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Lindsay JAB, McGowan NM, Henning T, Harriss E, Saunders KEA. Digital Interventions for Symptoms of Borderline Personality Disorder: Systematic Review and Meta-Analysis. J Med Internet Res 2024; 26:e54941. [PMID: 39612494 PMCID: PMC11645515 DOI: 10.2196/54941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 06/27/2024] [Accepted: 08/26/2024] [Indexed: 12/01/2024] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is a mental health condition with insufficient care availability worldwide. Digital mental health interventions could reduce this treatment gap. Persuasive system design (PSD) is a conceptual framework outlining elements of digital interventions that support behavior change. OBJECTIVE This systematic review aims to characterize digital interventions targeting BPD symptoms, assess treatment efficacy, and identify its association with intervention features, including PSD elements. METHODS A systematic review of automated digital interventions targeting symptoms of BPD was conducted. Eligible studies recruited participants aged ≥18 years, based on a diagnosis of BPD or one of its common comorbidities, or as healthy volunteers. OVID Embase, OVID MEDLINE, OVID PsycINFO, and the Cochrane Central Register for Controlled Trials were searched on July 19, 2022, and February 28, 2023. Intervention characteristics were tabulated. A meta-analysis of randomized controlled trials (RCTs) determined treatment effects separately for each core symptom of BPD using Hedges g. Associations between the treatment effect and intervention features, including PSD elements, were assessed by subgroup analysis (Cochran Q test). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the National Institutes of Health Quality Assessment Tool for pre-post studies. RESULTS A total of 40 (0.47%) publications out of 8520 met the inclusion criteria of this review, representing 6611 participants. Studies comprised examinations of 38 unique interventions, of which 32 (84%) were RCTs. Synthesis found that included interventions had the following transdiagnostic treatment targets: severity of BPD symptoms (4/38, 11%), suicidal ideation (17/38, 45%), paranoia (5/38, 13%), nonsuicidal self-injury (5/38, 13%), emotion regulation (4/38, 11%), and anger (3/38, 8%). Common therapeutic approaches were based on dialectical behavioral therapy (8/38, 21%), cognitive behavioral therapy (6/38, 16%), or both (5/38, 13%). Meta-analysis found significant effects of digital intervention for both symptoms of paranoia (Hedges g=-0.52, 95% CI -0.86 to -0.18; P=.01) and suicidal ideation (Hedges g=-0.13, 95% CI -0.25 to -0.01; P=.03) but not overall BPD symptom severity (Hedges g=-0.17, 95% CI -0.42 to 0.10; P=.72). Subgroup analysis of suicidal ideation interventions found that evidence-based treatments such as cognitive behavioral therapy and dialectical behavior therapy were significantly more effective than alternative modalities (Cochran Q=4.87; P=.03). The degree of human support was not associated with the treatment effect. Interventions targeting suicidal ideation that used reminders, offered self-monitoring, and encouraged users to rehearse behaviors were associated with a greater reduction in ideation severity. CONCLUSIONS Evidence suggests that digital interventions may reduce the symptoms of suicidal ideation and paranoia and that the design of digital interventions may impact the efficacy of treatments targeting suicidal ideation. These results support the use of transdiagnostic digital interventions for paranoia and suicidal ideation. TRIAL REGISTRATION PROSPERO CRD42022358270; https://tinyurl.com/3mz7uc7k.
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Affiliation(s)
- Julia A B Lindsay
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Niall M McGowan
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Thomas Henning
- School of Medicine and Biomedical Sciences, University of Oxford, Oxford, United Kingdom
| | - Eli Harriss
- Bodleian Health Care Libraries, University of Oxford, Oxford, United Kingdom
| | - Kate E A Saunders
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- School of Medicine and Biomedical Sciences, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
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2
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Zech JM, Patel TA, Cougle JR. Correlates of treatment-seeking in DSM-5 generalized anxiety disorder: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III. J Anxiety Disord 2024; 106:102909. [PMID: 39047416 DOI: 10.1016/j.janxdis.2024.102909] [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: 12/02/2023] [Revised: 07/06/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024]
Abstract
Generalized Anxiety Disorder (GAD) presents a significant personal and societal burden and is associated with chronic medical comorbidities and markedly lower quality of life. Effective treatments exist, less than half of individuals with lifetime GAD will ever seek psychotherapeutic or pharmacological treatment. A thorough understanding of the factors that influence treatment seeking for GAD is warranted. The present study investigates the correlates of GAD treatment seeking, using data from the National Epidemiological Survey on Alcohol and Related Disorders-III (NESARC-III), which assessed for psychiatric disorders using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-5 Version (AUDADIS-5). A series of logistic regressions were run to identify demographic, diagnostic, and symptom-level correlates of treatment seeking in those meeting DSM-5 diagnostic criteria for GAD. Comorbid depression, panic disorder, and PTSD were all uniquely associated with higher rates of GAD-related treatment seeking. Additionally, several accompanying anxiety symptoms were also uniquely predicted treatment seeking, including fatigue, panic attacks, reassurance-seeking, and interpersonal avoidance. Findings underscore the multi-factorial nature of treatment seeking behavior in GAD and highlight the need for further research to fully understand these relationships and devise effective strategies to improve treatment seeking in this population.
