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Camacho-Téllez V, Castro MN, Wainsztein AE, Goldberg X, De Pino G, Costanzo EY, Cardoner N, Menchón JM, Soriano-Mas C, Guinjoan SM, Villarreal MF. Childhood adversity modulates structural brain changes in borderline personality but not in major depression disorder. Psychiatry Res Neuroimaging 2024; 340:111803. [PMID: 38460393 DOI: 10.1016/j.pscychresns.2024.111803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 11/24/2023] [Accepted: 02/20/2024] [Indexed: 03/11/2024]
Abstract
Adverse childhood experiences (ACEs) negatively affect the function and structure of emotion brain circuits, increasing the risk of various psychiatric disorders. It is unclear if ACEs show disorder specificity with respect to their effects on brain structure. We aimed to investigate whether the structural brain effects of ACEs differ between patients with major depression (MDD) and borderline personality disorder (BPD). These disorders share many symptoms but likely have different etiologies. To achieve our goal, we obtained structural 3T-MRI images from 20 healthy controls (HC), 19 MDD patients, and 18 BPD patients, and measured cortical thickness and subcortical gray matter volumes. We utilized the Adverse Childhood Experiences (ACE) questionnaire to quantify self-reported exposure to childhood trauma. Our findings suggest that individuals with MDD exhibit a smaller cortical thickness when compared to those with BPD. However, ACEs showed a significantly affected relationship with cortical thickness in BPD but not in MDD. ACEs were found to be associated with thinning in cortical regions involved in emotional behavior in BPD, whereas HC showed an opposite association. Our results suggest a potential mechanism of ACE effects on psychopathology involving changes in brain structure. These findings highlight the importance of early detection and intervention strategies.
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Affiliation(s)
- Vicente Camacho-Téllez
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias Fleni-CONICET (INEU), Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires (UBA), Argentina
| | - Mariana N Castro
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias Fleni-CONICET (INEU), Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires (UBA), Argentina.
| | - Agustina E Wainsztein
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias Fleni-CONICET (INEU), Argentina; Servicio de Psiquiatría, Fleni, Argentina
| | - Ximena Goldberg
- Mental Health Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Sabadell, Spain; CIBERSAM, Carlos III Health Institute, Madrid, Spain; ISGlobal, Barcelona, Spain
| | - Gabriela De Pino
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias Fleni-CONICET (INEU), Argentina; Laboratorio de Neuroimágenes, Departamento de Imágenes, Fleni, Argentina; Escuela de Ciencia y Tecnología, Universidad Nacional de San Martín, Argentina
| | - Elsa Y Costanzo
- Departamento de Salud Mental, Facultad de Medicina, Universidad de Buenos Aires (UBA), Argentina; Servicio de Psiquiatría, Fleni, Argentina
| | - Narcís Cardoner
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Sant Pau Mental Health Research Group, Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Psychiatry and Forensic Medicine, School of Medicine Bellaterra, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José M Menchón
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain
| | - Carles Soriano-Mas
- CIBERSAM, Carlos III Health Institute, Madrid, Spain; Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, Barcelona, Spain; Department of Social Psychology and Quantitative Psychology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Salvador M Guinjoan
- Laureate Institute for Brain Research, Tulsa, USA; Department of Psychiatry, Health Sciences Center, Oklahoma University, and Oxley College, Tulsa University, Tulsa, Oklahoma, USA
| | - Mirta F Villarreal
- Grupo de Investigación en Neurociencias Aplicadas a las Alteraciones de la Conducta (Grupo INAAC), Instituto de Neurociencias Fleni-CONICET (INEU), Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Argentina; Departamento de Física, Facultad de Ciencias Exactas y Naturales, UBA, Argentina
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Feurer C, Jimmy J, Uribe M, Shankman SA, Langenecker SA, Craske MG, Ajilore O, Phan KL, Klumpp H. Brain activity during reappraisal and associations with psychotherapy response in social anxiety and major depression: a randomized trial. Psychol Med 2024:1-11. [PMID: 38775085 DOI: 10.1017/s0033291724001120] [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] [Indexed: 06/29/2024]
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is an effective treatment for patients with social anxiety disorder (SAD) or major depressive disorder (MDD), yet there is variability in clinical improvement. Though prior research suggests pre-treatment engagement of brain regions supporting cognitive reappraisal (e.g. dorsolateral prefrontal cortex [dlPFC]) foretells CBT response in SAD, it remains unknown if this extends to MDD or is specific to CBT. The current study examined associations between pre-treatment neural activity during reappraisal and clinical improvement in patients with SAD or MDD following a trial of CBT or supportive therapy (ST), a common-factors comparator arm. METHODS Participants were 75 treatment-seeking patients with SAD (n = 34) or MDD (n = 41) randomized to CBT (n = 40) or ST (n = 35). Before randomization, patients completed a cognitive reappraisal task during functional magnetic resonance imaging. Additionally, patients completed clinician-administered symptom measures and a self-report cognitive reappraisal measure before treatment and every 2 weeks throughout treatment. RESULTS Results indicated that pre-treatment neural activity during reappraisal differentially predicted CBT and ST response. Specifically, greater trajectories of symptom improvement throughout treatment were associated with less ventrolateral prefrontal cortex (vlPFC) activity for CBT patients, but more vlPFC activity for ST patients. Also, less baseline dlPFC activity corresponded with greater trajectories of self-reported reappraisal improvement, regardless of treatment arm. CONCLUSIONS If replicated, findings suggest individual differences in brain response during reappraisal may be transdiagnostically associated with treatment-dependent improvement in symptom severity, but improvement in subjective reappraisal following psychotherapy, more broadly.
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Affiliation(s)
- Cope Feurer
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jagan Jimmy
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Melissa Uribe
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Stewart A Shankman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | - Scott A Langenecker
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
| | - Olusola Ajilore
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
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Steinmann S, Tiedemann KJ, Kellner S, Wellen CM, Haaf M, Mulert C, Rauh J, Leicht G. Reduced frontocingulate theta connectivity during emotion regulation in major depressive disorder. J Psychiatr Res 2024; 173:245-253. [PMID: 38554620 DOI: 10.1016/j.jpsychires.2024.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/19/2024] [Accepted: 03/19/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Cognitive reappraisal is an essential emotion regulation skill for social life and psychological health. However, individuals with major depressive disorder (MDD) cannot use this skill effectively. Successful cognitive reappraisal in healthy controls (HC) has been shown to be associated with theta activity in a frontal and subcortical network. In the present study, we investigated whether MDD patients are characterized by altered theta power and connectivity pattern during cognitive reappraisal compared to HC. METHODS Using EEG and eLORETA, we examined both theta activity and connectivity when 25 controls and 24 patients with MDD were asked to complete the emotion cognitive reappraisal task of viewing neutral and negative pictures and reappraise negative pictures. Habitual use of emotion regulation skills was collected using the Cognitive Emotion Regulation Questionnaire (CERQ). RESULTS The results showed that MDD patients had (1) reduced theta activity in the left dorsolateral (dlPFC), dorsomedial prefrontal (dmPFC), and rostral-ventral cingulate cortices (rvACC), as well as (2) reduced dlPFC-rvACC theta connectivity than HC during reappraisal. In addition, left dlPFC-rvACC theta connectivity was positively correlated with self-reported cognitive reappraisal in HC. This relation was not observed in MDD. In contrast, CERQ revealed significantly greater use of inadequate regulations skills and significantly lower use of adaptive skills in MDD. LIMITATION Sample size, limited solution space to cortical grey matter excluding regions such as the amygdala. CONCLUSION This study may indicate a putative frontocingulate dysfunction leading either to an increased use of inadequate emotion regulation or a decreased use of skills that serve to boost positive emotion.
