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Blay M, Verne M, Durpoix A, Benmakhlouf I, Labaume L. Clinical specificities of patients with substance use disorder and comorbid borderline personality disorder compared to patients with substance use disorder only: a retrospective study. J Addict Dis 2024:1-7. [PMID: 38835113 DOI: 10.1080/10550887.2024.2363038] [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: 06/06/2024]
Abstract
INTRODUCTION Substance use disorder (SUD) is a common condition often associated with borderline personality disorder (BPD), and patients with both disorders (SUD + BPD) have more complex presentations and poorer outcomes in treatment. Thus, there is a need to identify more clearly the clinical differences between patients with SUD + BPD and those with SUD only to help clinicians in their diagnostic process. METHODS Data from medical files of 92 patients with SUD (SUD only: n = 42; SUD + BPD: n = 50) treated in an outpatient psychiatry and addiction treatment center were extracted to compare the differences in terms of sociodemographic characteristics, substance used, psychopathological dimensions, comorbidity prevalence, and functional impairment. RESULTS Compared to the SUD only group, patients in the SUD + BPD group were younger, more disabled, and less satisfied with their social life. Regarding substance used, the comorbid group had more frequently cannabis use disorder and poly nonalcoholic SUD. Regarding psychopathological dimensions, the comorbid group had higher levels of impulsivity, emotion regulation difficulties and alexithymia. Finally, regarding comorbidities, the comorbid group had a higher risk of comorbid anxiety, obsessive-compulsive, and post-traumatic stress disorders. CONCLUSION While being only exploratory, these results add evidence on the impact of the BPD comorbidity in patients with SUD and underline important dimensions that should be considered by clinicians working with this population.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Outpatient Addictology and Psychiatry Center, Lyon, France
- UVSQ, INSERM, Centre de recherche en Epidémiologie et Santé des Populations Team "DevPsy", Université Paris-Saclay, Villejuif, France
| | - Manon Verne
- Lyon-Est Medical School, Claude Bernard University Lyon 1, Lyon, France
| | - Amaury Durpoix
- Department of psychiatry, University Hospital of Strasbourg, Strasbourg, France
| | - Inès Benmakhlouf
- ADDIPSY, Outpatient Addictology and Psychiatry Center, Lyon, France
| | - Laura Labaume
- ADDIPSY, Outpatient Addictology and Psychiatry Center, Lyon, France
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Stellern J, Xiao KB, Grennell E, Sanches M, Gowin JL, Sloan ME. Emotion regulation in substance use disorders: a systematic review and meta-analysis. Addiction 2023; 118:30-47. [PMID: 35851975 PMCID: PMC10087816 DOI: 10.1111/add.16001] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 06/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS The ability to regulate emotions effectively has been associated with resilience to psychopathology. Individuals with substance use disorders (SUDs) have been shown to have higher levels of negative emotionality, with some evidence suggesting impairment in emotion regulation compared with individuals without SUDs. However, no previous attempt has been made to systematically review the literature to assess the magnitude of this difference. We aimed to assess the association between SUD diagnosis and emotion regulation as measured by the Difficulties in Emotion Regulation Scale (DERS) and Emotion Regulation Questionnaire (ERQ) through a systematic review and meta-analysis of existing findings. METHODS The systematic review was conducted using PubMed, PsycINFO and Embase. We examined cross-sectional studies that compared a SUD group with a control group and measured emotion regulation using the DERS or the ERQ. The primary analysis focused on papers using the DERS, as this was the predominant instrument in the literature. RESULTS Twenty-two studies met our primary analysis criteria, representing 1936 individuals with a SUD and 1567 controls. Individuals with SUDs relative to controls had significantly greater DERS scores, with a mean difference of 21.44 [95% confidence interval (CI) = 16.49-26.40, P < 0.001] and Hedges' g = 1.05 (95% CI = 0.86-1.24, P < 0.001). The difference was robust, remaining significant after removing outliers and studies with high risk of bias. Individuals with SUDs demonstrated poorer emotion regulation on each subscale of the DERS, with the largest deficits in the Strategies and Impulse subscales. The ERQ analysis revealed greater use of expressive suppression in those with SUDs relative to controls (Hedges' g = 0.76, 95% CI = 0.25-1.28, P = 0.004). CONCLUSIONS People with substance use disorders appear to have greater difficulties in emotion regulation than people without substance use disorders.
