin
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Scot E Purdon
- Alberta Hospital Edmonton, Edmonton, Alberta, Canada.,Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
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Stone LE, Segal DL, Coolidge FL. Impact of self-reported cognitive dysfunction on the alternative model of personality disorders among older adults. Aging Ment Health 2022; 27:714-720. [PMID: 35356826 DOI: 10.1080/13607863.2022.2056141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
METHOD Older adults (N = 202) completed the Levels of Personality Functioning Scale-Self-Report, Personality Inventory for DSM-5, and Coolidge Axis II Inventory with its six self-report cognitive dysfunction scales. RESULTS Results suggested high correlational overlap between subjective cognitive problems with personality functioning and pathological personality, as measured by the AMPD. Hierarchical regressions revealed that subjective measures of executive functions, perceptual motor, and language difficulties were most strongly related to the AMPD's constructs. Results are discussed in the context of prior research on objective cognitive impairment among individuals with PDs. CONCLUSION The degree of overlap found within the current older adult sample suggested an age-related problem or potential age-bias, with older adults being at-risk of (a) having their subjective cognitive problems being incorrectly interpreted as personality pathology under the AMPD or (b) having personality pathology being overlooked under the AMPD, with symptoms instead attributed to subjective cognitive issues. This study suggested that subjective cognitive dysfunction may be one mechanism that contributes to differential performance of the AMPD among older adults.
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Affiliation(s)
- Lisa E Stone
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, CO, USA
| | - Daniel L Segal
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, CO, USA
| | - Frederick L Coolidge
- Department of Psychology, University of Colorado at Colorado Springs, Colorado Springs, CO, USA
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9
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Nenadić I. Narcissistic Traits and Executive Functions. Front Psychol 2021; 12:707887. [PMID: 34790143 PMCID: PMC8591048 DOI: 10.3389/fpsyg.2021.707887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/01/2021] [Indexed: 11/13/2022] Open
Abstract
Several personality disorders have been associated with cognitive impairment, including executive functions like working memory. Yet, it is unclear whether subclinical expression in non-clinical persons is associated with cognitive functioning. Recent studies indicate that non-clinical subjects might, in fact, perform better with increasing moderate to mild expressions of narcissistic features. We tested working memory performance in a cohort of n=70 psychiatrically and neurologically healthy subjects using Wechsler Adult Intelligence Scale (WAIS/WIE) subtests Arithmetic, Digit Span and Letter-Number Sequencing, and assessed narcissistic features using three different inventories: the widely used Narcissistic Personality Inventory (NPI), as well as two clinically used measures of narcissistic traits and states, respectively, derived from schema-focused therapy, i.e., the Young Schema Questionnaire (YSQ) entitlement/grandiosity subscale and the Schema Mode Inventory (SMI) self-aggrandizer subscale. In accordance with our hypothesis, we found nominally significant positive correlations of WIE Arithmetic performance with NPI total score (Spearman's rho=0.208; p=0.043) and SMI self-aggrandizer scale (Spearman's rho=0.231; p=0.027), but findings did not survive false discovery rate (FDR) adjustment for multiple comparisons (pFDR=0.189 and pFDR=0.243, respectively). While our findings add to recent studies on cognitive performance in subclinical narcissism, they fail to demonstrate an association of cognitive performance with narcissistic traits across multiple working memory tests, indicating the need for additional study, including complementary executive functions in larger cohorts and ranges of phenotype expression.
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Affiliation(s)
- Igor Nenadić
- Department of Psychiatry and Psychotherapy, Philipps Universität Marburg, Marburg, Germany
- Department of Psychology, Goethe-Universität Frankfurt, Frankfurt, Germany
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
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10
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Belvederi Murri M, Folesani F, Costa S, Biancosino B, Zerbinati L, Ounalli H, Rossetto A, Caruso R, Nanni MG, Grassi L. The Relationship Between Cognitive Abilities and Trait Clinical Features in Patients With Borderline Personality Disorder. J Pers Disord 2021; 35:730-749. [PMID: 33779282 DOI: 10.1521/pedi_2020_34_497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Very few studies have focused on the relationship between cognitive functions and clinical features in borderline personality disorder (BPD). Subjects with BPD and healthy controls were administered the Repeatable Battery for the Assessment of Neuropsychological Status, Trail Making Test A and B, and the Wisconsin Card Sorting Test. The Brief Symptom Inventory (BSI-53) was used to assess the severity of current symptoms. Attachment style was assessed with the Experiences in Close Relationship Questionnaire, identity integration with the Personality Structure Questionnaire, and other domains of personality dysfunction with the RUDE Scale for Personality Dysfunction. Patients with BPD performed significantly worse than healthy controls in all cognitive domains. Cognitive functions, particularly delayed memory and visuospatial abilities, displayed meaningful associations with trait-like clinical features, above the effect of global cognition and state psychopathology. These findings highlight the need to evaluate effects of cognitive rehabilitation on trait features among individuals with BPD.
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Affiliation(s)
- Martino Belvederi Murri
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Federica Folesani
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Silvia Costa
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Bruno Biancosino
- Department of Mental Health and Pathological Addiction, Ferrara Health Agency, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Heifa Ounalli
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Agnese Rossetto
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Maria Giulia Nanni
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy
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Abramovitch A, Short T, Schweiger A. The C Factor: Cognitive dysfunction as a transdiagnostic dimension in psychopathology. Clin Psychol Rev 2021; 86:102007. [PMID: 33864968 DOI: 10.1016/j.cpr.2021.102007] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/12/2021] [Accepted: 03/12/2021] [Indexed: 12/19/2022]
Abstract
Research into cognitive functions across psychological disorders suggests that cognitive deficiencies may be present across multiple disorders, potentially pointing to a transdiagnostic phenomenon. More recently, a single dimension model of psychopathology, the p factor, has been proposed, in which cognitive deficits are thought to be an intrinsic construct, assumed to be transdiagnostic. However, no systematic investigation to date tested this hypothesis. The aim of the present study was to systematically review meta-analyses to assess the hypothesis that the C factor (cognitive dysfunction) is transdiagnostic in psychopathology and review potential moderators that may account for such a phenomenon. We conducted a systematic review of meta-analyses examining cognitive function across all disorders for which data were available. Included meta-analyses (n = 82), comprising 97 clinical samples, yielded 1,055 effect sizes. Twelve major disorders/categories (e.g., bipolar disorder, substance use disorders) were included, comprising 29 distinct clinical entities (e.g., euthymic bipolar disorder; alcohol use disorder). Results show that all disorders reviewed are associated with underperformance across cognitive domains, supporting the hypothesis that the C factor (or cognitive dysfunction) is a transdiagnostic factor related to p. To examine moderators that may explain or contribute to c, we first consider important interpretative limitations of neuropsychological data in psychopathology. More crucially, we review oft-neglected motivational and emotional transdiagnostic constructs of p, as prominent contributing constructs to the C factor. These constructs are offered as a roadmap for future research examining these constructs related to p, that contribute, and may account for cognitive dysfunctions in psychopathology.
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Affiliation(s)
| | - Tatiana Short
- Department of Psychology, Texas State University, USA
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12
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Moraleda-Barreno E, Cáceres Pachón MDP, Lozano ÓM, Pérez Moreno PJ, Lorca Marín JA, Fernández-Calderón F, Díaz Batanero C, Gómez-Bujedo J. Impairments in Executive Functioning in Patients with Comorbid Substance Use and Personality Disorders: A Systematic Review. J Dual Diagn 2021; 17:64-79. [PMID: 33092494 DOI: 10.1080/15504263.2020.1829769] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this systematic review was to examine the evidence for impaired executive functioning in patients diagnosed with a dual pathology of personality disorder (PD) and substance use disorder, and to identify whether differences exist in comparison to those with a single diagnosis. Methods: A systematic search was conducted to identify studies using measures of executive functioning in patients with PD-substance use disorder dual pathology. Sixteen studies were selected. Results: The results indicate that dual pathology patients with Cluster C personality disorder do not differ from controls, and that the presence of dual pathology does not influence the updating domain of executive functioning. The findings were inconclusive with regard to dual pathology patients with Cluster B personality disorders. Whilst the various studies consistently show that these patients show worse performance than the control groups, here are contradictory results with regard to whether Cluster B personality disorders add more alterations in executive functioning to those that already appear in substance use disorder. Conclusions: The results suggest the need for further research that more adequately controls variables such as time in treatment, medication, and sample size, whilst there is also a need to employ longitudinal designs that include more patients from Clusters A and C.
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Affiliation(s)
- Enrique Moraleda-Barreno
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | | | - Óscar M Lozano
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Pedro J Pérez Moreno
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - José Andrés Lorca Marín
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Fermín Fernández-Calderón
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Carmen Díaz Batanero
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
- Research Center in Natural Resources, Health and the Environment, University of Huelva, Huelva, Spain
| | - Jesús Gómez-Bujedo
- Department of Clinical and Experimental Psychology, University of Huelva, Huelva, Spain
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Luca A, Nicoletti A, Mostile G, Zappia M. The Parkinsonian Personality: More Than Just a "Trait". Front Neurol 2019; 9:1191. [PMID: 30697187 PMCID: PMC6340987 DOI: 10.3389/fneur.2018.01191] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Antonina Luca
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania, Italy
| | - Alessandra Nicoletti
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania, Italy
| | - Giovanni Mostile
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania, Italy
| | - Mario Zappia
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania, Italy
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14
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The effect of methylphenidate on decision making in patients with borderline personality disorder and attention-deficit/hyperactivity disorder. Int Clin Psychopharmacol 2018; 33:233-237. [PMID: 29847836 DOI: 10.1097/yic.0000000000000219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Impaired decision making in patients with borderline personality disorder (BPD) has been reported in several studies. Although methylphenidate (MPH) is known to ameliorate impaired decision making in patients with attention-deficit/hyperactivity disorder (ADHD), it has not yet been examined in patients with BPD. We therefore assessed the efficacy of a single dose of MPH on cognitive functions and decision making in patients with BPD. Twenty-two patients diagnosed with BPD participated in the study. The study was a randomized, double-blind placebo-controlled, random block order cross-over trial. Patients participated in two sessions and performed the Test of Variables of Attention, a digit-span test, and the computerized Iowa Gambling Task, after they had been administered either the MPH or a placebo. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale-18. Lower scores on the inattention symptoms scale were associated with a greater improvement in decision making following the administration of MPH when compared with improvements in patients with higher ADHD scores [F(1,17)=5.63, P=0.030]. We conclude that MPH may improve decision making in patients with BPD, although this effect is mediated by the level of ADHD symptoms. Further studies are needed to assess whether a prolonged beneficial effect of MPH on decision making in patients with BPD might also be present in 'real life'.
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Luca A, Nicoletti A, Mostile G, Sciacca G, Dibilio V, Cicero CE, Raciti L, Donzuso G, Zappia M. Temperament traits and executive functions in Parkinson's disease. Neurosci Lett 2018; 684:25-28. [PMID: 29940327 DOI: 10.1016/j.neulet.2018.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/11/2018] [Accepted: 06/21/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Aim of the study was to evaluate the possible relationship between Temperament traits and executive dysfunction in patients with Parkinson's disease (PD). METHODS Patients affected by PD diagnosed according to the UK Parkinson's disease Society Brain Bank criteria were enrolled in the study. Patients with a Mini Mental State Examination <24 were excluded from the study. The Temperament and Character Inventory (TCI), a self-report questionnaire assessing the Harm Avoidance (HA), Novelty Seeking (NS) and Reward Dependence (RD) temperamental traits, has been performed. The executive functions were assessed with the Frontal Assessment Battery (FAB). RESULTS Fifty PD patients (28 men and 22 women; mean age 59.1 ± 10.1 years) were enrolled. High HA (mean score 73.3 ± 24.7) and a low NS score (24.2 ± 18.7) were recorded. Fifteen (30%) patients presented a pathological FAB score (≤13.5). Patients with a pathological FAB score presented an HA score significantly higher than patients with normal FAB score (respectively 84.9 ± 13.7 versus 69.8 ± 26.9; p = 0.045). At the univariate analysis an association between high HA score and pathological FAB score was found (OR 3.85, 95%CI 1.06-13.9; p-value 0.040). CONCLUSION Our study confirmed an association between executive disturbances and HA in PD patients, possibly related to a common impairment of the frontostriatal circuits.