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Affiliation(s)
- Saskia Steinmann
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Kim Janine Tiedemann
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stephanie Kellner
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claudius M Wellen
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Moritz Haaf
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Mulert
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Center for Psychiatry, Justus Liebig University, Giessen, Germany
| | - Jonas Rauh
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry 2024; 23:4-25. [PMID: 38214629 PMCID: PMC10786009 DOI: 10.1002/wps.21156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, USA
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
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Maturana‐Quijada P, Steward T, Vilarrasa N, Miranda‐Olivos R, Jiménez‐Murcia S, Carey HJ, Fernández‐Formoso J, Guerrero‐Perez F, Sánchez I, Custal N, Virgili N, Lopez‐Urdiales R, Soriano‐Mas C, Fernandez‐Aranda F. Dynamic fronto-amygdalar interactions underlying emotion-regulation deficits in women at higher weight. Obesity (Silver Spring) 2023; 31:2283-2293. [PMID: 37545191 PMCID: PMC10946850 DOI: 10.1002/oby.23830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 04/12/2023] [Accepted: 05/01/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE The regulation of negative emotions entails the modulation of subcortical regions, such as the amygdala, by prefrontal regions. There is preliminary evidence suggesting that individuals at higher weight may present with hypoactivity in prefrontal regulatory systems during emotional regulation, although the directionality of these pathways has not been tested. In this study, we compared fronto-amygdalar effective connectivity during cognitive reappraisal as a function of BMI in 48 adult women with obesity and 54 control participants. METHODS Dynamic causal modeling and parametric empirical Bayes were used to map effective connectivity between the dorsomedial prefrontal cortex, orbitofrontal cortex, dorsolateral prefrontal cortex, and the amygdala. RESULTS Difficulty in Emotion Regulation Scale scores were higher in the obesity group compared with control participants (p < 0.001). A top-down cortical model best explained our functional magnetic resonance imaging data (posterior probability = 86%). Participants at higher BMI were less effective at inhibiting activity in the amygdala via the orbitofrontal cortex and dorsomedial prefrontal cortex during reappraisal compared with those at lower BMI. In contrast, increased excitatory modulation of dorsolateral prefrontal cortex-to-amygdalar connectivity was found in participants at lower BMI. CONCLUSIONS These findings support a framework involving alterations in fronto-amygdalar connectivity contributing to difficulties in regulating negative affect in individuals at higher weight.
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Affiliation(s)
- Pablo Maturana‐Quijada
- Psychiatry and Mental Health Group, Neuroscience ProgramInstitut d’ Investigació Biomèdica de Bellvitge (IDIBELL)BarcelonaSpain
| | - Trevor Steward
- Melbourne School of Psychological Sciences, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | - Nuria Vilarrasa
- Department of Endocrinology and NutritionBellvitge University Hospital–IDIBELLBarcelonaSpain
- CIBER Diabetes and Associated Metabolic Diseases (CIBERDEM)Instituto de Salud Carlos IIIBarcelonaSpain
| | - Romina Miranda‐Olivos
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn)Instituto Salud Carlos IIIBarcelonaSpain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neuroscience ProgramInstitut d' Investigacio Biomèdica de Bellvitge (IDIBELL)BarcelonaSpain
| | - Susana Jiménez‐Murcia
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn)Instituto Salud Carlos IIIBarcelonaSpain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neuroscience ProgramInstitut d' Investigacio Biomèdica de Bellvitge (IDIBELL)BarcelonaSpain
- Department of Clinical Sciences, School of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
- Clinical Psychology UnitBellvitge University Hospital‐IDIBELLBarcelonaSpain
| | - Holly J. Carey
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, Faculty of Medicine, Dentistry and Health SciencesUniversity of MelbourneParkvilleVictoriaAustralia
| | | | - Fernando Guerrero‐Perez
- Department of Endocrinology and NutritionBellvitge University Hospital–IDIBELLBarcelonaSpain
| | - Isabel Sánchez
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn)Instituto Salud Carlos IIIBarcelonaSpain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neuroscience ProgramInstitut d' Investigacio Biomèdica de Bellvitge (IDIBELL)BarcelonaSpain
- Clinical Psychology UnitBellvitge University Hospital‐IDIBELLBarcelonaSpain
| | - Nuria Custal
- Clinical Psychology UnitBellvitge University Hospital‐IDIBELLBarcelonaSpain
| | - Nuria Virgili
- Department of Endocrinology and NutritionBellvitge University Hospital–IDIBELLBarcelonaSpain
- CIBER Diabetes and Associated Metabolic Diseases (CIBERDEM)Instituto de Salud Carlos IIIBarcelonaSpain
| | - Rafael Lopez‐Urdiales
- Department of Endocrinology and NutritionBellvitge University Hospital–IDIBELLBarcelonaSpain
| | - Carles Soriano‐Mas
- Psychiatry and Mental Health Group, Neuroscience ProgramInstitut d’ Investigació Biomèdica de Bellvitge (IDIBELL)BarcelonaSpain
- Ciber Salud Mental (CIBERSAM)Instituto Salud Carlos IIIBarcelonaSpain