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Affiliation(s)
- Jordan Stellern
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ke Bin Xiao
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada
| | - Erin Grennell
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Marcos Sanches
- Biostatistics Core, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joshua L Gowin
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew E Sloan
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Pharmacology and Toxicology, University of Toronto, Toronto, Ontario, Canada.,Division of Neurosciences and Clinical Translation, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychological Clinical Science, University of Toronto Scarborough, Toronto, Ontario, Canada
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The Mexican magnetic resonance imaging dataset of patients with cocaine use disorder: SUDMEX CONN. Sci Data 2022; 9:133. [PMID: 35361781 PMCID: PMC8971535 DOI: 10.1038/s41597-022-01251-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 03/10/2022] [Indexed: 01/16/2023] Open
Abstract
Cocaine use disorder (CUD) is a substance use disorder (SUD) characterized by compulsion to seek, use and abuse of cocaine, with severe health and economic consequences for the patients, their families and society. Due to the lack of successful treatments and high relapse rate, more research is needed to understand this and other SUD. Here, we present the SUDMEX CONN dataset, a Mexican open dataset of 74 CUD patients (9 female) and matched 64 healthy controls (6 female) that includes demographic, cognitive, clinical, and magnetic resonance imaging (MRI) data. MRI data includes: 1) structural (T1-weighted), 2) multishell high-angular resolution diffusion-weighted (DWI-HARDI) and 3) functional (resting state fMRI) sequences. The repository contains unprocessed MRI data available in brain imaging data structure (BIDS) format with corresponding metadata available at the OpenNeuro data sharing platform. Researchers can pursue brain variability between these groups or use a single group for a larger population sample. Measurement(s) | functional brain measurement • Diffusion Weighted Imaging • Abnormality of brain morphology • Alteration Of Cognitive Function • Clinical Study | Technology Type(s) | Functional Magnetic Resonance Imaging • Diffusion Weighted Imaging • Turbo Field Echo MRI • neuropsychological test • Clinical Evaluation | Factor Type(s) | Cocaine Dependence | Sample Characteristic - Organism | Homo | Sample Characteristic - Location | Mexico City |
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Messas G, Fernandez AV. Recontextualizing the subject of phenomenological psychopathology: Establishing a new paradigm case. Front Psychiatry 2022; 13:1035967. [PMID: 36339859 PMCID: PMC9634405 DOI: 10.3389/fpsyt.2022.1035967] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Recently, there have been calls to develop a more contextual approach to phenomenological psychopathology-an approach that attends to the socio-cultural as well as personal and biographical factors that shape experiences of mental illness. In this Perspective article, we argue that to develop this contextual approach, phenomenological psychopathology should adopt a new paradigm case. For decades, schizophrenia has served as the paradigmatic example of a condition that can be better understood through phenomenological investigation. And recent calls for a contextual approach continue to use schizophrenia as their primary example. We argue, in contrast, that substance misuse provides a better paradigm case around which to develop a contextually sensitive phenomenological psychopathology. After providing a brief vignette and analysis of a case of substance misuse, we explain why this kind of condition requires considerable sensitivity and attention to context, better motivating the incorporation and development of new contextually sensitive approaches.