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Affiliation(s)
- Antonina Luca
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Via Santa Sofia 79, 95123, Catania, Italy
| | - Alessandra Nicoletti
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Via Santa Sofia 79, 95123, Catania, Italy
| | - Giovanni Mostile
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Via Santa Sofia 79, 95123, Catania, Italy
| | - Giorgia Sciacca
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Via Santa Sofia 79, 95123, Catania, Italy
| | - Valeria Dibilio
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Via Santa Sofia 79, 95123, Catania, Italy
| | - Calogero Edoardo Cicero
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Via Santa Sofia 79, 95123, Catania, Italy
| | - Loredana Raciti
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Via Santa Sofia 79, 95123, Catania, Italy
| | - Giulia Donzuso
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Via Santa Sofia 79, 95123, Catania, Italy
| | - Mario Zappia
- Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Via Santa Sofia 79, 95123, Catania, Italy.
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Executive Functioning Correlates of DSM-5 Maladaptive Personality Traits: Initial Evidence from an Italian Sample of Consecutively Admitted Adult Outpatients. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018. [DOI: 10.1007/s10862-018-9645-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Marceau EM, Kelly PJ, Solowij N. The relationship between executive functions and emotion regulation in females attending therapeutic community treatment for substance use disorder. Drug Alcohol Depend 2018; 182:58-66. [PMID: 29154148 DOI: 10.1016/j.drugalcdep.2017.10.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Difficulties in emotion regulation influence the development of substance use disorder (SUD), its severity, course, treatment outcomes, and relapse. Impaired executive functions (EFs) are common in SUD populations and may relate to emotion dysregulation. The current study tested whether performance on three basic EF tasks ('working memory', 'inhibition', and 'task-switching') and/or inventory-based assessment of EF were related to difficulties in emotion regulation in females attending residential SUD therapeutic community treatment. METHODS Cross-sectional design in which participants (N=50, all female) completed a questionnaire battery including the Difficulties in Emotion Regulation Scale (DERS) and Behavior Rating Inventory of Executive Function - Adult Version (BRIEF-A) was used. Participants also completed neuropsychological assessment of EF including the Working Memory Index (WMI; Wechsler Adult Intelligence Scale), and measures of inhibition and task-switching (Color-Word Interference Test; Delis-Kaplan Executive Function System). RESULTS Executive dysfunction, as assessed by the Global Executive Composite (GEC; BRIEF-A), and personality disorder indicators (Standardised Assessment of Personality - Abbreviated Scale; SAPAS) were positively correlated with DERS scores. Sequential hierarchical regression indicated that task-switching, GEC, and SAPAS scores statistically predicted DERS scores, while working memory and inhibition did not. Mediation analysis indicated that there was a significant indirect effect of GEC scores and task-switching performance on DERS scores, through SAPAS scores. CONCLUSIONS Impairment of EF, particularly task-switching, is related to difficulties in emotion regulation in a female sample attending residential SUD treatment. Cognitive training interventions that improve task-switching performance may be beneficial in promoting effective emotion regulation and improved SUD treatment outcomes.
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Affiliation(s)
- Ely M Marceau
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Peter J Kelly
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia
| | - Nadia Solowij
- School of Psychology and Illawarra Health and Medical Research Institute, University of Wollongong, Northfields Ave, Wollongong, NSW 2522, Australia.
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