- Department of Social Psychology and Quantitative Psychology, School of PsychologyUniversity of BarcelonaBarcelonaSpain
| | - Fernando Fernandez‐Aranda
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn)Instituto Salud Carlos IIIBarcelonaSpain
- Psychoneurobiology of Eating and Addictive Behaviors Group, Neuroscience ProgramInstitut d' Investigacio Biomèdica de Bellvitge (IDIBELL)BarcelonaSpain
- Department of Clinical Sciences, School of Medicine and Health SciencesUniversity of BarcelonaBarcelonaSpain
- Clinical Psychology UnitBellvitge University Hospital‐IDIBELLBarcelonaSpain
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Hadar-Shoval D, Elyoseph Z, Lvovsky M. The plasticity of ChatGPT's mentalizing abilities: personalization for personality structures. Front Psychiatry 2023; 14:1234397. [PMID: 37720897 PMCID: PMC10503434 DOI: 10.3389/fpsyt.2023.1234397] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/22/2023] [Indexed: 09/19/2023] Open
Abstract
This study evaluated the potential of ChatGPT, a large language model, to generate mentalizing-like abilities that are tailored to a specific personality structure and/or psychopathology. Mentalization is the ability to understand and interpret one's own and others' mental states, including thoughts, feelings, and intentions. Borderline Personality Disorder (BPD) and Schizoid Personality Disorder (SPD) are characterized by distinct patterns of emotional regulation. Individuals with BPD tend to experience intense and unstable emotions, while individuals with SPD tend to experience flattened or detached emotions. We used ChatGPT's free version 23.3 and assessed the extent to which its responses akin to emotional awareness (EA) were customized to the distinctive personality structure-character characterized by Borderline Personality Disorder (BPD) and Schizoid Personality Disorder (SPD), employing the Levels of Emotional Awareness Scale (LEAS). ChatGPT was able to accurately describe the emotional reactions of individuals with BPD as more intense, complex, and rich than those with SPD. This finding suggests that ChatGPT can generate mentalizing-like responses consistent with a range of psychopathologies in line with clinical and theoretical knowledge. However, the study also raises concerns regarding the potential for stigmas or biases related to mental diagnoses to impact the validity and usefulness of chatbot-based clinical interventions. We emphasize the need for the responsible development and deployment of chatbot-based interventions in mental health, which considers diverse theoretical frameworks.
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Affiliation(s)
- Dorit Hadar-Shoval
- Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Zohar Elyoseph
- Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Emek Yezreel, Israel
- Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
- Educational Psychology Department, Center for Psychobiological Research, Max Stern Yezreel Valley College, Emek Yezreel, Israel
| | - Maya Lvovsky
- Educational Psychology Department, Center for Psychobiological Research, Max Stern Yezreel Valley College, Emek Yezreel, Israel
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Peng B, Liao J, Li Y, Jia G, Yang J, Wu Z, Zhang J, Yang Y, Luo X, Wang Y, Zhang Y, Pan J. Personality characteristics, defense styles, borderline symptoms, and non-suicidal self-injury in first-episode major depressive disorder. Front Psychol 2023; 14:989711. [PMID: 36777206 PMCID: PMC9909038 DOI: 10.3389/fpsyg.2023.989711] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/10/2023] [Indexed: 01/28/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) is commonly seen in adolescents with depression and is a high-risk factor leading to suicide. The psychological mechanisms underlying depression with NSSI are still unclear. The purpose of this study was to explore the differences in personality traits, defensive styles, and borderline symptoms among first-episode youth patients with depression and self-injury compared with patients with depression without self-injury and healthy populations. Methods The current study recruited 188 participants, including 64 patients with depression and NSSI, 60 patients with depression without NSSI, and 64 healthy control subjects. Eysenck Personality Questionnaire, the Defense Style Questionnaire, the short version of the Borderline Symptom List, the Beck Depression Inventory, and the Ottawa Self-Injury Inventory were used to assess all participants. Results Patients with depression and NSSI showed more psychoticism than patients with depression without NSSI and healthy control subjects. Patients with depression and NSSI presented more intermediate defense styles than healthy control subjects. In the patients with depression and NSSI group, the frequency of self-injury in the last week was negatively correlated with mature defense styles and positively correlated with depressive symptoms and borderline symptoms. Further regression analysis showed that EPQ-psychoticism and depressive symptoms were independent risk factors for NSSI in patients with depression. Conclusion This study found that patients with depression and self-injury presented more neuroticism, introversion, EPQ-psychoticism, immature defenses, intermediate defenses, and borderline symptoms. Self-injury frequency was negatively correlated with mature defense styles and positively correlated with depressive symptoms and borderline symptoms. EPQ-Psychoticism and depressive symptoms are risk factors for predicting non-suicidal self-injury in patients with depression.
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Affiliation(s)
- Bo Peng
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China,Department of Depressive Disorder, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China,Shenzhen Mental Health Center, Shenzhen, Guangdong, China
| | - Jiwu Liao
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yang Li
- Teachers College, Columbia University, New York, NY, United States
| | - Guangbo Jia
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China
| | - Jihui Yang
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China
| | - Zhiwei Wu
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China
| | - Jian Zhang
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China
| | - Yingjia Yang
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China
| | - Xinxin Luo
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China
| | - Yao Wang
- Department of Depressive Disorder, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China,Shenzhen Mental Health Center, Shenzhen, Guangdong, China
| | - Yingli Zhang
- Department of Depressive Disorder, Shenzhen Kangning Hospital, Shenzhen, Guangdong, China,Shenzhen Mental Health Center, Shenzhen, Guangdong, China,*Correspondence: Yingli Zhang, ✉
| | - Jiyang Pan
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China,Jiyang Pan, ✉
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8
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Sun J, Ma Y, Guo C, Du Z, Chen L, Wang Z, Li X, Xu K, Luo Y, Hong Y, Yu X, Xiao X, Fang J, Lu J. Distinct patterns of functional brain network integration between treatment-resistant depression and non treatment-resistant depression: A resting-state functional magnetic resonance imaging study. Prog Neuropsychopharmacol Biol Psychiatry 2023; 120:110621. [PMID: 36031163 DOI: 10.1016/j.pnpbp.2022.110621] [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: 06/09/2022] [Revised: 08/13/2022] [Accepted: 08/21/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Previous neuroimaging has paid little attention to the differences in brain network integration between patients with treatment-resistant depression(TRD) and non-TRD (nTRD), and the relationship between their impaired brain network integration and clinical symptoms has not been elucidated. METHOD Eighty one major depressive disorder (MDD) patients (40 in TRD, 41 in nTRD) and 40 healthy controls (HCs) were enrolled for the functional magnetic resonance imaging (fMRI) scans. A seed-based functional connectivity (FC) method was used to investigate the brain network abnormalities of default mode network (DMN), affective network (AN), salience network (SN) and cognitive control network (CCN) for the MDD. Finally, the correlation was analyzed between the abnormal FCs and 17-item Hamilton Rating Scale for Depression scale (HAMD-17) scores. RESULTS Compared with the HC group, the FCs in DMN, AN, SN, CCN were altered in both the TRD and nTRD groups. Compared with the nTRD group, FC alterations in the AN and CCN were more abnormal in the TRD group, and the FC alterations were generally decreased at the SN in the TRD group. In addition, the FC values of right dorsolateral prefrontal cortices and left caudate nucleus in the TRD group and the FC values of right subgenual anterior cingulate cortex and left middle temporal gyrus in the nTRD group were positively correlated with HAMD-17 scale scores. CONCLUSIONS Abnormal FCs are present in four brain networks (DMN, AN, SN, CCN) in both the TRD and nTRD groups. Except of DMN, FCs in AN, SN and CCN maybe underlay the neurobiological mechanism in differentiating TRD from nTRD.
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Affiliation(s)
- Jifei Sun
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China
| | - Yue Ma
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China
| | - Chunlei Guo
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China
| | - Zhongming Du
- Dongzhimen Hospital, Beijing University of Chinese Medicine, 100700 Beijing, China
| | - Limei Chen
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China
| | - Zhi Wang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China
| | - Xiaojiao Li
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China
| | - Ke Xu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China
| | - Yi Luo
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China
| | - Yang Hong
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China
| | - Xue Yu
- Beijing First Hospital of Integrated Chinese and Western Medicine, 100026 Beijing, China
| | - Xue Xiao
- Beijing First Hospital of Integrated Chinese and Western Medicine, 100026 Beijing, China
| | - Jiliang Fang
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, 100053 Beijing, China.
| | - Jie Lu
- Xuanwu Hospital, Capital Medical University, 100053 Beijing, China.
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9
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Zhao X, Liu Y, Wang S, Chen J, Chen T, Liu G. Electrophysiological evidence for inhibition hypothesis of micro-expressions based on tensor component analysis and Physarum network algorithm. Neurosci Lett 2022; 790:136897. [PMID: 36195299 DOI: 10.1016/j.neulet.2022.136897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 09/01/2022] [Accepted: 09/29/2022] [Indexed: 11/30/2022]
Abstract
The inhibition hypothesis advocated by Ekman (1985) states when an emotion is concealed or masked, the true emotion is manifested as a micro-expression (ME) which is a fleeting expression lasting for 40 to 500 ms. However, research about the inhibition hypothesis of ME from the perspective of electrophysiology is lacking. Here, we report the electrophysiological evidence obtained from an electroencephalography (EEG) data analysis method. Specifically, we designed an ME elicitation paradigm to collect data of MEs of positive emotions and EEG from 70 subjects, and proposed a method based on tensor component analysis (TCA) combined with the Physarum network (PN) algorithm to characterize the spatial, temporal, and spectral signatures of dynamic EEG data of MEs. The proposed TCA-PN methods revealed two pathways involving dorsal and ventral streams in functional brain networks of MEs, which reflected the inhibition processing and emotion arousal of MEs. The results provide evidence for the inhibition hypothesis from an electrophysiological standpoint, which allows us to better understand the neural mechanism of MEs.
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Affiliation(s)
- Xingcong Zhao
- School of Electronic and Information Engineering, Southwest University, 400715, China
| | - Ying Liu
- School of Music, Southwest University, 400715, China
| | - Shiyuan Wang
- School of Electronic and Information Engineering, Southwest University, 400715, China
| | - Jiejia Chen
- School of Electronic and Information Engineering, Southwest University, 400715, China
| | - Tong Chen
- School of Electronic and Information Engineering, Southwest University, 400715, China
| | - Guangyuan Liu
- School of Electronic and Information Engineering, Southwest University, 400715, China; Key Laboratory of Cognition and Personality, Ministry of Education, Southwest University, 400715, China.
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10
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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.
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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
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11
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Oversampled and undersolved: Depressive rumination from an active inference perspective. Neurosci Biobehav Rev 2022; 142:104873. [PMID: 36116573 DOI: 10.1016/j.neubiorev.2022.104873] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 11/22/2022]
Abstract
Rumination is a widely recognized cognitive deviation in depression. Despite the recognition, researchers have struggled to explain why patients cannot disengage from the process, although it depresses their mood and fails to lead to effective problem-solving. We rethink rumination as repetitive but unsuccessful problem-solving attempts. Appealing to an active inference account, we suggest that adaptive problem-solving is based on the generation, evaluation, and performance of candidate policies that increase an organism's knowledge of its environment. We argue that the problem-solving process is distorted during rumination. Specifically, rumination is understood as engaging in excessive yet unsuccessful oversampling of policy candidates that do not resolve uncertainty. Because candidates are sampled from policies that were selected in states resembling one's current state, "bad" starting points (e.g., depressed mood, physical inactivity) make the problem-solving process vulnerable for generating a ruminative "halting problem". This problem leads to high opportunity costs, learned helplessness and diminished overt behavior. Besides reviewing evidence for the conceptual paths of this model, we discuss its neurophysiological correlates and point towards clinical implications.
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