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Affiliation(s)
- Guilherme Messas
- Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil.,Collaborating Centre for Values-Based Practice in Health and Social Care, St. Catherine's College, University of Oxford, Oxford, United Kingdom
| | - Anthony Vincent Fernandez
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Danish Institute for Advanced Study, University of Southern Denmark, Odense, Denmark
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Sicorello M, Schmahl C. Emotion dysregulation in borderline personality disorder: A fronto–limbic imbalance? Curr Opin Psychol 2021; 37:114-120. [DOI: 10.1016/j.copsyc.2020.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/18/2020] [Accepted: 12/07/2020] [Indexed: 12/30/2022]
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Reich DB, Belleau EL, Temes CM, Gonenc A, Pizzagalli DA, Gruber SA. Amygdala Resting State Connectivity Differences between Bipolar II and Borderline Personality Disorders. Neuropsychobiology 2019; 78:229-237. [PMID: 31553999 PMCID: PMC7968721 DOI: 10.1159/000502440] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 07/22/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) and bipolar II disorder (BD II) have significant clinical overlap, leaving the potential for diagnostic inaccuracies and inadequate treatment recommendations. However, few studies have probed for clinical and neurobiological differences between the two disorders. Clinically, some prior studies have linked BPD with greater impulsivity and more frequent negative affective shifts than BD II, whereas previous neuroimaging studies have highlighted both similar and distinct neural abnormalities in BPD and BD II. Notably, no prior study has specifically targeted cortico-limbic neural differences, which have been hypothesized to underlie these core clinical differences. METHODS Individuals with BPD (n = 14) and BD II (n = 15) completed various clinical measures and a resting state functional imaging scan at 3T. Whole-brain amygdala resting state functional connectivity (RSFC) was compared between the two groups. RESULTS Relative to the BD II group, BPD participants reported significantly higher levels of impulsivity, trait anxiety, more frequent negative affective shifts, greater interpersonally reactive affective instability, lower overall functioning, and were characterized by lower amygdala-middle frontal gyrus RSFC. Lower amygdala-middle frontal gyrus RSFC was associated with greater impulsivity, trait anxiety, affective shifts, interpersonal affective reactivity, and functional impairment. LIMITATIONS The current study consisted of small sample sizes and lacked a control group. CONCLUSIONS This preliminary study suggests that amygdala-frontal RSFC may distinguish BPD from BD II. These results may guide future work aimed at identifying neural markers that can help disentangle these two disorders, leading to greater diagnostic accuracy and appropriate treatment implementation.
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Affiliation(s)
- D Bradford Reich
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts, USA,
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA,
| | - Emily L Belleau
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
| | - Christina M Temes
- Laboratory for the Study of Adult Development, McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Atilla Gonenc
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
| | - Diego A Pizzagalli
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, Massachusetts, USA
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
| | - Staci A Gruber
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- McLean Imaging Center, McLean Hospital, Belmont, Massachusetts, USA
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Duque-Alarcón X, Alcalá-Lozano R, González-Olvera JJ, Garza-Villarreal EA, Pellicer F. Effects of Childhood Maltreatment on Social Cognition and Brain Functional Connectivity in Borderline Personality Disorder Patients. Front Psychiatry 2019; 10:156. [PMID: 30988667 PMCID: PMC6452291 DOI: 10.3389/fpsyt.2019.00156] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/04/2019] [Indexed: 01/09/2023] Open
Abstract
Borderline personality disorder (BPD) is a chronic condition characterized by high levels of impulsivity, affective instability, and difficulty to establish and manage interpersonal relationships. However, little is known about its etiology and neurobiological substrates. In our study, we wanted to investigate the influence of child abuse in the psychopathology of BPD by means of social cognitive paradigms [the Movie for the Assessment of Social Cognition (MASC) and the reading the mind in the eyes test (RMET)], and resting state functional magnetic resonance imaging (rs-fMRI). For this, we recruited 33 participants, 18 BPD patients, and 15 controls. High levels of self-reported childhood maltreatment were reported by BPD patients. For the sexual abuse subdimension, there were no differences between the BPD and the control groups, but there was a negative correlation between MASC scores and total childhood maltreatment levels, as well as between physical abuse, physical negligence, and MASC. Both groups showed that the higher the level of childhood maltreatment, the lower the performance on the MASC social cognitive test. Further, in the BPD group, there was hypoconnectivity between the structures responsible for emotion regulation and social cognitive responses that have been described as part of the frontolimbic circuitry (i.e., amygdala). Differential levels of connectivity, associated with different types and levels of abuse were also observed.
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Affiliation(s)
- Xochitl Duque-Alarcón
- Clínica de Especialidades de Neuropsiquiatría, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Mexico City, Mexico
| | - Ruth Alcalá-Lozano
- Departamento de Investigación Clínica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Jorge J González-Olvera
- Departamento de Investigación Clínica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
| | - Eduardo A Garza-Villarreal
- Departamento de Investigación Clínica, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico.,MIND Lab, Center of Functionally Integrative Neuroscience, University of Aarhus, Aarhus, Denmark
| | - Francisco Pellicer
- Laboratorio de Neurofisiología Integrativa, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City, Mexico
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