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Affiliation(s)
- James M Zech
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Tapan A Patel
- Department of Psychology, Florida State University, Tallahassee, FL, United States
| | - Jesse R Cougle
- Department of Psychology, Florida State University, Tallahassee, FL, United States.
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Leucci AC, De Giorgi I, Pelizza L, Bortolotti B, D'Adda F, Gammino L, Gibiino S, Lia L, Magro M, Pellegrini L, Menchetti M. Borderline personality disorder and aggressive behavior: A study based on the DSM-5 alternative model. J Psychiatr Res 2024; 173:367-371. [PMID: 38593695 DOI: 10.1016/j.jpsychires.2024.03.020] [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: 06/07/2023] [Revised: 03/11/2024] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
INTRODUCTION Unplanned reactive aggressive acts are a clinical feature of particular interest in patients with borderline personality disorder (BPD). The early identification of personality traits correlated to aggressive behavior is certainly desirable in BDP populations. This study analyzes a clinical sample of 122 adult outpatients with BPD referred to Adult Mental Health Services of the Department of Mental Health of Bologna, in Italy. METHODS The study examines the relationship with personality facets of the DSM-5 alternative model for personality disorders (AMPD), Personality Inventory for DSM (PID-5), with respect to the four main components of aggression measured by the Aggression Questionnaire (AQ): hostility, anger, verbal and physical aggression. Using robust regression models, the relationships between PID-5 facets and domains and the aggression components under consideration were identified. RESULTS Verbal and physical aggression in our sample of BPD outpatients is mainly associated to PID-5 antagonism domain. Physically aggressive behavior is also related to callousness facet. CONCLUSIONS The traits most consistently associated with aggression were the domain of Antagonism and the facet of Hostility. The study findings highlight the need for clinicians working with individuals with BPD to pay particular attention to traits of hostility, callousness, and hostility to understand aggression.
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Affiliation(s)
- Anna Caterina Leucci
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Ilaria De Giorgi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | - Biancamaria Bortolotti
- Department of Mental Health and Pathological Addictions, Bologna Local Health Unit, Bologna, Italy
| | - Francesca D'Adda
- Department of Mental Health and Pathological Addictions, Bologna Local Health Unit, Bologna, Italy
| | - Lorenzo Gammino
- Department of Mental Health and Pathological Addictions, Bologna Local Health Unit, Bologna, Italy
| | - Sara Gibiino
- Department of Mental Health and Pathological Addictions, Bologna Local Health Unit, Bologna, Italy
| | - Loredana Lia
- Department of Mental Health and Pathological Addictions, Bologna Local Health Unit, Bologna, Italy
| | - Margherita Magro
- Department of Mental Health and Pathological Addictions, Bologna Local Health Unit, Bologna, Italy
| | - Luca Pellegrini
- Hertfordshire Partnership NHS University Foundation Trust, Welwyn Garden City, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy; Department of Mental Health and Pathological Addictions, Bologna Local Health Unit, Bologna, Italy
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Marengo L, Douaihy A, Zhong Y, Krancevich K, Brummit B, Sakolsky D, Deal M, Zelazny J, Goodfriend E, Saul M, Murata S, Thoma B, Mansour H, Tew J, Ahmed N, Marsland A, Brent D, Melhem NM. Opioid use as a proximal risk factor for suicidal behavior in young adults. Suicide Life Threat Behav 2022; 52:199-213. [PMID: 34767271 PMCID: PMC10697688 DOI: 10.1111/sltb.12806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 06/14/2021] [Accepted: 08/12/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION There is a concomitant rise in suicide rates with the prevalence of opioids involved in overdose deaths, especially among adolescents and young adults. However, there are limited studies on whether opioid use prospectively predicts suicidal behavior in youth. METHODS Our sample included 183 psychiatric patients (18-30 years) admitted for a suicide attempt (SA), have current suicidal ideation (SI), and psychiatric controls without ideation or attempt (PC). Suicidal behavior was assessed using the Columbia Suicide Severity Rating Scale. We also recruited a healthy control group (HC; n = 40). Patients and controls were followed over a year. ANOVA, regression, and cox regression were used. RESULTS Suicide attempt (β = 0.87, CI [0.1-1.6], p = 0.02) and SI [(β = 0.75, CI [0.03-1.5], p = 0.04) were significantly more likely than HCs to have used opioids in the past year at baseline. Opioid use was associated with increased anxiety symptoms (β = 0.75, CI [0.001-1.5], p = 0.05), PTSD symptoms (β = 3.90, CI [1.1-6.7], p = 0.01), and aggression (β = 0.02, CI [0.01-0.04], p = 0.02). Opioid use in the month prior to hospitalization predicted SA at 6 months (OR = 1.87, CI [1.06-3.31], p = 0.032). CONCLUSIONS Opioid use is a proximal predictor for SA. These findings may help clinicians better identify patients at risk for suicidal behavior, allowing for more personalized treatment approaches.
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Affiliation(s)
- Laura Marengo
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Antoine Douaihy
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Yongqi Zhong
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania, USA
| | - Katie Krancevich
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Bradley Brummit
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Meredith Deal
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jamie Zelazny
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Eli Goodfriend
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Melissa Saul
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Stephen Murata
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Brian Thoma
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Hader Mansour
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Jamie Tew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nadeem Ahmed
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Anna Marsland
- Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David Brent
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Nadine M Melhem
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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Wittmann L, Groen G. [A Police Perspective on the Interaction with Individuals with Mental Disorders]. PSYCHIATRISCHE PRAXIS 2020; 48:31-36. [PMID: 32659794 DOI: 10.1055/a-1190-7598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Police officers often come in contact with individuals suffering from behavior disturbances. The present study examined the subjective experience of these interactions from a police perspective to detect further needs in police trainings to make these interactions safer. METHODS N = 958 police officers filled out a questionnaire regarding their subjective experience. The questionnaire assessed the frequency of contact with individuals with behavior disturbances, specific challenges in regard to the interaction and associated subjective anxiety or stress as well as knowledge about behavior disturbances. RESULTS Police staff experience individuals suffering from behavior disturbances often as unpredictable, verbally and physically aggressive. 27.9 % report anxiety in these interactions and 76 % report a lack of specific knowledge. CONCLUSION Police training programs should focus on increasing mental health literacy, specific communication skills and anti-stigma interventions.
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Affiliation(s)
| | - Gunter Groen
- Hochschule für Angewandte Wissenschaften Hamburg
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Born this way? A review of neurobiological and environmental evidence for the etiology of psychopathy. PERSONALITY NEUROSCIENCE 2020; 2:e8. [PMID: 32435743 PMCID: PMC7219694 DOI: 10.1017/pen.2019.7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/18/2022]
Abstract
Across a significant body of research, psychopathy has often been conceptualized as a biologically based malady. In this research, genetic and neurobiological differences have been conceptualized to underlie psychopathy, while affected individuals' life experiences only influence expressed psychopathic features and their severity. Psychopathy research has largely ignored developmental evidence demonstrating significant influences of environment on both biological and behavioral processes, resulting in several prominent criticisms (Edens & Vincent, 2008; Loeber, Byrd, & Farrington, 2015). The current review was conducted with two main aims: (a) to collect and consider etiological evidence from the extant body of research on genetic and neurobiological factors in psychopathy; and (b) to evaluate findings from genetic, neurotransmitter, brain structure, and brain function studies in the context of relevant evidence from developmental research. Examples from research on adversity and traumatic stress, a common correlate of psychopathy, were used to highlight current research gaps and future directions to aid in the integration of developmental and neurobiological research agendas. While some promising evidence exists regarding possible underlying neurobiological processes of psychopathic traits, this evidence is insufficient to suggest a largely biological etiology for the disorder. Further, information from developmental and epigenetic research may suggest complex, multidimensional trajectories for individuals experiencing psychopathy. Based on these observations, the authors make several recommendations for future research, as well as for current clinical application and practice.
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Fahlgren MK, Berman ME, McCloskey MS. The role of therapeutic alliance in therapy for adults with problematic aggression and associated disorders. Clin Psychol Psychother 2020; 27:858-886. [PMID: 32410318 DOI: 10.1002/cpp.2475] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 11/06/2022]
Abstract
The nature and quality of the relationship between therapist and client in psychotherapy, known as therapeutic alliance, have been proposed as one of the most important factors for successful treatment outcome, which has been has robustly supported across many types of treatment, populations, raters of alliance (i.e., client, therapist, or observer), and alliance measures. However, most research on alliance and treatment outcome has been conducted in children and adults with internalizing problems (e.g., mood and anxiety disorders) or children with externalizing problems (e.g., conduct disorder), despite the fact that alliance may be particularly important for adults with externalizing problems such as problematic aggression, who may have high levels of resistance, blaming, and interpersonal problems. Very limited research has examined the role of alliance in individuals who present to treatment due to high levels of aggressive behaviour specifically (e.g., those convicted of a violent offence). The current systematic review examined the extant research on the relationship between alliance and outcome in treatment of highly aggressive individuals, as well as those who are diagnosed with a disorder for which aggression is a primary symptom (i.e., post-traumatic stress disorder, antisocial personality disorder, and borderline personality disorder). Overall, it was shown that alliance has a positive impact on treatment outcome among those engaging in or at risk for problematic aggression. Additionally, the alliance-outcome relationship may be affected by therapy modality, alliance rater perspective, and potential mechanisms of alliance. Implications for future research, including utilizing more primarily aggressive samples, are discussed.
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Affiliation(s)
- Martha K Fahlgren
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
| | - Mitchell E Berman
- Department of Psychology, Mississippi State University, Starkville, Mississippi, USA
| | - Michael S McCloskey
- Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA
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8
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Abstract
OBJECTIVE This paper aims to provide a selective review of the co-occurrence of borderline personality disorder (BPD) and violence, a much less explored aspect of aggression with this cohort. CONCLUSIONS Violence in BPD patients is expressed particularly towards intimate partners and known persons, usually in the homes of perpetrators. Anger, impulsivity and avoiding abandonment are traits associated with violence while suicidal behaviour, identity disturbance and affective instability are not. These patients are disproportionately found in higher levels of secure care although most violence occurs in the community. In males it is more likely driven by substance use, often at transition from adolescence to adulthood, while more severe borderline pathology is implicated in women. Early identification of an at-risk cohort is recommended with development of collaborative safety plans with patients that include identification of a 'risk signature' that guides risk management. A multi-modal approach using risk management protocols with availability of contingency plans within a multi-agency forum in a local context is recommended.
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Affiliation(s)
- Jaydip Sarkar
- Consultant Forensic Psychiatrist, Victorian Institute of Forensic Mental Health, Forensicare, Fairfield, VIC, Australia
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9
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Bassir Nia A, Eveleth MC, Gabbay JM, Hassan YJ, Zhang B, Perez-Rodriguez MM. Past, present, and future of genetic research in borderline personality disorder. Curr Opin Psychol 2018; 21:60-68. [PMID: 29032046 PMCID: PMC5847441 DOI: 10.1016/j.copsyc.2017.09.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 08/24/2017] [Accepted: 09/05/2017] [Indexed: 01/19/2023]
Abstract
Borderline Personality Disorder (BPD) is a major mental illness with a lifetime prevalence of approximately 1-3%, characterized by a persistent pattern of instability in relationships, mood, impulse regulation, and sense of self. This results in impulsive self-damaging behavior, high suicide rates, and severe functional impairment. BPD has a complex, multifactorial etiology, resulting from an interaction among genetic and environmental substrates, and has moderate to high heritability based on twin and family studies. However, our understanding of the genetic architecture of BPD is very limited. This is a critical obstacle since genetics can pave the way for identifying new treatment targets and developing preventive and disease-modifying pharmacological treatments which are currently lacking. We review genetic studies in BPD, with a focus on limitations and challenges and future directions. Genetic research in BPD is still in its very early stages compared to other major psychiatric disorders. Most early genetic studies in BPD were non-replicated association studies in small samples, focused on single candidate genes. More recently, there has been one genome-wide linkage study and a genome-wide association study (GWAS) of subclinical BPD traits and a first GWAS in a relatively modest sample of patients fulfilling full diagnostic criteria for the disorder. Although there are adequate animal models for some of the core dimensions of BPD, there is a lack of translational research including data from animal models in BPD. Research in more pioneering fields, such as imaging genetics, deep sequencing and epigenetics, holds promise for elucidating the pathophysiology of BPD and identifying new treatment targets.
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Affiliation(s)
- Anahita Bassir Nia
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Matthew C Eveleth
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jonathan M Gabbay
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Yonis J Hassan
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Bosi Zhang
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - M Mercedes Perez-Rodriguez
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; The Mental Illness Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA; CIBERSAM, Autonoma University, Fundacion Jimenez Diaz and Ramon y Cajal Hospital, Madrid, Spain.
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Asenapine in the management of impulsivity and aggressiveness in bipolar disorder and comorbid borderline personality disorder: an open-label uncontrolled study. Int Clin Psychopharmacol 2018; 33:121-130. [PMID: 29189421 PMCID: PMC5895133 DOI: 10.1097/yic.0000000000000206] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Borderline personality disorder (BPD) often co-occurres with bipolar disorder (BD). Impulsivity and aggressiveness represent core shared features and their pharmacological management is mainly based on mood stabilizers and antipsychotics, although scarce evidence is available for this context of comorbidity. The aim of the present study was to evaluate the role of Asenapine as an adjunctive drug for reducing aggressiveness and impulsivity in a sample of Italian BD type I outpatients with or without a comorbid BPD. This was an observational 12-week open-label uncontrolled clinical study carried out from April to October 2014 in two psychiatric clinics in Sicily. Each patient was treated with asenapine at two dose options, 5 mg (twice daily) or 10 mg (twice daily), and concomitant ongoing medications were not discontinued. We measured impulsivity using the Barratt Impulsiveness Scale (BIS) and aggressiveness using the Aggressive Questionnaire (AQ). For the analysis of our outcomes, patients were divided into two groups: with or without comorbid BPD. Adjunctive therapy was associated with a significant decrease of BIS and AQ overall scores in the entire bipolar sample. Yet, there was no significant difference in BIS and AQ reductions between subgroups. Using a regression model, we observed that concomitant BPD played a negative role on the Hostility subscale and overall AQ score variations; otherwise, borderline co-diagnosis was related positively to the reduction of physical aggression. According to our post-hoc analysis, global aggressiveness scores are less prone to decrease in patients with a dual diagnosis, whereas physical aggressiveness appears to be more responsive to the add-on therapy in patients with comorbidity.
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11
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Delprato A, Bonheur B, Algéo MP, Murillo A, Dhawan E, Lu L, Williams RW, Crusio WE. A quantitative trait locus on chromosome 1 modulates intermale aggression in mice. GENES BRAIN AND BEHAVIOR 2018; 17:e12469. [PMID: 29457871 DOI: 10.1111/gbb.12469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/30/2018] [Accepted: 02/15/2018] [Indexed: 12/28/2022]
Abstract
Aggression between male conspecifics is a complex social behavior that is likely modulated by multiple gene variants. In this study, the BXD recombinant inbred mouse strains (RIS) were used to map quantitative trait loci (QTLs) underlying behaviors associated with intermale aggression. Four hundred and fifty-seven males from 55 strains (including the parentals) were observed at an age of 13 ± 1 week in a resident-intruder test following 10 days of isolation. Attack latency was measured directly within a 10-minute time period and the test was repeated 24 hours later. The variables we analyzed were the proportion of attacking males in a given strain as well as the attack latency (on days 1 and 2, and both days combined). On day 1, 29% of males attacked, and this increased to 37% on day 2. Large strain differences were obtained for all measures of aggression, indicating substantial heritability (intraclass correlations 0.10-0.18). We identified a significant QTL on chromosome (Chr) 1 and suggestive QTLs on mouse Chrs 1 and 12 for both attack and latency variables. The significant Chr 1 locus maps to a gene-sparse region between 82 and 88.5 Mb with the C57BL/6J allele increasing aggression and explaining about 18% of the variance. The most likely candidate gene modulating this trait is Htr2b which encodes the serotonin 2B receptor and has been implicated in aggressive and impulsive behavior in mice, humans and other species.
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Affiliation(s)
- A Delprato
- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, University of Bordeaux, Pessac Cedex, France.,CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, Pessac Cedex, France.,BioScience Project, Wakefield, Massachusetts
| | - B Bonheur
- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, University of Bordeaux, Pessac Cedex, France.,CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, Pessac Cedex, France
| | - M-P Algéo
- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, University of Bordeaux, Pessac Cedex, France.,CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, Pessac Cedex, France
| | - A Murillo
- BioScience Project, Wakefield, Massachusetts
| | - E Dhawan
- BioScience Project, Wakefield, Massachusetts
| | - L Lu
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - R W Williams
- Department of Genetics, Genomics and Informatics, University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - W E Crusio
- Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, University of Bordeaux, Pessac Cedex, France.,CNRS, Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, UMR 5287, Pessac Cedex, France
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Lindberg N, Miettunen J, Heiskala A, Kaltiala-Heino R. Mortality of young offenders: a national register-based follow-up study of 15- to 19-year-old Finnish delinquents referred for forensic psychiatric examination between 1980 and 2010. Child Adolesc Psychiatry Ment Health 2017; 11:37. [PMID: 28794798 PMCID: PMC5547467 DOI: 10.1186/s13034-017-0174-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 06/27/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The mortality rate of young offenders is high. Furthermore, mortality in young offenders is associated with psychiatric and substance use disorders. The primary aim of this national register-based follow-up study was to investigate the mortality rate of Finnish delinquents who underwent a forensic psychiatric examination between 1980 and 2010. As delinquency is not a solid entity, we further aimed to compare the risk of premature death among different subgroups of the delinquents; violent versus non-violent offenders, offenders with alcohol use disorders versus those with no such diagnoses, offenders with schizophrenia spectrum disorders versus conduct- and personality-disordered offenders, under-aged versus young adult offenders, and, finally, boys versus girls. METHODS We collected the forensic psychiatric examination reports of all 15- to 19-year-old offenders who were born in Finland and had undergone the examination between 1.1.1980 and 31.12.2010 (n = 606) from the archives of the National Institute of Health and Welfare and retrospectively reviewed them. For each delinquent, four age-, gender- and place of birth-matched controls were randomly selected from the Central Population Register (n = 2424). The delinquents and their controls were followed until the end of 2015. The median follow-up time was 23.9 years (interquartile range 15.3-29.5). We obtained the mortality data from the causes of death register. Deaths attributable to a disease or an occupational disease were considered natural, and those attributable to an accident, suicide or homicide were considered unnatural. RESULTS By the end of the follow-up period, 22.1% (n = 134) of the delinquents and 3.4% (n = 82) of their controls had died (OR 8.11, 95% CI 6.05-10.86, p < 0.001). Among boys, 22.0% (n = 121) of the delinquents and 3.7% (n = 81) of the controls had died (OR 7.38, 95% CI 5.46-9.95, p < 0.001). Male delinquents' risk of unnatural death was almost 11-fold, of natural death more than twofold, and of unclear death more than fourfold compared to that of their controls. No girls had natural or unclear deaths, but 23.6% (n = 13) of the delinquents and 0.5% (n = 1) of the controls had died due to unnatural causes (OR 67.79, 95% CI 8.63-532.00, p < 0.001). The violent delinquents' risk of premature death was twice that of the non-violent delinquents. The other comparisons demonstrated no statistically significant differences between subgroups. CONCLUSIONS Even though the Finnish correction system prefers psychiatric treatment and rehabilitation over criminal sanctions, and the national health care system offers developmental-phase-specific psychiatric care, the mortality rate of delinquents, especially of those with a history of violent offences, is high. The excess mortality of offenders can be regarded as a specific public-health inequity that calls for more effective intervention procedures than those used thus far.
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Affiliation(s)
- Nina Lindberg
- 0000 0000 9950 5666grid.15485.3dForensic Psychiatry, Helsinki University and Helsinki University Hospital, PO Box 590, 00029 HUS Helsinki, Finland
| | - Jouko Miettunen
- 0000 0001 0941 4873grid.10858.34Center for Life Course Health Research, University of Oulu, Oulu, Finland ,0000 0004 4685 4917grid.412326.0Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Anni Heiskala
- 0000 0001 0941 4873grid.10858.34Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Riittakerttu Kaltiala-Heino
- 0000 0001 2314 6254grid.5509.9School of Medicine, Tampere University, Tampere, Finland ,0000 0004 0628 2985grid.412330.7Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland ,0000 0004 0628 2766grid.417253.6Vanha Vaasa Hospital, Vaasa, Finland
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Abstract
Borderline personality disorder (BPD) is a severe mental disorder with a multifactorial etiology. The development and maintenance of BPD is sustained by diverse neurobiological factors that contribute to the disorder's complex clinical phenotype. These factors may be identified using a range of techniques to probe alterations in brain systems that underlie BPD. We systematically searched the scientific literature for empirical studies on the neurobiology of BPD, identifying 146 articles in three broad research areas: neuroendocrinology and biological specimens; structural neuroimaging; and functional neuroimaging. We consolidate the results of these studies and provide an integrative model that attempts to incorporate the heterogeneous findings. The model specifies interactions among endogenous stress hormones, neurometabolism, and brain structures and circuits involved in emotion and cognition. The role of the amygdala in BPD is expanded to consider its functions in coordinating the brain's dynamic evaluation of the relevance of emotional stimuli in the context of an individual's goals and motivations. Future directions for neurobiological research on BPD are discussed, including implications for the Research Domain Criteria framework, accelerating genetics research by incorporating endophenotypes and gene × environment interactions, and exploring novel applications of neuroscience findings to treatment research.
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Emotion dysregulation mediates the relationship between traumatic exposure and aggression in healthy young women. PERSONALITY AND INDIVIDUAL DIFFERENCES 2015; 76:222-227. [PMID: 29674794 DOI: 10.1016/j.paid.2014.11.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Research has linked trauma-sequelae, such as posttraumatic stress disorder, to aggression. However, not all who experience a trauma become violent, suggesting non-trauma factors, such as emotion dysregulation, influence aggression expression and if confirmed, may influence treatment approaches. Aggression can be considered a multifaceted construct with Impulsive Aggression (IA) as emotional, reactive, and uncontrolled and Premeditated Aggression (PA) as deliberate, planned, and instrumental. We hypothesized that parceling apart IA and PA may further refine predictors of aggression in the context of trauma exposure. We tested this hypothesis in undergraduate women (N = 208) who completed trauma, emotion, and aggression measures. Path analysis indicated that Borderline Features, including emotion dysregulation, mediated the relationship between trauma exposure and IA and PA. The finding extends clinical literature by providing evidence that emotion dysregulation influences both IA and PA in a non-clinical sample, while clinical sample research shows emotion dysregulation more specifically mediated the relationship between trauma and IA. Factors responsible for these differences are discussed.
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Mortality of firesetters: a follow-up study of Finnish male firesetters who underwent a pretrial forensic examination in 1973-1998. Psychiatry Res 2015; 225:638-42. [PMID: 25500349 DOI: 10.1016/j.psychres.2014.11.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 10/16/2014] [Accepted: 11/09/2014] [Indexed: 11/22/2022]
Abstract
Little is known about mortality among firesetters. However, they hold many risk factors associated with elevated mortality. This study aimed to investigate mortality rates and patterns in the course of a 39-year follow-up of a consecutive sample (n=441) of pretrial male firesetters evaluated in a forensic psychiatric unit in Finland. For each firesetter, four controls matched for age, sex and place of birth were randomly selected from the Central Population Register. Mortality data was obtained from the Causes of Death statistics. By the end of the follow-up period, 48.0% of the firesetters and 22.0% of the controls had died (OR 2.47, 95% CI 2.00-3.05). Altogether, 24.1% of the firesetters and 17.6% of the control subjects had died of natural causes (OR 1.49, 95% CI 1.16-1.92), whereas 20.9% and 3.8% respectively, died an unnatural death (OR 6.71, 95% CI 4.79-9.40). Alcohol-related deaths were more frequent among firesetters than controls. Our findings confirm that fire-setting behavior is associated with high mortality. More attention must be paid to the treatment of suicidality, psychiatric comorbidities and alcohol use disorders within this group both during and after their sentences.
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Yalch MM, Hopwood CJ, Zanarini MC. Hyperbolic Temperament as a Distinguishing Feature Between Borderline Personality Disorder and Mood Dysregulation. BORDERLINE PERSONALITY AND MOOD DISORDERS 2015:119-132. [DOI: 10.1007/978-1-4939-1314-5_7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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17
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Cook TB, Brenner LA, Cloninger CR, