1
|
Yilmaz M, Türkarslan KK, Zanini L, Hasdemir D, Spitoni GF, Lingiardi V. Transference interpretation and psychotherapy outcome: a systematic review of a no-consensus relationship. RESEARCH IN PSYCHOTHERAPY (MILANO) 2024; 27:744. [PMID: 38695607 PMCID: PMC11116935 DOI: 10.4081/ripppo.2024.744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 04/18/2024] [Indexed: 05/26/2024]
Abstract
Despite its well-established importance in psychoanalytic theory, there is a scarcity of empirical evidence on the relationship between a therapist's transference interpretation (TI) and therapeutic outcome. The current scientific literature shows no consensus on the existence and nature of such an association. Therefore, the present study aimed to systematically review the literature on the link between TI and outcomes in psychodynamic psychotherapies. The American Psychological Association PsycInfo, MEDLINE, and the Web of Science Core Collection were selected as the primary databases for the literature search. Studies were included if they measured the frequency/ concentration of TI in psychodynamic psychotherapy [e.g., transference focused psychotherapy (TFP), supportive-expressive therapy] or compared a treatment group (e.g., high in TI and TFP) with a control group (e.g., low in TI supportive therapy) in an adult population with psychiatric symptoms. Out of 825 retrieved abstracts, 25 articles (21 studies) were included in the final synthesis. 13 out of 21 (62%) studies showed a significant improvement in at least one therapy outcome measure following the use of TI. The present systematic review also revealed high heterogeneity across studies in terms of TI measurement, outcome assessment (e.g., psychiatric symptoms, dynamic change, interpersonal functioning, therapeutic alliance), study design (e.g., experimental, quasi-experimental, naturalistic), patient population (e.g., anxiety disorders, personality disorders), and types of treatment (e.g., TFP, supportive-expressive therapy), preventing researchers from asserting solid conclusions. The results strongly highlight the urgent need for highquality research to understand which types of patients, how, and when TIs could be effective throughout the therapy process.
Collapse
Affiliation(s)
- Meltem Yilmaz
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| | | | - Ludovica Zanini
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| | - Dilara Hasdemir
- Steve Hicks School of Social Work, University of Texas at Austin, TX.
| | - Grazia Fernanda Spitoni
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome.
| |
Collapse
|
2
|
Evanski JM, Zundel CG, Baglot SL, Desai S, Gowatch LC, Ely SL, Sadik N, Lundahl LH, Hill MN, Marusak HA. The First "Hit" to the Endocannabinoid System? Associations Between Prenatal Cannabis Exposure and Frontolimbic White Matter Pathways in Children. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:11-18. [PMID: 38021250 PMCID: PMC10654001 DOI: 10.1016/j.bpsgos.2023.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/19/2023] [Accepted: 09/21/2023] [Indexed: 12/01/2023] Open
Abstract
Background Cannabis is the most used federally illicit substance among pregnant people in the United States. However, emerging preclinical data show that a significant portion of cannabis constituents, such as Δ9-tetrahydrocannabinol and its bioactive metabolites, readily cross the placenta and accumulate in the fetal brain, disrupting neurodevelopment. Recent research using the Adolescent Brain Cognitive Development (ABCD) Study cohort has linked prenatal cannabis exposure (PCE) to greater neurobehavioral problems and lower total gray and white matter volume in children. Here, we examined the impact of PCE on frontolimbic white matter pathways that are critical for cognitive- and emotion-related functioning, show a high density of cannabinoid receptors, and are susceptible to cannabis exposure during other periods of rapid neurodevelopment (e.g., adolescence). Methods This study included 11,530 children (mean ± SD age = 118.99 ± 7.49 months; 47% female) from the ABCD Study cohort. Linear mixed-effects models were used to examine the effects of caregiver-reported PCE on fractional anisotropy of 10 frontolimbic pathways (5 per hemisphere). Results PCE was associated with lower fractional anisotropy of the right (β = -0.005, p < .001) and left (β = -0.003, p = .007) fornix, and these results remained significant after adjusting for a variety of covariates, multiple comparisons, fractional anisotropy of all fibers, and using a quality-control cohort only. Conclusions In sum, we demonstrated small, yet reliable, effects of PCE on white matter integrity during childhood, particularly in the fornix, which plays a crucial role in emotion- and memory-related processes. Future studies are needed to understand the impacts of small changes in brain structure or function on neurodevelopment and risk of neurobehavioral problems.
Collapse
Affiliation(s)
- Julia M. Evanski
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Clara G. Zundel
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Samantha L. Baglot
- Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education University of Calgary, Calgary, Alberta, Canada
| | - Shreya Desai
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Leah C. Gowatch
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Samantha L. Ely
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Nareen Sadik
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Leslie H. Lundahl
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
| | - Matthew N. Hill
- Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education University of Calgary, Calgary, Alberta, Canada
| | - Hilary A. Marusak
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan
- Hotchkiss Brain Institute and Mathison Centre for Mental Health Research and Education University of Calgary, Calgary, Alberta, Canada
- Department of Pharmacology, Wayne State University School of Medicine, Detroit, Michigan
- Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, Michigan
| |
Collapse
|
3
|
Amiri S, Mirfazeli FS, Grafman J, Mohammadsadeghi H, Eftekhar M, Karimzad N, Mohebbi M, Nohesara S. Alternation in functional connectivity within default mode network after psychodynamic psychotherapy in borderline personality disorder. Ann Gen Psychiatry 2023; 22:18. [PMID: 37170093 PMCID: PMC10176869 DOI: 10.1186/s12991-023-00449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by impairments in emotion regulation, impulse control, and interpersonal and social functioning along with a deficit in emotional awareness and empathy. In this study, we investigated whether functional connectivity (FC) within the default mode network (DMN) is affected by 1-year psychodynamic psychotherapy in patients with BPD. METHODS Nine BPD patients filled out the demography, Interpersonal Reactive Index (IRI), Toronto Alexithymia Scale 20 (TAS 20), the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and the Borderline Evaluation Severity over Time (BEST) questionnaire. The BPD group (9F) and the control group (9F) had a mean ± SD age of 28.2 ± 5.3 years and 30.4 ± 6.1 years, respectively. BPD subjects underwent longitudinal resting-state fMRI before psychodynamic psychotherapy and then every 4 months for a year after initiating psychotherapy. FC in DMN was characterized by calculating the nodal degree, a measure of centrality in the graph theory. RESULTS The results indicated that patients with BPD present with aberrant DMN connectivity compared to healthy controls. Over a year of psychotherapy, the patients with BPD showed both FC changes (decreasing nodal degree in the dorsal anterior cingulate cortex and increasing in other cingulate cortex regions) and behavioral improvement in their symptoms and substance use. There was also a significant positive association between the decreased nodal degree in regions of the dorsal cingulate cortex and a decrease in the score of the TAS-20 indicating difficulty in identifying feelings after psychotherapy. CONCLUSION In BPD, there is altered FC within the DMN and disruption in self-processing and emotion regulation. Psychotherapy may modify the DMN connectivity and that modification is associated with positive changes in BPD emotional symptoms.
Collapse
Affiliation(s)
- Saba Amiri
- Neuroscience Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Fatemeh Sadat Mirfazeli
- Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Jordan Grafman
- Department of Physical Medicine & Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine & Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Homa Mohammadsadeghi
- Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Mehrdad Eftekhar
- Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nazila Karimzad
- Iran Psychiatric Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Mohebbi
- Islamic Azad University Science and Research Branch Qazvin, Qazvin, Iran
| | - Shabnam Nohesara
- Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| |
Collapse
|
4
|
Clarkin JF, Meehan KB, De Panfilis C, Doering S. Empirical Developments in Transference-Focused Psychotherapy. Am J Psychother 2023; 76:39-45. [PMID: 36221977 DOI: 10.1176/appi.psychotherapy.20220017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Transference-focused psychotherapy (TFP) is an empirically supported individualized psychotherapy for patients with borderline personality disorder. This review highlights its development and current status. METHODS A review of the theoretical background underpinning TFP and empirical advances in the development of TFP provide perspective. RESULTS Otto Kernberg's object relations model of personality and its implications for assessment and diagnosis of personality disorders are described. The authors review the programmatic research that has been developed and has demonstrated the efficacy of TFP. In view of the empirical studies that have demonstrated the successful outcomes and processes of TFP for patients with borderline personality disorder, compared with other approaches, TFP has been applied to a broader range of difficulties related to patients' self-functioning and interpersonal functioning across the range of severities in personality pathology, consistent with the Alternative DSM-5 Model for Personality Disorders. The authors discuss borderline personality organization in the context of interpersonal, neurocognitive, and self-regulatory dysfunction, including preliminary findings. CONCLUSIONS The theoretical and empirical advances in TFP lead to future directions for research evaluating personality disorder and its treatment.
Collapse
Affiliation(s)
- John F Clarkin
- Department of Psychiatry, Weill Medical College, Cornell University, New York City (Clarkin); Department of Psychology, Long Island University Brooklyn, New York City (Meehan); Department of Medicine and Surgery, University of Parma, Parma, Italy (De Panfilis); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Doering)
| | - Kevin B Meehan
- Department of Psychiatry, Weill Medical College, Cornell University, New York City (Clarkin); Department of Psychology, Long Island University Brooklyn, New York City (Meehan); Department of Medicine and Surgery, University of Parma, Parma, Italy (De Panfilis); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Doering)
| | - Chiara De Panfilis
- Department of Psychiatry, Weill Medical College, Cornell University, New York City (Clarkin); Department of Psychology, Long Island University Brooklyn, New York City (Meehan); Department of Medicine and Surgery, University of Parma, Parma, Italy (De Panfilis); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Doering)
| | - Stephan Doering
- Department of Psychiatry, Weill Medical College, Cornell University, New York City (Clarkin); Department of Psychology, Long Island University Brooklyn, New York City (Meehan); Department of Medicine and Surgery, University of Parma, Parma, Italy (De Panfilis); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Doering)
| |
Collapse
|
5
|
Buchheim A, Kernberg OF, Netzer N, Buchheim P, Perchtold-Stefan C, Sperner-Unterweger B, Beckenbauer F, Labek K. Differential neural response to psychoanalytic intervention techniques during structural interviewing: A single-case analysis using EEG. Front Hum Neurosci 2023; 16:1054518. [PMID: 36684843 PMCID: PMC9846161 DOI: 10.3389/fnhum.2022.1054518] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/02/2022] [Indexed: 01/05/2023] Open
Abstract
Background Previous studies detected changes in the electroencephalographic (EEG) signal as an effect of psychoanalytic interventions. However, no study has investigated neural correlates of specific psychoanalytic interventions in the EEG power spectrum yet. In the present case study, we contrasted three types of interventions (clarification, confrontation, and interpretation) and a neutral control condition during a structural psychoanalytic interview conducted while EEG was recorded. Methods A 27-year-old male patient diagnosed with major depressive disorder and borderline personality disorder with recurrent suicidal and self-injurious behavior underwent a structural interview while recording EEG. Two independent experts selected by consensus the characteristic episodes of the four conditions (clarification, confrontation, interpretation, and neutral control) within the interview, which were included in the EEG analyses. Fast Fourier transformation (FFT) was applied to subsegments of the intervention type to analyze the EEG power spectra. Alpha and beta power from central, frontal, and parietal sites were considered in linear mixed-effects models with segments as a random factor with maximum-likelihood estimates due to the lack of balance in the length of the interview segments. Results The interventions "interpretation" and "confrontation" showed a significantly lower alpha power compared with the control condition in the central electrodes. In the frontal and parietal sites of the alpha power and all beta power sites, the omnibus tests (full model/model without intervention) and comparisons relative to control conditions showed no significant overall result or failed significance after alpha error correction. Conclusion Incisive interventions, such as confrontation with discrepancies and interpretation of unconscious intrapsychic conflicts, may have provoked temporary emotional lability, leading to a change in psychic processing akin to interference from external stimuli. This conclusion is consistent with the finding that interpretations, which are potentially the most concise interventions, had the strongest effects on alpha power. Using EEG during therapeutic psychoanalytic intervention techniques might be a helpful tool to evaluate differential responses to the psychotherapeutic process on a neural level. However, this single-case result has to be replicated in a larger sample and does not allow generalizations.
Collapse
Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria,*Correspondence: Anna Buchheim,
| | - Otto F. Kernberg
- New York-Presbyterian Hospital–Westchester Division, New York, NY, United States
| | - Nikolaus Netzer
- Hermann Buhl Institute, University of Innsbruck, Eurac Research, Innsbruck, Austria,Eurac Research, Bolzano, Italy
| | - Peter Buchheim
- Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
| | | | - Barbara Sperner-Unterweger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | | | - Karin Labek
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
6
|
Basharpoor S, Zakibakhsh Mohammadi N, Heidari F, Azarkolah A, Vicario CM, Salehinejad MA. Emotional working memory training improves cognitive inhibitory abilities in individuals with borderline personality trait: A randomized parallel-group trial. J Affect Disord 2022; 319:181-188. [PMID: 36155238 DOI: 10.1016/j.jad.2022.09.089] [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] [Received: 01/14/2022] [Revised: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive inhibition impairment is one of the causes of impulsive behaviors in individuals with borderline personality disorder (BPD). This study aimed to investigate the effect of emotional working memory training (EWMT) on cognitive inhibition in individuals with a clinically significant borderline personality trait. METHODS In a randomized, parallel-group trial, 40 individuals with borderline personality trait, were selected out of 1000 screened individuals and were randomly assigned to the experimental (N = 20) and waiting-list control (N = 20) groups based on the score on the Borderline Personality Scale and the follow-up Structured Clinical Interview for DSM-IV Personality Disorders. The experimental group underwent 10 sessions of EWMT and the control group did not receive any intervention (waiting list). Participants completed the Stroop Color and Word Test (SCWT) and Go/No-Go task Before and after the intervention. RESULTS EWMT significantly reduced reaction time of incongruent trials in the SCWT and commission errors in the Go/No-Go task after the intervention only in the experimental group. Furthermore, the interference score in SCWT and commission error rate at the post-intervention time were significantly lower for the experimental vs the waitlist group. LIMITATIONS The single-blind design and absence of follow-up measures. CONCLUSIONS EWMT can improve cognitive inhibition in individuals with borderline personality trait and could be used for therapeutic purposes of impulsivity behavior in BPD.
Collapse
Affiliation(s)
- Sajjad Basharpoor
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Nasim Zakibakhsh Mohammadi
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Fazeleh Heidari
- Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Anita Azarkolah
- Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran; Atieh Clinical Neuroscience Center, Tehran, Iran
| | - Carmelo M Vicario
- Department of Cognitive Science, University of Messina, Messina, Italy
| | - Mohammad Ali Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany.
| |
Collapse
|
7
|
Choi-Kain LW, Sahin Z, Traynor J. Borderline Personality Disorder: Updates in a Postpandemic World. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:337-352. [PMID: 37200886 PMCID: PMC10187392 DOI: 10.1176/appi.focus.20220057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Progress in understanding borderline personality disorder has unfolded in the last decade, landing in a new COVID-19-influenced world. Borderline personality disorder is now firmly established as a valid diagnosis, distinct from its co-occurring mood, anxiety, trauma-related, and behavioral disorders. Further, it is also understood as a reflection of general personality dysfunction, capturing essential features shared among all personality disorders. Neuroimaging research, representing the vast neurobiological advances made in the last decade, illustrates that the disorder shares frontolimbic dysfunction with many psychiatric diagnoses but has a distinct signature of interpersonal and emotional hypersensitivity. This signature is the conceptual basis of the psychotherapies and clinical management approaches proven effective for the disorder. Medications remain adjunctive and are contraindicated by some guidelines internationally. Less invasive brain-based therapeutics show promise. The most significant change in the treatment landscape is a focus on briefer, less intensive formats of generalist management. Shorter variants of therapies, such as dialectical behavior therapy and mentalization-based treatment, are in the process of being shown to be adequately effective. Earlier intervention and greater emphasis on functional improvement are needed to more effectively curb the disabilities and risks of borderline personality disorder for patients and their families. Remote interventions show promise in broadening access to care.
Collapse
Affiliation(s)
- Lois W Choi-Kain
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| | - Zeynep Sahin
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| | - Jenna Traynor
- Gunderson Personality Research Institute, McLean Hospital, Belmont, Massachusetts, and Faculty of Medicine, Harvard Medical School, Boston
| |
Collapse
|
8
|
Geurts DEM, Van den Heuvel TJ, Huys QJM, Verkes RJ, Cools R. Amygdala response predicts clinical symptom reduction in patients with borderline personality disorder: A pilot fMRI study. Front Behav Neurosci 2022; 16:938403. [PMID: 36110290 PMCID: PMC9468714 DOI: 10.3389/fnbeh.2022.938403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
Borderline personality disorder (BPD) is a prevalent, devastating, and heterogeneous psychiatric disorder. Treatment success is highly variable within this patient group. A cognitive neuroscientific approach to BPD might contribute to precision psychiatry by identifying neurocognitive factors that predict who will benefit from a specific treatment. Here, we build on observations that BPD is accompanied by the enhanced impact of the aversive effect on behavior and abnormal neural signaling in the amygdala. We assessed whether BPD is accompanied by abnormal aversive regulation of instrumental behavior and associated neural signaling, in a manner that is predictive of symptom reduction after therapy. We tested a clinical sample of 15 female patients with BPD, awaiting dialectical behavior therapy (DBT), and 16 matched healthy controls using fMRI and an aversive Pavlovian-to-instrumental transfer (PIT) task that assesses how instrumental behaviors are influenced by aversive Pavlovian stimuli. Patients were assessed 1 year after the start of DBT to quantify changes in BPD symptom severity. At baseline, behavioral aversive PIT and associated neural signaling did not differ between groups. However, the BOLD signal in the amygdala measured during aversive PIT was associated with symptom reduction at 1-year follow-up: higher PIT-related aversive amygdala signaling before treatment was associated with reduced clinical improvement at follow-up. Thus, within the evaluated group of BPD patients, the BOLD signal in the amygdala before treatment was related to clinical symptom reduction 1 year after the start of treatment. The results suggest that less PIT-related responsiveness of the amygdala increases the chances of treatment success. We note that the relatively small sample size is a limitation of this study and that replication is warranted.
Collapse
Affiliation(s)
- Dirk E. M. Geurts
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| | - Thom J. Van den Heuvel
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Scelta, Expert Centre for Personality Disorders, GGNet, Nijmegen, Netherlands
| | - Quentin J. M. Huys
- Mental Health Neuroscience Department, Division of Psychiatry and Max Planck UCL Centre for Computational Psychiatry and Ageing Research, Institute of Neurology, University College London, London, United Kingdom
| | - Robbert J. Verkes
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
- Kairos Center for Forensic Psychiatry, Pro Persona Mental Health, Nijmegen, Netherlands
| | - Roshan Cools
- Centre for Cognitive Neuroimaging, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands
- Department of Psychiatry, Radboud University Medical Center, Nijmegen, Netherlands
| |
Collapse
|
9
|
Kwon H, Kim JI, Son SY, Jang YH, Kim BN, Lee HJ, Lee JM. Sparse Hierarchical Representation Learning on Functional Brain Networks for Prediction of Autism Severity Levels. Front Neurosci 2022; 16:935431. [PMID: 35873817 PMCID: PMC9301472 DOI: 10.3389/fnins.2022.935431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
Machine learning algorithms have been widely applied in diagnostic tools for autism spectrum disorder (ASD), revealing an altered brain connectivity. However, little is known about whether an magnetic resonance imaging (MRI)-based brain network is related to the severity of ASD symptoms in a large-scale cohort. We propose a graph convolution neural network-based framework that can generate sparse hierarchical graph representations for functional brain connectivity. Instead of assigning initial features for each node, we utilized a feature extractor to derive node features and the extracted representations can be fed to a hierarchical graph self-attention framework to effectively represent the entire graph. By incorporating connectivity embeddings in the feature extractor, we propose adjacency embedding networks to characterize the heterogeneous representations of the brain connectivity. Our proposed model variants outperform the benchmarking model with different configurations of adjacency embedding networks and types of functional connectivity matrices. Using this approach with the best configuration (SHEN atlas for node definition, Tikhonov correlation for connectivity estimation, and identity-adjacency embedding), we were able to predict individual ASD severity levels with a meaningful accuracy: the mean absolute error (MAE) and correlation between predicted and observed ASD severity scores resulted in 0.96, and r = 0.61 (P < 0.0001), respectively. To obtain a better understanding on how to generate better representations, we investigate the relationships between the extracted feature embeddings and the graph theory-based nodal measurements using canonical correlation analysis. Finally, we visualized the model to identify the most contributive functional connections for predicting ASD severity scores.
Collapse
Affiliation(s)
- Hyeokjin Kwon
- Department of Electronic Engineering, Hanyang University, Seoul, South Korea
| | - Johanna Inhyang Kim
- Department of Psychiatry, Hanyang University Medical Center, Seoul, South Korea
| | - Seung-Yeon Son
- Department of Artificial Intelligence, Hanyang University, Seoul, South Korea
| | - Yong Hun Jang
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Bung-Nyun Kim
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, South Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, South Korea
| |
Collapse
|
10
|
Lampalzer U, Tozdan S, von Franqué F, Briken P. Hypersexuality and Impulsivity in Self-Referred Men With Sexual Interest in Minors: Are They Related? Do They Change During Treatment? An Exploratory Pilot Study. Sex Med 2021; 9:100429. [PMID: 34509753 PMCID: PMC8498949 DOI: 10.1016/j.esxm.2021.100429] [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: 06/20/2021] [Revised: 07/24/2021] [Accepted: 07/28/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Studies on characteristics of self-referred men with sexual interest in minors (SIM) and treatment approaches in this group of patients are still relatively rare. Aim The aim of this exploratory pilot study was to investigate hypersexuality and impulsivity as 2 dynamic risk factors that could possibly change during treatment in self-referred men with SIM. Methods Data were collected at the “Kein Täter Werden (means: not become an offender)” network site in Hamburg. Using self-report questionnaires, the extent of hypersexuality and impulsivity was analyzed with the samples’ pretreatment data via descriptive statistics and compared with nonclinical samples of other studies. The relation between hypersexuality and impulsivity was analyzed via Spearman's correlation coefficient with pretreatment data (N = 77). Intragroup analysis compared hypersexuality and impulsivity from pre- and posttreatment (n = 29). Main Outcome Measures Hypersexual Behavior Inventory and Barratt Impulsiveness Scale Version 11. Results The degree of generalized impulsivity in the SIM group was comparable to that in nonclinical samples while the degree of hypersexuality was considerably higher than in nonclinical samples. Sixty-four percent of the participants were in the range of clinically relevant hypersexuality. Impulsivity and hypersexuality were weakly positively correlated with each other. During treatment hypersexuality significantly decreased while impulsivity did not differ significantly between before beginning treatment and after (partial) completion. Conclusion Hypersexuality, but not impulsivity, was pronounced in the group of self-referred men with SIM and should be targeted in treatment. In order to improve treatment outcome regarding risk reduction in self-referred men with SIM, a focus on treatment approaches that were developed to treat hypersexuality can be expected to be effective while focusing on generalized impulsivity may be less relevant. Lampalzer U, Tozdan S, von Franqué F, et al. Hypersexuality and Impulsivity in Self-Referred Men With Sexual Interest in Minors: Are They Related? Do They Change During Treatment? An Exploratory Pilot Study. Sex Med 2021;9:100429.
Collapse
Affiliation(s)
- Ute Lampalzer
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Safiye Tozdan
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Fritjof von Franqué
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
11
|
Zarnowski O, Ziton S, Holmberg R, Musto S, Riegle S, Van Antwerp E, Santos-Nunez G. Functional MRI findings in personality disorders: A review. J Neuroimaging 2021; 31:1049-1066. [PMID: 34468063 DOI: 10.1111/jon.12924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/11/2021] [Accepted: 08/13/2021] [Indexed: 11/28/2022] Open
Abstract
Personality disorders (PDs) have a prevalence of approximately 10% in the United States, translating to over 30 million people affected in just one country. The true prevalence of these disorders may be even higher, as the paucity of objective diagnostic criteria could be leading to underdiagnosis. Because little is known about the underlying neuropathologies of these disorders, patients are diagnosed using subjective criteria and treated nonspecifically. To better understand the neural aberrancies responsible for these patients' symptoms, a review of functional MRI literature was performed. The findings reveal that each PD is characterized by a unique set of activation changes corresponding to individual structures or specific neural networks. While unique patterns of neural activity are distinguishable within each PD, aberrations of the limbic/paralimbic structures and default mode network are noted across several of them. In addition to identifying valuable activation patterns, this review reveals a void in research pertaining to paranoid, schizoid, histrionic, narcissistic, and dependent PDs. By delineating patterns in PD neuropathology, we can more effectively direct future research efforts toward enhancing objective diagnostic techniques and developing targeted treatment modalities. Furthermore, understanding why patients are manifesting certain symptoms can advance clinical awareness and improve patient outcomes.
Collapse
Affiliation(s)
- Oskar Zarnowski
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Shirley Ziton
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Rylan Holmberg
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Sarafina Musto
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Sean Riegle
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, USA
| | - Emily Van Antwerp
- West Virginia School of Osteopathic Medicine, Lewisburg, West Virginia, USA
| | - Gabriela Santos-Nunez
- University of Massachusetts Memorial Medical Center, Radiology Department, Worcester, Massachusetts, USA
| |
Collapse
|
12
|
Hörz-Sagstetter S, Ohse L, Kampe L. Three Dimensional Approaches to Personality Disorders: a Review on Personality Functioning, Personality Structure, and Personality Organization. Curr Psychiatry Rep 2021; 23:45. [PMID: 34181116 PMCID: PMC8238706 DOI: 10.1007/s11920-021-01250-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The concept of personality functioning (Alternative DSM-5 Model of Personality Disorders) has led to increased interest in dimensional personality disorder diagnosis. While differing markedly from the current categorical classification, it is closely related to the psychodynamic concepts of personality structure and personality organization. In this review, the three dimensional approaches, their underlying models, and common instruments are introduced, and empirical studies on similarities and differences between the concepts and the categorical classification are summarized. Additionally, a case example illustrates the clinical application. RECENT FINDINGS Numerous studies demonstrate the broad empirical basis, validated assessment instruments and clinical usefulness of the dimensional concepts. Their advantages compared to the categorical approach, but also the respective differences, have been demonstrated empirically, in line with clinical observations. Evidence supports the three dimensional concepts, which share conceptual overlap, but also entail unique aspects of personality pathology, respectively.
Collapse
Affiliation(s)
| | - Ludwig Ohse
- Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Germany
| | - Leonie Kampe
- Psychologische Hochschule Berlin (PHB), Am Köllnischen Park 2, 10179, Berlin, Germany
- Zentrum für Psychosoziale Medizin, Klinikum Itzehoe, Germany
| |
Collapse
|
13
|
Kampe L, Bohn J, Remmers C, Hörz-Sagstetter S. It's Not That Great Anymore: The Central Role of Defense Mechanisms in Grandiose and Vulnerable Narcissism. Front Psychiatry 2021; 12:661948. [PMID: 34177651 PMCID: PMC8226035 DOI: 10.3389/fpsyt.2021.661948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 04/06/2021] [Indexed: 12/01/2022] Open
Abstract
Objectives: The concept of narcissism contains a yet unresolved paradox: Its grandiose facet depicts the psychopathological core but is often associated with life-satisfaction and overall functioning, whereas its vulnerable facet is associated with psychological distress, but still not included in the international classification systems. Our goal was to investigate the relationship between the two facets of narcissism expecting underlying defense mechanisms to be core elements. First, we aimed to identify defense mechanisms specific to grandiose and vulnerable narcissism. Second, we explored how both facets are differentially associated with psychological distress, assuming that grandiose narcissism would be associated with less psychological distress than vulnerable narcissism. Third, we investigated the mediating role of defense mechanisms between narcissism and psychological distress. Methods: In a non-clinical sample of N = 254 individuals, the Pathological Narcissism Inventory was used for the assessment of grandiose and vulnerable facets of narcissism, the Defense Style Questionnaire for defense mechanisms, and the Brief Symptom Inventory for psychological distress. Structural equation modeling was employed to identify distinct factors of grandiose and vulnerable narcissism. Associations between specific defense mechanisms and both facets were calculated. Furthermore, the direct association between both facets and psychological distress was examined. We finally explored whether defense mechanisms mediate the association between distress and both grandiose and vulnerable narcissism. Results: A distinct pattern of defense mechanisms for each facet of narcissism could be extracted: Both facets showed significant positive correlations with specific intermediate and all maladaptive defense mechanisms. Only grandiose narcissism showed significant positive correlations with adaptive defenses. Vulnerable narcissism showed negative correlations with all adaptive defenses. Specifically, grandiose narcissism was significantly related to anticipation, pseudo-altruism, rationalization, and dissociation, whereas vulnerable narcissism was negatively related to all these defense mechanisms. While grandiose narcissism was not related to psychological distress, vulnerable narcissism showed high correlations with psychological distress. Intriguingly, mediator analysis found that grandiose narcissism was related to psychological distress when mediated by maladaptive defense mechanisms. Discussion: The role of defense mechanisms is central for a differentiated understanding of the two different faces of narcissism. The relevance of assessing defense mechanisms in clinical settings, and related empirical findings are discussed.
Collapse
Affiliation(s)
- Leonie Kampe
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Psychosoziales Zentrum Itzehoe, Itzehoe, Germany
| | - Johannes Bohn
- Department of Education and Psychology, Freie Universität Berlin, Berlin, Germany
| | - Carina Remmers
- Faculty of Health/School of Psychology and Psychiatry, Witten/Herdecke University, Witten, Germany
| | - Susanne Hörz-Sagstetter
- Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin, Germany
| |
Collapse
|
14
|
Abstract
Recent advances in the understanding of personality pathology have contributed to an emphasis on the core of personality pathology as deficits in self-functioning and interpersonal functioning at different levels of severity that must be assessed for clinical intervention. In concert with these conceptual and empirical advances, transference-focused psychotherapy (TFP), an empirically supported psychodynamic treatment for borderline personality disorder, has been in constant development with extensive clinical use. This article describes an object relations model for conceptualizing and assessing levels of personality organization, a transdiagnostic approach to personality pathology, and related treatment modifications, thus expanding the utilization of TFP beyond borderline personality disorder to the full range of personality dysfunction. The core of this treatment approach is a sequential interpretive process between patient and therapist. This process takes place within the context of a structured treatment frame tailored to the unique individual with problems in self-functioning and interpersonal functioning in his/her particular environment.
Collapse
Affiliation(s)
- John F Clarkin
- Clinical Professor of Psychology in Psychiatry, Department of Psychiatry, New York Presbyterian Hospital-Weill Medical College of Cornell University, White Plains, New York
| | - Eve Caligor
- Clinical Professor of Psychiatry, Clinical Professor of Psychology in Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York
| | - Julia Sowislo
- Instructor of Psychology in Psychiatry, Department of Psychiatry, New York Presbyterian Hospital-Weill Medical College of Cornell University, White Plains, New York
| |
Collapse
|
15
|
Svrakic DM, Zorumski CF. Neuroscience of Object Relations in Health and Disorder: A Proposal for an Integrative Model. Front Psychol 2021; 12:583743. [PMID: 33790822 PMCID: PMC8005655 DOI: 10.3389/fpsyg.2021.583743] [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: 07/16/2020] [Accepted: 01/08/2021] [Indexed: 11/13/2022] Open
Abstract
Recent advances in the neuroscience of episodic memory provide a framework to integrate object relations theory, a psychoanalytic model of mind development, with potential neural mechanisms. Object relations are primordial cognitive-affective units of the mind derived from survival- and safety-level experiences with caretakers during phase-sensitive periods of infancy and toddlerhood. Because these are learning experiences, their neural substrate likely involves memory, here affect-enhanced episodic memory. Inaugural object relations are encoded by the hippocampus-amygdala synaptic plasticity, and systems-consolidated by medial prefrontal cortex (mPFC). Self- and object-mental representations, extracted from these early experiences, are at first dichotomized by contradictory affects evoked by frustrating and rewarding interactions ("partial object relations"). Such affective dichotomization appears to be genetically hardwired the amygdala. Intrinsic propensity of mPFC to form schematic frameworks for episodic memories may pilot non-conscious integration of dichotomized mental representations in neonates and infants. With the emergence of working memory in toddlers, an activated self- and object-representation of a particular valence can be juxtaposed with its memorized opposites creating a balanced cognitive-affective frame (conscious "integration of object relations"). Specific events of object relations are forgotten but nevertheless profoundly influence the mental future of the individual, acting (i) as implicit schema-affect templates that regulate attentional priorities, relevance, and preferential assimilation of new information based on past experience, and (ii) as basic units of experience that are, under normal circumstances, integrated as attractors or "focal points" for interactive self-organization of functional brain networks that underlie the mind. A failure to achieve integrated object relations is predictive of poor adult emotional and social outcomes, including personality disorder. Cognitive, cellular-, and systems-neuroscience of episodic memory appear to support key postulates of object relations theory and help elucidate neural mechanisms of psychodynamic psychotherapy. Derived through the dual prism of psychoanalysis and neuroscience, the gained insights may offer new directions to enhance mental health and improve treatment of multiple forms of psychopathology.
Collapse
Affiliation(s)
- Dragan M. Svrakic
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| | - Charles F. Zorumski
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
- Department of Psychiatry, Taylor Family Institute for Innovative Psychiatric Research, Washington University School of Medicine in St. Louis, St. Louis, MO, United States
| |
Collapse
|
16
|
Tang G, Chen P, Chen G, Zhong S, Gong J, Zhong H, Ye T, Chen F, Wang J, Luo Z, Qi Z, Jia Y, Wang Y, Huang L. Inflammation is correlated with abnormal functional connectivity in unmedicated bipolar depression: an independent component analysis study of resting-state fMRI. Psychol Med 2021; 52:1-11. [PMID: 33602352 DOI: 10.1017/s003329172100009x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Inflammation might play a role in bipolar disorder (BD), but it remains unclear the relationship between inflammation and brain structural and functional abnormalities in patients with BD. In this study, we focused on the alterations of functional connectivity (FC), peripheral pro-inflammatory cytokines and their correlations to investigate the role of inflammation in FC in BD depression. METHODS In this study, 42 unmedicated patients with BD II depression and 62 healthy controls (HCs) were enrolled. Resting-state-functional magnetic resonance imaging was performed in all participants and independent component analysis was used. Serum levels of Interleukin-6 (IL-6) and Interleukin-8 (IL-8) were measured in all participants. Correlation between FC values and IL-6 and IL-8 levels in BD was calculated. RESULTS Compared with the HCs, BD II patients showed decreased FC in the left orbitofrontal cortex (OFC) implicating the limbic network and the right precentral gyrus implicating the somatomotor network. BD II showed increased IL-6 (p = 0.039), IL-8 (p = 0.002) levels. Moreover, abnormal FC in the right precentral gyrus were inversely correlated with the IL-8 (r = -0.458, p = 0.004) levels in BD II. No significant correlation was found between FC in the left OFC and cytokines levels. CONCLUSIONS Our findings that serum IL-8 levels are associated with impaired FC in the right precentral gyrus in BD II patients suggest that inflammation might play a crucial role in brain functional abnormalities in BD.
Collapse
Affiliation(s)
- Guixian Tang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Pan Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Guanmao Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Shuming Zhong
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou510630, China
| | - JiaYing Gong
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
- Department of Radiology, Six Affiliated Hospital of Sun Yat-sen University, Guangzhou510655, China
| | - Hui Zhong
- Biomedical Translational Research Institute, Jinan University, Guangzhou510630, China
| | - Tao Ye
- Clinical Laboratory Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
| | - Feng Chen
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Jurong Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Zhenye Luo
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Zhangzhang Qi
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Yanbin Jia
- Department of Psychiatry, First Affiliated Hospital of Jinan University, Guangzhou510630, China
| | - Ying Wang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| | - Li Huang
- Medical Imaging Center, First Affiliated Hospital of Jinan University, Guangzhou510630, China
- Institute of Molecular and Functional Imaging, Jinan University, Guangzhou510630, China
| |
Collapse
|
17
|
Lee JY, Choi YH, Cha JH, Lee JY, Lee YJ, Kim BH, Kim IK, Lee JM, Lee HJ. Altered asymmetries of the structural networks comprising the fronto-limbic brain circuitry of preterm infants. Sci Rep 2021; 11:1318. [PMID: 33446672 PMCID: PMC7809421 DOI: 10.1038/s41598-020-79446-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
This study aimed to elaborate upon prior findings suggestive of the altered lateralization of structural connectivity in the developing preterm brain by using diffusion tensor imaging tractography to explore how network topological asymmetries in fronto-limbic neural circuitry are altered at 36–41 weeks, postmenstrual age in 64 preterm infants without severe brain injury and 33 term-born infants. We compared the pattern of structural connectivity and network lateralization of the betweenness centrality in the medial fronto-orbital gyrus, superior temporal gyrus, amygdala, and hippocampus—the structures comprising the fronto-limbic brain circuit—between preterm and term infants. Global efficiency, local efficiency, and small-world characteristics did not differ significantly between the two hemispheres in term-born infants, suggesting that integration and segregation are balanced between the left and right hemispheres. However, the preterm brain showed significantly greater leftward lateralization of small-worldness (P = 0.033); the lateralization index of the betweenness centrality revealed that the medial fronto-orbital gyrus (P = 0.008), superior temporal gyrus (P = 0.031), and hippocampus (P = 0.028) showed significantly increased leftward asymmetry in preterm infants relative to term-infants independent of sex, age at imaging, and bronchopulmonary dysplasia. The altered lateralization of fronto-limbic brain circuitry might be involved in the early development of social–emotional disorders in preterm infants.
Collapse
Affiliation(s)
- Joo Young Lee
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-792, Republic of Korea
| | - Yong-Ho Choi
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Jong Ho Cha
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-792, Republic of Korea
| | - Ji Young Lee
- Department of Radiology, Hanyang Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Young-Jun Lee
- Department of Radiology, Hanyang Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bo-Hyun Kim
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Il-Kewon Kim
- Division of Neonatology and Developmental Medicine, Seoul Hanyang University Hospital, Seoul, Republic of Korea
| | - Jong-Min Lee
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea.
| | - Hyun Ju Lee
- Department of Pediatrics, Hanyang University Hospital, Hanyang University College of Medicine, 17 Haengdang-dong, Seongdong-gu, Seoul, 133-792, Republic of Korea. .,Division of Neonatology and Developmental Medicine, Seoul Hanyang University Hospital, Seoul, Republic of Korea.
| |
Collapse
|
18
|
Iskric A, Barkley-Levenson E. Neural Changes in Borderline Personality Disorder After Dialectical Behavior Therapy-A Review. Front Psychiatry 2021; 12:772081. [PMID: 34975574 PMCID: PMC8718753 DOI: 10.3389/fpsyt.2021.772081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
The biological component of the biosocial theory of emotion regulation stipulates that borderline personality disorder (BPD) arises from biological vulnerabilities to heightened emotional reactivity. Comprehensive reviews have consistently implicated abnormalities in the amygdala, anterior cingulate cortex, and hippocampus in the neurobiology of BPD. While Dialectical Behavior Therapy (DBT) is the leading evidence-based psychotherapy for the treatment of BPD, there remains a paucity of literature examining changes in the neurobiology of BPD following DBT treatment. Nine studies were identified that examined neurobiological changes in BPD after the completion of DBT. Results indicated that there was significant deactivation of amygdala activity as well as the anterior cingulate cortex in patients with BPD after DBT treatment. As well, several studies found after DBT treatment, BPD patients had a decreased activity in the inferior frontal gyrus in response to arousing stimuli and increased activity in response to inhibitory control. Future research on the neurobiological change after DBT treatment can help clarify biological mechanisms of change in BPD.
Collapse
Affiliation(s)
- Adam Iskric
- Department of Psychology, Hofstra University, Hempstead, NY, United States
| | | |
Collapse
|
19
|
Vanek J, Prasko J, Ociskova M, Hodny F, Holubova M, Minarikova K, Slepecky M, Nesnidal V. Insomnia in Patients with Borderline Personality Disorder. Nat Sci Sleep 2021; 13:239-250. [PMID: 33654445 PMCID: PMC7910080 DOI: 10.2147/nss.s295030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE Both sleep disorders and BPD are prevalent in the population, and one is often a comorbidity of the other. This narrative review aims to assess contemporary literature and scientific databases to provide the current state of knowledge about sleep disorders in patients with borderline personality disorder (BPD) and clinical suggestions for managing sleep disorders in BPD patients and future research direction. METHODS Articles were acquired via PubMed and Web of Science, and papers published between January 1980 and October 2020 were extracted. Authors made a series of literature searches using the keywords: Sleep problems, Insomnia, Nightmares, Obstructive sleep apnea, Borderline personality disorder. The inclusion criteria were: published in peer-reviewed journals; studies in humans; or reviews on the related topic; English language. The exclusion criteria were: abstracts from conferences; commentaries; subjects younger than 18 years. After an inspection of the full texts, 42 papers from 101 were selected. Secondary documents from the reference lists of the primary designated papers were searched, assessed for suitability, and included. In total, 71 papers were included in the review process. RESULTS Sleep disturbance is common among patients with BPD. Nevertheless, the number of investigations is limited, and the prevalence differs between 5-45%. Studies assessing objective changes in sleep architecture in BPD show inconsistent results. Some of them identify REM sleep changes and a decrease in slow-wave sleep, while other studies found no objective sleep architecture changes. There is also a higher prevalence of nightmares in patients with BPD. Untreated insomnia can worsen BPD symptoms via interference with emotional regulation. BPD itself seems to influence the subjective quality of sleep significantly. Proper diagnosis and treatment of sleep disorders in patients with BPD could lead to better results in therapy. Psychotherapeutic approaches can improve both sleep disorders and BPD symptoms. CONCLUSION Recognising and managing sleep disorders in patients with BPD may help alleviate the disorder's symptoms. Treatment of people with BPD may be more effective if the treatment plan explicitly addresses sleep problems. Further research is needed to reach reliable conclusions.
Collapse
Affiliation(s)
- Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Frantisek Hodny
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic
| | - Kamila Minarikova
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic
| | - Vlastimil Nesnidal
- Department of Psychiatry, Faculty of Medicine and Dentistry, University Palacky Olomouc, University Hospital, Olomouc, 77520, The Czech Republic
| |
Collapse
|
20
|
Bansal R, Peterson BS. Use of random matrix theory in the discovery of resting state brain networks. Magn Reson Imaging 2020; 77:69-87. [PMID: 33326838 DOI: 10.1016/j.mri.2020.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 12/01/2020] [Accepted: 12/06/2020] [Indexed: 11/30/2022]
Abstract
Connectomics identifies brain networks in vivo in resting state functional MRI. However, the presence of noise produces spurious identification of brain networks, which have low test-retest reliability. A Network Based Statistics approach to network identification has been previously proposed that affords much better statistical power relative to Bonferroni method but nevertheless provides a sufficiently conservative, family-wise control for false positives. We propose the use of Random Matrix Theory (RMT) to discover brain networks and to associate those networks with demographic and clinical variables. We parcellated the brain into cortical and subcortical regions using either an anatomical or a functional brain atlas. We applied RMT to study functional connectivity across brain regions by first computing the correlation matrix for time courses in those brain regions and then identifying eigenvalues that deviate from the theoretical random distribution that RMT predicts, on the assumption that real brain networks would produce eigenvalues that differ significantly from the random distribution. We assessed the specificity and test-retest reliability of identified networks through application of this RMT-based approach to (1) synthetic data generated under the null-hypothesis, (2) resting state functional MRI data from 4 real-world cohorts of patients and healthy controls, and (3) synthetic data generated by the addition of increasing amounts of noise to real-world datasets. Our findings showed that RMT method was robust to the atlas used for parcellating the brain and did not discover a brain network in synthetic data when in fact a network was not present (i.e., specificity was high); RMT-identified networks in the real-world dataset had high test-retest reliability; and RMT-based method consistently discovered the same network in the presence of increasing noise in the real-world dataset.
Collapse
Affiliation(s)
- Ravi Bansal
- Institute for the Developing Mind, Children's Hospital Los Angeles, CA 90027, USA; Department of Pediatrics, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90033, USA.
| | - Bradley S Peterson
- Institute for the Developing Mind, Children's Hospital Los Angeles, CA 90027, USA; Department of Psychiatry, Keck School of Medicine at the University of Southern California, Los Angeles, CA 90033, USA
| |
Collapse
|
21
|
Kramer U, Grandjean L, Beuchat H, Kolly S, Conus P, de Roten Y, Draganski B, Despland JN. Mechanisms of change in brief treatments for borderline personality disorder: a protocol of a randomized controlled trial. Trials 2020; 21:335. [PMID: 32299512 PMCID: PMC7160891 DOI: 10.1186/s13063-020-4229-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is one of the most frequent, most debilitating and lethal mental conditions and is associated with a serious burden of disease. Treatment for patients with BPD involves structured psychotherapy, and may involve brief psychiatric treatment as first-line intervention. No controlled study has assessed the effectiveness of such brief intervention. Whereas most psychotherapy studies in patients with BPD focus on the effectiveness of the intervention, we still lack an understanding of how and why these effects are produced from a patient process perspective. It is therefore of utmost importance to study the treatment-underlying mechanisms of change. The present study plans to apply novel measurement methods for assessing change in two central psychobiological processes in BPD: emotion and socio-cognitive processing. The study uses theory-driven and ecologically valid experimental tasks, which take the patient's individual experience as the anchor, by integrating methodology from psychotherapy process and neurofunctional imagery research. METHODS The aim of this two-arm, randomized controlled study is to test the effects (i.e., symptom reduction) and the underlying mechanisms of change associated with a brief psychiatric treatment (10 sessions over 4 months), compared with treatment as usual. Participants (N = 80 patients with BPD) undergo assessments at four points (intake, 2 months, discharge, and 12-month follow up). In addition to symptom measures, individuals undergo a 2-step assessment for the potential mechanisms of change (i.e., emotion and socio-cognitive processing): (1) behavioral and (2) (for a sub-sample) neurofunctional. We hypothesize that change in the mechanisms explains the treatment effects. DISCUSSION This study uses an easy-to-implement treatment of BPD, and a sophisticated assessment procedure to demonstrate the critical role of psychobiological change in emotion and socio-cognitive processing in brief treatments. It will help increase the effectiveness of brief treatment for BPD and help diminish the societal burden of disease related to BPD, in these early stages of treatment. TRIAL REGISTRATION {2}: ClinicalTrials.gov: NCT03717818. Registered on 24 October 2018). Protocol version {3} number 2 from 9 February 2018.
Collapse
Affiliation(s)
- Ueli Kramer
- Institute of Psychotherapy and General Psychiatry Service, Department of Psychiatry, Lausanne University Clinic and University of Lausanne and Lausanne University Hospital, Place Chauderon 18, CH-1003 Lausanne, Switzerland
- General Psychiatry Service, Department of Psychiatry, Lausanne University Clinic and University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Windsor, Windsor, Canada
| | - Loris Grandjean
- Institute of Psychotherapy and General Psychiatry Service, Department of Psychiatry, Lausanne University Clinic and University of Lausanne and Lausanne University Hospital, Place Chauderon 18, CH-1003 Lausanne, Switzerland
| | - Hélène Beuchat
- Institute of Psychotherapy and General Psychiatry Service, Department of Psychiatry, Lausanne University Clinic and University of Lausanne and Lausanne University Hospital, Place Chauderon 18, CH-1003 Lausanne, Switzerland
| | - Stéphane Kolly
- General Psychiatry Service, Department of Psychiatry, Lausanne University Clinic and University of Lausanne, Lausanne, Switzerland
| | - Philippe Conus
- General Psychiatry Service, Department of Psychiatry, Lausanne University Clinic and University of Lausanne, Lausanne, Switzerland
| | - Yves de Roten
- Institute of Psychotherapy and General Psychiatry Service, Department of Psychiatry, Lausanne University Clinic and University of Lausanne and Lausanne University Hospital, Place Chauderon 18, CH-1003 Lausanne, Switzerland
| | - Bogdan Draganski
- Department of Clinical Neurosciences, Lausanne University Clinic and University of Lausanne, Lausanne, Switzerland
| | - Jean-Nicolas Despland
- Institute of Psychotherapy and General Psychiatry Service, Department of Psychiatry, Lausanne University Clinic and University of Lausanne and Lausanne University Hospital, Place Chauderon 18, CH-1003 Lausanne, Switzerland
| |
Collapse
|
22
|
Meehan KB. An Empirical Perspective on the Transference in Psychotherapy: Commentary on Kernberg. J Am Psychoanal Assoc 2019; 67:987-997. [PMID: 32043391 DOI: 10.1177/0003065119899326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
23
|
Lei X, Zhong M, Zhang B, Yang H, Peng W, Liu Q, Zhang Y, Yao S, Tan C, Yi J. Structural and Functional Connectivity of the Anterior Cingulate Cortex in Patients With Borderline Personality Disorder. Front Neurosci 2019; 13:971. [PMID: 31572119 PMCID: PMC6753388 DOI: 10.3389/fnins.2019.00971] [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: 01/09/2019] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
Background Emerging evidences supported the hypothesis that emotional dysregulation results from aberrant connectivity within the fronto-limbic neural networks in patients with borderline personality disorder (BPD). Considering its important role in emotional regulation, the anterior cingulate cortex (ACC) has not yet been fully explored in BPD patients. Therefore, using the seed-based resting state functional connectivity (rsFC) and probabilistic fiber tracking, we aimed to explore the alterations of functional and structural connectivity (SC) of the ACC in patients with BPD. Methods A cohort of 50 unmedicated, young BPD patients and 54 sex-, age-, and education-matched healthy controls (HCs) completed psychological tests and underwent rs-fMRI and diffuse tensor imaging (DTI) scanning. Rs-FC analysis and probabilistic fiber tracking were used to plot SC and FC of the ACC. Results With the left ACC selected as a seed, BPD patients exhibited increased rsFC and abnormal SC with the right middle frontal gyrus (MFG), and decreased rsFC with the left middle temporal gyrus (MTG), compared with HCs. Additionally, negative cognitive emotion regulation and depressive symptoms both correlated negatively with the rsFC of the left ACC in BPD patients. Conclusion Abnormal SC and FC of the ACC underlie the deficient emotional regulation circuitry in BPD patients. Such alterations may be important biomarkers of BPD and thus could point to potential BPD treatment targets.
Collapse
Affiliation(s)
- Xiaoxia Lei
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Mingtian Zhong
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Bowen Zhang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Huihui Yang
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wanrong Peng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qian Liu
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Yu Zhang
- Center for Studies of Psychological Application, School of Psychology, South China Normal University, Guangzhou, China
| | - Shuqiao Yao
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
| | - Changlian Tan
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinyao Yi
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, China.,Medical Psychological Institute, Central South University, Changsha, China
| |
Collapse
|
24
|
Borderline Personality Disorder in Patients With Medical Illness: A Review of Assessment, Prevalence, and Treatment Options. Psychosom Med 2019; 81:584-594. [PMID: 31232916 DOI: 10.1097/psy.0000000000000724] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Borderline personality disorder (BPD) occurs in 0.7% to 3.5% of the general population. Patients with BPD experience excessive comorbidity of psychiatric and somatic diseases and are known to be high users of health care services. Because of a range of challenges related to adverse health behaviors and their interpersonal style, patients with BPD are often regarded as "difficult" to interact with and treat optimally. METHODS This narrative review focuses on epidemiological studies on BPD and its comorbidity with a specific focus on somatic illness. Empirically validated treatments are summarized, and implementation of specific treatment models is discussed. RESULTS The prevalence of BPD among psychiatric inpatients (9%-14%) and outpatients (12%-18%) is high; medical service use is very frequent, annual societal costs vary between &OV0556;11,000 and &OV0556;28,000. BPD is associated with cardiovascular diseases and stroke, metabolic disease including diabetes and obesity, gastrointestinal disease, arthritis and chronic pain, venereal diseases, and HIV infection as well as sleep disorders. Psychotherapy is the treatment of choice for BPD. Several manualized treatments for BPD have been empirically validated, including dialectical behavior therapy, transference-focused psychotherapy, mentalization-based therapy, and schema-focused therapy. CONCLUSIONS Health care could be substantially improved if all medical specialties would be familiar with BPD, its pathology, medical and psychiatric comorbidities, complications, and treatment. In mental health care, several empirically validated treatments that are applicable in a wide range of clinical settings are available.
Collapse
|
25
|
[Borderline personality : Alterations to brain structure and function through psychotherapy]. DER NERVENARZT 2019; 89:1232-1236. [PMID: 30094483 DOI: 10.1007/s00115-018-0587-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND There are now several scientifically evaluated psychotherapeutic methods for borderline personality disorder (BPD), all of which aim to improve the ability to regulate emotions. In recent years, there have been first studies on the neuronal correlates of the mechanisms of emotion regulation and of changes caused by psychotherapeutic interventions. METHODS This article reviews the data on functional and structural imaging studies that examine facets of disturbed emotion regulation before and after psychotherapy. RESULTS Although the overall database is still sparse, clinical improvement in psychotherapy appears to be associated with modulation of brain structure and function. Frontolimbic regulation circuits including the amygdala, insula, anterior cingulate cortex (ACC) and other prefrontal areas appear to be involved in these changes. An important finding is the reduction of initially increased amygdala activity after successful Dialectical Behavior Therapy (DBT). CONCLUSION The changes shown here most probably reflect an improvement in emotion regulation capacities in BPD and demonstrate the possibility of modulating disturbed emotion regulation processes. Since long-term follow-up data are still missing, the sustainability of the suggestive improvements still has to be proven in further studies.
Collapse
|
26
|
Magni LR, Carcione A, Ferrari C, Semerari A, Riccardi I, Nicolo’ G, Lanfredi M, Pedrini L, Cotelli M, Bocchio L, Pievani M, Gasparotti R, Rossi R. Neurobiological and clinical effect of metacognitive interpersonal therapy vs structured clinical model: study protocol for a randomized controlled trial. BMC Psychiatry 2019; 19:195. [PMID: 31234864 PMCID: PMC6591903 DOI: 10.1186/s12888-019-2127-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is a complex and debilitating disorder, characterized by deficits in metacognition and emotion dysregulation. The "gold standard" treatment for this disorder is psychotherapy with pharmacotherapy as an adjunctive treatment to target state symptoms. The present randomized clinical trial aims to assess the clinical and neurobiological changes following Metacognitive Interpersonal Therapy (MIT) compared with Structured Clinical Management (SCM) derived from specific recommendations in APA (American Psychiatric Association) guidelines for BPD. METHODS The study design is a randomized parallel controlled clinical trial and will include 80 BPD outpatients, aged 18-45 enrolled at 2 recruitment centers. Primary outcome will be the clinical change in emotion regulation capacities assessed with the Difficulties in Emotion Regulation Scale (DERS). We will also investigated the effect of psychotherapy on metacognitive abilities and several clinical features such as BPD symptomatology, general psychopathology, depression, personal functioning, and trait dimensions (anger, impulsivity, alexithymia). We will evaluate changes in brain connectivity patterns and during the view of emotional pictures. A multidimensional assessment will be performed at the baseline, at 6, 12, 18 months. We will obtain structural and functional Magnetic Resonance Images (MRIs) in MIT-Treated BPD (N = 30) and SCM-treated BPD (N = 30) at baseline and after treatment, as well as in a group of 30 healthy and unrelated volunteers that will be scanned once for comparison. DISCUSSION The present study could contribute to elucidate the neurobiological mechanisms underlying psychotherapy efficacy. The inclusion of a multidisciplinary study protocol will allow to study BPD considering different features that can affect the treatment response and their reciprocal relationships. TRIAL REGISTRATION NCT02370316 . Registered 02/24/2015.
Collapse
Affiliation(s)
- Laura Rosa Magni
- grid.419422.8Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonino Carcione
- Third Centre of Cognitive Psychotherapy, Rome, Italy ,Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Clarissa Ferrari
- grid.419422.8Service of Statistics, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Antonio Semerari
- Third Centre of Cognitive Psychotherapy, Rome, Italy ,Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Ilaria Riccardi
- Third Centre of Cognitive Psychotherapy, Rome, Italy ,Italian School of Cognitive Psychotherapy (SICC), Rome, Italy
| | - Giuseppe Nicolo’
- Third Centre of Cognitive Psychotherapy, Rome, Italy ,Italian School of Cognitive Psychotherapy (SICC), Rome, Italy ,Dipartimento Salute Mentale Roma 5, Rome, Italy
| | - Mariangela Lanfredi
- grid.419422.8Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Laura Pedrini
- grid.419422.8Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Maria Cotelli
- grid.419422.8Neuropsychology Unit, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Luisella Bocchio
- grid.425670.2IRCCS Istituto Centro S. Giovanni di Dio, Fatebenefratelli, Brescia, Italy
| | - Michela Pievani
- grid.419422.8Laboratory Alzheimer’s Neuroimaging and Epidemiology, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Roberto Gasparotti
- 0000000417571846grid.7637.5Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy
| | - Roberta Rossi
- Unit of Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy.
| | | |
Collapse
|
27
|
Soloff PH, Chowdury A, Diwadkar VA. Affective interference in borderline personality disorder: The lethality of suicidal behavior predicts functional brain profiles. J Affect Disord 2019; 252:253-262. [PMID: 30991253 PMCID: PMC6563825 DOI: 10.1016/j.jad.2019.04.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/11/2019] [Accepted: 04/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Negative affective interference with executive cognition is associated with emotion dysregulation and behavioral dyscontrol in BPD, including a diathesis to suicidal and self-injurious behavior. While clinically well described, the neural basis of affective interference with central executive network function, and resulting suicidal behavior is poorly understood. METHOD In an fMRI study, 23 BPD suicide attempters completed an affectively modified Continuous Performance Task(X-CPT), in which targets and distractors were rendered on Negative, Positive and Neutral Ekman faces, with a Distorted image as a behavioral baseline. Responses to targets were contextualized by the affective context of the face. Lethality Rating Scale scores (LRS) were modeled as the primary regressor of interest on activation peaks, with HamD scores covaried. RESULTS In the Negative vs. Neutral contrast, LRS scores were inversely related to activation in the ACC, parietal precuneus, BG and OFC, with no positive relationships. Results were similar in the Negative vs Positive contrast. In the Neutral vs. Positive contrast, activations were much less extensive, with mixed positive and negative relationships. Contextualizing responses based on the effects of valence decreased participant's ability to distinguish between targets and distracters; however, no differences were observed between valence contexts. fMRI-estimated effects were not confounded by differences in behavioral sensitivity across contexts. LIMITATIONS In this female-only sample, possible gender differences were not addressed. CONCLUSIONS With negative affective interference, increased lethality of suicidal behavior in BPD predicted diminished neural activation in areas critical to executive cognitive function. Therapies diminishing affective interference may reduce risk of suicidal behavior.
Collapse
Affiliation(s)
- Paul H. Soloff
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Asadur Chowdury
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
| | - Vaibhav A. Diwadkar
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
| |
Collapse
|
28
|
Yin J. Study on the Progress of Neural Mechanism of Positive Emotions. Transl Neurosci 2019; 10:93-98. [PMID: 31098318 PMCID: PMC6487779 DOI: 10.1515/tnsci-2019-0016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/25/2019] [Indexed: 01/10/2023] Open
Abstract
Positive emotions refer to emotions accompanied by pleasant feelings, such as happiness, interest, satisfaction, pride, and love, which are generated by individuals in response to internal and external stimuli and events. Positive emotions are conscious processes that involve a variety of components, such as a pleasant experience, facial/body expressions, evaluations, and especially behavioural plans and activation states. People's cognitive process is often accompanied by emotions, and the influence of positive emotions on cognitive activities has gradually become the focus of research in recent years. This study constructs a regulation model and an assessment model of positive emotions, and analyses the neural mechanisms of the effects of dopamine substances on human positive emotions.
Collapse
Affiliation(s)
- Jie Yin
- School of Educational Science, Hengyang Normal University, Hengyang 421002, China
| |
Collapse
|
29
|
Kneer J, Borchardt V, Kärgel C, Sinke C, Massau C, Tenbergen G, Ponseti J, Walter H, Beier KM, Schiffer B, Schiltz K, Walter M, Kruger THC. Diminished fronto-limbic functional connectivity in child sexual offenders. J Psychiatr Res 2019. [PMID: 29530321 DOI: 10.1016/j.jpsychires.2018.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Child sexual abuse and neglect have been related to an increased risk for the development of a wide range of behavioral, psychological, and sexual problems and increased rates of suicidal behavior. Contrary to the large amount of research focusing on the negative mental health consequences of child sexual abuse, very little is known about the characteristics of child sexual offenders and the neuronal underpinnings contributing to child sexual offending. METHODS AND SAMPLE This study investigates differences in resting state functional connectivity (rs-FC) between non-pedophilic child sexual offenders (N = 20; CSO-P) and matched healthy controls (N = 20; HC) using a seed-based approach. The focus of this investigation of rs-FC in CSO-P was put on prefrontal and limbic regions highly relevant for emotional and behavioral processing. RESULTS Results revealed a significant reduction of rs-FC between the right centromedial amygdala and the left dorsolateral prefrontal cortex in child sexual offenders compared to controls. CONCLUSION & RECOMMENDATIONS Given that, in the healthy brain, there is a strong top-down inhibitory control of prefrontal over limbic structures, these results suggest that diminished rs-FC between the amygdala and the dorsolateral prefrontal cortex and may foster sexual deviance and sexual offending. A profound understanding of these concepts should contribute to a better understanding of the occurrence of child sexual offending, as well as further development of more differentiated and effective interventions.
Collapse
Affiliation(s)
- Jonas Kneer
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg Strasse 1, D-30625 Hannover, Germany
| | - Viola Borchardt
- Clinical Affective Neuroimaging Laboratory, Magdeburg, Germany; Leibniz Institute for Neurobiology, Department of Behavioral Neurology, Magdeburg, Germany
| | - Christian Kärgel
- LWL-University Hospital Bochum, Division of Forensic Psychiatry, Alexandrinenstr. 1-3, 44791 Bochum, Germany
| | - Christopher Sinke
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg Strasse 1, D-30625 Hannover, Germany
| | - Claudia Massau
- LWL-University Hospital Bochum, Division of Forensic Psychiatry, Alexandrinenstr. 1-3, 44791 Bochum, Germany
| | - Gilian Tenbergen
- Department of Psychology, SUNY College at Oswego, Oswego, NY, USA
| | - Jorge Ponseti
- Institute of Sexual Medicine and Forensic Psychiatry and Psychotherapy, Kiel University, Medical School, Kiel, Germany
| | - Henrik Walter
- Division of Mind and Brain Research, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus M Beier
- Institute of Sexology and Sexual Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Boris Schiffer
- LWL-University Hospital Bochum, Division of Forensic Psychiatry, Alexandrinenstr. 1-3, 44791 Bochum, Germany
| | - Kolja Schiltz
- Department of Forensic Psychiatry, Psychiatric Hospital of the Ludwig-Maximilians-University, München, Germany; (j)Otto-von-Guericke-University Magdeburg, Department of Psychiatry, Leipziger Str. 44, 39120 Magdeburg, Germany
| | - Martin Walter
- Department of Psychiatry University of Tübingen Osianderstr. 24, 72076 Tübingen, Germany
| | - Tillmann H C Kruger
- Division of Clinical Psychology and Sexual Medicine, Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg Strasse 1, D-30625 Hannover, Germany
| |
Collapse
|
30
|
Kramer U, Kolly S, Maillard P, Pascual-Leone A, Samson AC, Schmitt R, Bernini A, Allenbach G, Charbon P, de Roten Y, Conus P, Despland JN, Draganski B. Change in Emotional and Theory of Mind Processing in Borderline Personality Disorder: A Pilot Study. J Nerv Ment Dis 2018; 206:935-943. [PMID: 30507735 DOI: 10.1097/nmd.0000000000000905] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Changes in emotional processing (EP) and in theory of mind (TOM) are central across treatment approaches for patients with borderline personality disorder (BPD). Although the assessment of EP relies on the observation of a patient's self-criticism in a two-chair dialogue, an individual's TOM assessments is made based on responses to humorous stimuli based on false beliefs. For this pilot study, we assessed eight patients with BPD before and after a 3-month-long psychiatric treatment, using functional magnetic resonance imaging and behavioral tasks. We observed arousal increase within the session of the two-chair dialogue (d = 0.36), paralleled by arousal decrease between sessions (d = 0.80). We found treatment-associated trends for neural activity reduction in brain areas central for EP and TOM. Our exploratory findings using an integrative assessment procedure of changes in EP and TOM point toward evidence for treatment effects at the brain systems level related to behavioral modulation.
Collapse
Affiliation(s)
| | - Stéphane Kolly
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | | | | | | | - Ruth Schmitt
- Department of Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Adriano Bernini
- Laboratory for Research in Neuroimaging (LREN), Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Gilles Allenbach
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Patrick Charbon
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | | | - Philippe Conus
- Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | | | | |
Collapse
|
31
|
Uscinska M, Bellino S. Treatment-induced brain plasticity in borderline personality disorder: review of functional MRI studies. FUTURE NEUROLOGY 2018. [DOI: 10.2217/fnl-2018-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although neural substrates of symptoms expression in borderline personality disorder (BPD) have been studied extensively, neural mechanisms mediating post treatment amelioration of symptoms remain poorly characterized. Herein present review sheds a critical light on all here-to-date functional MRI findings of brain changes in BPD patients following a treatment with psychotherapy or drugs. Preliminary evidence points to downregulation of neuronal activity within the insula and amygdala, together with differential employment of prefrontal areas, mainly orbitofrontal cortex, anterior cingulate cortex and dorsolateral prefrontal cortex, as well as enhanced functional connectivity between limbic and prefrontal regions induced by dialectical behavioral therapy. Identifying neural circuits behind treatment processes may refine strategies to target specific symptoms, thereby resolving some of the controversies over BPD treatment.
Collapse
Affiliation(s)
- Maria Uscinska
- Department of Neurosciences, Centre for Personality Disorders, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| | - Silvio Bellino
- Department of Neurosciences, Centre for Personality Disorders, University of Turin, Via Cherasco 11, 10126, Turin, Italy
| |
Collapse
|
32
|
Marceau EM, Meuldijk D, Townsend ML, Solowij N, Grenyer BF. Biomarker correlates of psychotherapy outcomes in borderline personality disorder: A systematic review. Neurosci Biobehav Rev 2018; 94:166-178. [DOI: 10.1016/j.neubiorev.2018.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 08/24/2018] [Accepted: 09/04/2018] [Indexed: 12/18/2022]
|
33
|
|
34
|
Brain and Behavior: Commentary on Two Cases Involving the Effect of Structural Brain Lesions on Psychiatric Disorders. J Psychiatr Pract 2018; 24:206-208. [PMID: 30015791 DOI: 10.1097/pra.0000000000000302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In this issue of the journal, 2 case reports are presented that illustrate explicit influences of structural brain lesions on psychiatric symptoms. In both cases, the patients had preexisting, classically diagnosed psychiatric disorders-schizophrenia in the first case and bipolar I disorder in the second case. In the first case, a 61-year-old woman with chronic paranoid schizophrenia experienced a marked reduction in psychotic symptoms after bilateral frontal strokes. In the second case, a 60-year-old man who had experienced manic and depressive episodes since his 20s developed partial complex seizures after having repeated head trauma in his 40s, with subsequent onset of chronic personality changes associated with temporal lobe epilepsy that made his psychiatric treatment a greater challenge. The presentations in these 2 cases raise intriguing neuropsychiatric questions concerning the effects on regional brain activity of a variety of nonpharmacological psychiatric interventions (eg, stereotactic neurosurgical techniques, deep brain stimulation, electroconvulsive therapy, certain types of psychotherapy), and concerning possible physiological pathways shared by seizure kindling in epilepsy and recurrent episodes of bipolar disorder.
Collapse
|
35
|
Churchill CJ, Fellman G. Sociology and psychoanalysis in the liberal arts. INTERNATIONAL FORUM OF PSYCHOANALYSIS 2018. [DOI: 10.1080/0803706x.2017.1284344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
36
|
McHugh C, Balaratnasingam S. Impulsivity in personality disorders: current views and future directions. Curr Opin Psychiatry 2018; 31:63-68. [PMID: 29120916 DOI: 10.1097/yco.0000000000000383] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE OF REVIEW Impulsivity is considered a trans-diagnostic feature of many mental disorders, yet our understanding of the concept and approaches to measurement have evolved significantly with advances in neuroimaging. This review will provide an overview of impulsivity as it is currently understood, its association with personality disorder and implications for treatment. RECENT FINDINGS Impulsivity is now considered to involve failure of inhibitory control, either motor or cognitive, and deficits of the reward valuation system. Inhibitory control, and discounting of rewards are both independently associated with personality disorder. The tendency to choose immediate rewards over those with an associated delay is a feature of borderline personality disorder (BPD) regardless of conditions of stress. Deficits in response inhibition were also associated with BPD and were worsened under conditions of stress. These findings indicate that state impulsivity has an important role in the expression of impulsive behaviour. Exploratory studies measuring changes in these networks following psychotherapy have confirmed such methods could be used to measuring treatment response. SUMMARY Understanding the discrete mechanisms of impulsive decision-making and behavior, and their implications in personality disorder, offers new targets for diagnosis and intervention. Future research should aim to understand changes of impulsivity with development. Identifying the role of psychological and pharmacological intervention in modulating the development of impulsivity may prevent progression to personality disorder, and associated adverse outcomes.
Collapse
Affiliation(s)
| | - Sivasankaran Balaratnasingam
- Faculty of Health and Medical Sciences, University of Western Australia, Western Australia.,The Cairns Clinic, Queensland, Australia
| |
Collapse
|
37
|
Kramer U. Mechanisms of Change in Treatments of Personality Disorders: Introduction to the Special Section. J Pers Disord 2018; 32:1-11. [PMID: 29388900 DOI: 10.1521/pedi.2018.32.supp.1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The present introduction to the Special Section on Mechanisms of Change in Treatments of Personality Disorders explains the value of research focusing on processes of change in psychotherapy by referring to a variety of methodologies. Whereas outcome for these treatments has been repeatedly demonstrated, it remains an open question what the core psychobiological features of change are. Taking a radically empirical perspective, this introduction focuses on patient and therapeutic relationship variables, such as emotional and socio-cognitive processing. The six empirical articles of the Special Section are introduced, as are the three discussions of the Special Section.
Collapse
Affiliation(s)
- Ueli Kramer
- Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| |
Collapse
|
38
|
Schnell K, Herpertz SC. Emotion Regulation and Social Cognition as Functional Targets of Mechanism-Based Psychotherapy in Major Depression With Comorbid Personality Pathology. J Pers Disord 2018; 32:12-35. [PMID: 29388896 DOI: 10.1521/pedi.2018.32.supp.12] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This article characterizes functional systems as targets of integrated modular psychotherapy for episodes of major depression (MD) with a comorbid condition of borderline personality disorder (BPD) or chronic depression (CD). Both types of comorbidities to MD are conceptualized as a trait-like concept dominated by impairments in interpersonal functioning. Despite differences in psychopathology, existing data show significant similarities in impairments of emotion regulation and social cognition in BPD and CD, thought to reflect common disease mechanisms linked to early-life adversity. The preexistence of BPD and CD and related functional impairments inhibits the remission of episodic MD and calls for mechanism-based interventions that complement existing treatments of MD by targeting these dysfunctions. Contemporary methods of psychotherapy already provide interventions to address such complicated states of comorbidity by specifically improving dysfunctions of emotion regulation and social cognition. We suggest a layout of modular interventions that can address identified dysfunctions in comorbid MD.
Collapse
Affiliation(s)
- Knut Schnell
- Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany.,Asklepios Center for Psychiatry and Psychotherapy Göttingen, Göttingen, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, University Hospital Heidelberg, Heidelberg, Germany
| |
Collapse
|
39
|
Herpertz SC, Schneider I, Schmahl C, Bertsch K. Neurobiological Mechanisms Mediating Emotion Dysregulation as Targets of Change in Borderline Personality Disorder. Psychopathology 2018; 51:96-104. [PMID: 29672301 DOI: 10.1159/000488357] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/13/2018] [Indexed: 11/19/2022]
Abstract
Emotion dysregulation is a hallmark of borderline personality disorder (BPD). Most interventions for patients with BPD, therefore, aim at the improvement of emotion regulation. In the current paper, we provide an overview of studies investigating the effects of psychotherapeutic or pharmacological interventions on neurobiological correlates of various aspects of emotion regulation. In fact, studies suggest that the prefrontal-limbic circuit may play a major role in mediating effects of clinically efficacious psychotherapeutic treatments, i.e., they lead to clinical improvement via modulating the function and structure of the amygdala, the insula, and the dorsal anterior cingulate cortex, as well as prefrontal areas involved in the cognitive regulation of emotions, and enhancing the coupling of limbic and prefrontal areas. Oxytocin as a promising pharmacological approach to emotion dysregulation in BPD was shown to dampen amygdala activity in response to emotional stimuli. Understanding the brain mechanisms that mediate treatment effects will harness further development of targeted mechanism-based interventions for patients with BPD.
Collapse
Affiliation(s)
- Sabine C Herpertz
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Isabella Schneider
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine, Central Institute of Mental Health, University of Heidelberg, Heidelberg, Germany
| | - Katja Bertsch
- Department of General Psychiatry, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
40
|
Berchio C, Piguet C, Gentsch K, Küng AL, Rihs TA, Hasler R, Aubry JM, Dayer A, Michel CM, Perroud N. Face and gaze perception in borderline personality disorder: An electrical neuroimaging study. Psychiatry Res Neuroimaging 2017; 269:62-72. [PMID: 28941875 DOI: 10.1016/j.pscychresns.2017.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/18/2017] [Accepted: 08/25/2017] [Indexed: 11/24/2022]
Abstract
Humans are sensitive to gaze direction from early life, and gaze has social and affective values. Borderline personality disorder (BPD) is a clinical condition characterized by emotional dysregulation and enhanced sensitivity to affective and social cues. In this study we wanted to investigate the temporal-spatial dynamics of spontaneous gaze processing in BPD. We used a 2-back-working-memory task, in which neutral faces with direct and averted gaze were presented. Gaze was used as an emotional modulator of event-related-potentials to faces. High density EEG data were acquired in 19 females with BPD and 19 healthy women, and analyzed with a spatio-temporal microstates analysis approach. Independently of gaze direction, BPD patients showed altered N170 and P200 topographies for neutral faces. Source localization revealed that the anterior cingulate and other prefrontal regions were abnormally activated during the N170 component related to face encoding, while middle temporal deactivations were observed during the P200 component. Post-task affective ratings showed that BPD patients had difficulty to disambiguate neutral gaze. This study provides first evidence for an early neural bias toward neutral faces in BPD independent of gaze direction and also suggests the importance of considering basic aspects of social cognition in identifying biological risk factors of BPD.
Collapse
Affiliation(s)
- Cristina Berchio
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland.
| | - Camille Piguet
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland; Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood Disorders Unit, University Hospitals of Geneva, Switzerland
| | - Kornelia Gentsch
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood Disorders Unit, University Hospitals of Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Anne-Lise Küng
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood Disorders Unit, University Hospitals of Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Tonia A Rihs
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland
| | - Roland Hasler
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood Disorders Unit, University Hospitals of Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Jean-Michel Aubry
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood Disorders Unit, University Hospitals of Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Alexandre Dayer
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland; Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood Disorders Unit, University Hospitals of Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Christoph M Michel
- Department of Basic Neurosciences, University of Geneva, Geneva, Switzerland; Biomedical Imaging Center (CIBM) Lausanne, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, Mood Disorders Unit, University Hospitals of Geneva, Switzerland; Department of Psychiatry, University of Geneva, Geneva, Switzerland
| |
Collapse
|
41
|
Sinke C, Wollmer MA, Kneer J, Kahl KG, Kruger THC. Interaction between behavioral inhibition and emotional processing in borderline personality disorder using a pictorial emotional go/no-go paradigm. Psychiatry Res 2017; 256:286-289. [PMID: 28654876 DOI: 10.1016/j.psychres.2017.06.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/13/2017] [Accepted: 06/08/2017] [Indexed: 11/17/2022]
Abstract
Borderline personality disorder (BPD) is characterized by difficulties in emotional regulation and impulse control. In this study, we presented a novel picture-based emotional go/no-go task with distracting emotional faces in the background, which was administered to 16 patients with BPD and 16 age-matched healthy controls. The faces displayed different emotional content (angry, neutral, or happy). Results showed differences in sensitivity between patients and the control group, with patients exhibiting less sensitivity in the task, and also showed influences of emotional content represented in the distracting faces in both groups. Specifically, happy faces decreased sensitivity compared to angry faces. It seemed as though processing of a positive emotional stimulus led to a more relaxed state and thereby to decreased sensitivity, while a negative emotional stimulus induced more alertness and tension, leading to higher sensitivity. Thus, this paradigm is suitable to investigate the interplay between emotion processing and impulse control in patients with BPD.
Collapse
Affiliation(s)
- Christopher Sinke
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany
| | - M Axel Wollmer
- Asklepios Clinic North - Ochsenzoll, Asklepios Campus Hamburg, Medical Faculty, Semmelweis University, Hamburg, Germany
| | - Jonas Kneer
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany
| | - Kai G Kahl
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany
| | - Tillmann H C Kruger
- Department for Psychiatry, Social Psychiatry and Psychotherapy, Medical School Hannover, Germany.
| |
Collapse
|
42
|
Abstract
OBJECTIVE The present paper elaborates a process perspective of change in psychotherapy for personality disorders (PDs). Firstly, the paper reviews the literature of mechanisms of change in treatments of PD, with the main focus on emotional processing and socio-cognitive processing. Secondly, it proposes an illustrative case-series analysis of eight cases, drawn from a mediation analysis conducted within the context of a randomized controlled trial for borderline personality disorder (BPD). METHOD As such, cases with good and poor outcomes are compared, as are cases with poor and good intake features and cases with poor and good process markers across treatment. RESULTS The results illustrate possible pathways to healthy change over the course of four months of treatment, and possible pathways of the absence of change. CONCLUSIONS These results are discussed with regard to three main research perspectives: the combination of qualitative and quantitative methodology in psychotherapy research may be applied to case study research, a neurobehavioral perspective on change may incorporate the individualized experience in the laboratory and therapist responsiveness to patient characteristics may be a core feature of fostering change. Clinical or methodological significance of this article: The present paper illustrates individual pathways to change in personality disorders. It illustrates how coping capacities influence the process of psychotherapy and outcome in personality disorders. It demonstrates the relevance of individualizing treatments for personality disorders. It demonstrates several integrative features of psychotherapy research, in particular the use of neurobehavioral paradigms and the integration of single-case research within randomized controlled trials.
Collapse
Affiliation(s)
- Ueli Kramer
- a Department of Psychiatry , Institute of Psychotherapy and General Psychiatry, University of Lausanne , Lausanne , Switzerland.,b Department of Psychology , University of Windsor , Windsor , Canada
| |
Collapse
|
43
|
Clarkin JF, Cain NM, Lenzenweger MF. Advances in transference-focused psychotherapy derived from the study of borderline personality disorder: clinical insights with a focus on mechanism. Curr Opin Psychol 2017; 21:80-85. [PMID: 29065381 DOI: 10.1016/j.copsyc.2017.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/12/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
Abstract
The most current conceptualization of personality pathology emphasizes the assessment of the severity of selected domains of functioning involving lack of accurate perceptions of self and others that are common across the personality disorder categories. Advances in our understanding of personality pathology have stimulated further development of Transference-Focused Psychotherapy (TFP) for patients with borderline personality disorder, including treatment focus on both behavior and mental representations of self and others, the trajectory of change in TFP, and the extension of TFP principles to the entire domain of personality pathology.
Collapse
Affiliation(s)
- John F Clarkin
- Clinical Professor of Psychology in Psychiatry, Weill Cornell Medical College, New York, NY, USA.
| | - Nicole M Cain
- Associate Professor of Psychology, Long Island University-Brooklyn, USA
| | - Mark F Lenzenweger
- Distinguished Professor of Psychology, Binghamton University, The State University of New York, Binghamton, NY, USA
| |
Collapse
|
44
|
Links PS, Shah R, Eynan R. Psychotherapy for Borderline Personality Disorder: Progress and Remaining Challenges. Curr Psychiatry Rep 2017; 19:16. [PMID: 28271272 DOI: 10.1007/s11920-017-0766-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The main purpose of this review was to critically evaluate the literature on psychotherapies for borderline personality disorder (BPD) published over the past 5 years to identify the progress with remaining challenges and to determine priority areas for future research. METHOD A systematic review of the literature over the last 5 years was undertaken. RESULTS The review yielded 184 relevant abstracts, and after applying inclusion criteria, 16 articles were fully reviewed based on the articles' implications for future research and/or clinical practice. CONCLUSION Our review indicated that patients with various severities benefited from psychotherapy; more intensive therapies were not significantly superior to less intensive therapies; enhancing emotion regulation processes and fostering more coherent self-identity were important mechanisms of change; therapies had been extended to patients with BPD and posttraumatic stress disorder; and more research was needed to be directed at functional outcomes.
Collapse
Affiliation(s)
- Paul S Links
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, London, Canada. .,The University of Western Ontario, London, Canada. .,London Health Sciences Centre, Department of Psychiatry, Victoria Hospital-North Tower, Rm B8-132, 800 Commissioners Road East, London, N6A 5W9, ON, Canada. .,St. Joseph's Health Care London, London, Canada.
| | - Ravi Shah
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, London, Canada.,The University of Western Ontario, London, Canada.,London Health Sciences Centre, Department of Psychiatry, Victoria Hospital-North Tower, Rm B8-132, 800 Commissioners Road East, London, N6A 5W9, ON, Canada.,St. Joseph's Health Care London, London, Canada
| | - Rahel Eynan
- Lawson Health Research Institute, Schulich School of Medicine & Dentistry, London, Canada.,The University of Western Ontario, London, Canada.,London Health Sciences Centre, Department of Psychiatry, Victoria Hospital-North Tower, Rm B8-132, 800 Commissioners Road East, London, N6A 5W9, ON, Canada.,St. Joseph's Health Care London, London, Canada
| |
Collapse
|
45
|
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.
Collapse
|
46
|
Effects of Psychotherapy on Neuronal Correlates of Reappraisal in Female Patients With Borderline Personality Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2016; 1:548-557. [PMID: 29653096 DOI: 10.1016/j.bpsc.2016.07.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 07/18/2016] [Indexed: 11/23/2022]
|
47
|
Buchheim A, Erk S, George C, Kächele H, Martius P, Pokorny D, Spitzer M, Walter H. Neural Response during the Activation of the Attachment System in Patients with Borderline Personality Disorder: An fMRI Study. Front Hum Neurosci 2016; 10:389. [PMID: 27531977 PMCID: PMC4969290 DOI: 10.3389/fnhum.2016.00389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
Abstract
Individuals with borderline personality disorder (BPD) are characterized by emotional instability, impaired emotion regulation and unresolved attachment patterns associated with abusive childhood experiences. We investigated the neural response during the activation of the attachment system in BPD patients compared to healthy controls using functional magnetic resonance imaging (fMRI). Eleven female patients with BPD without posttraumatic stress disorder (PTSD) and 17 healthy female controls matched for age and education were telling stories in the scanner in response to the Adult Attachment Projective Picture System (AAP), an eight-picture set assessment of adult attachment. The picture set includes theoretically-derived attachment scenes, such as separation, death, threat and potential abuse. The picture presentation order is designed to gradually increase the activation of the attachment system. Each picture stimulus was presented for 2 min. Analyses examine group differences in attachment classifications and neural activation patterns over the course of the task. Unresolved attachment was associated with increasing amygdala activation over the course of the attachment task in patients as well as controls. Unresolved controls, but not patients, showed activation in the right dorsolateral prefrontal cortex (DLPFC) and the rostral cingulate zone (RCZ). We interpret this as a neural signature of BPD patients’ inability to exert top-down control under conditions of attachment distress. These findings point to possible neural mechanisms for underlying affective dysregulation in BPD in the context of attachment trauma and fear.
Collapse
Affiliation(s)
- Anna Buchheim
- Institute of Psychology, University of Innsbruck Innsbruck, Austria
| | - Susanne Erk
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
| | - Carol George
- Department of Psychology, Mills College Oakland, CA, USA
| | - Horst Kächele
- International Psychoanalytic University Berlin Berlin, Germany
| | | | - Dan Pokorny
- Department of Psychosomatic Medicine and Psychotherapy, University of Ulm Ulm, Germany
| | - Manfred Spitzer
- Department of Psychiatry III, University of Ulm Ulm, Germany
| | - Henrik Walter
- Department of Psychiatry and Psychotherapy, Division of Mind and Brain Research, University Hospital Charité Berlin, Germany
| |
Collapse
|
48
|
Winter D. Attention to emotional stimuli in borderline personality disorder - a review of the influence of dissociation, self-reference, and psychotherapeutic interventions. Borderline Personal Disord Emot Dysregul 2016; 3:11. [PMID: 27713819 PMCID: PMC5050674 DOI: 10.1186/s40479-016-0047-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 09/27/2016] [Indexed: 12/19/2022] Open
Abstract
Interactions between attention and processing of emotional stimuli shed light on both sensitivity to emotional stimuli as well as emotion dysregulation. Both of the latter processes have been proposed as central characteristics of altered emotion processing in those with borderline personality disorder (BPD). This review first summarizes the conflicting behavioural, psychophysiological and neuroimaging evidence for the hypothesis that emotional dysregulation should be reflected by higher distractibility through emotional stimuli in those with BPD. Dissociation, self-reference, as well as symptom severity modulated by psychotherapeutic interventions are proposed to help clarify divergent findings. Data suggest an association of dissociation with impaired task continuation during the presentation of interfering emotional and neutral stimuli, as well as high recruitment of neuronal attention networks together with a blunted emotional response. Considering self-reference, evidence suggests that negative rather than positive information may be more self-relevant to those with BPD. This may be due to a negative self-concept and self-evaluation. Social or trauma-relevant information attracts more attention from individuals with BPD and thus suggests higher self-relevance. After psychotherapeutic interventions, initial evidence may indicate normalization of the way attention and emotional stimuli interact in BPD. When studying attention-emotion interactions in BPD, methodological heterogeneities regarding sample, task, and stimulus characteristics need to be considered. When doing so, dissociation, self-reference, and psychotherapeutic interventions offer promising targets for future studies on attention-emotion interactions in those with BPD. This could promote a deeper insight into the affected individuals' struggle with emotions.
Collapse
Affiliation(s)
- Dorina Winter
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, PO Box 12 21 20, 68072 Mannheim, Germany
| |
Collapse
|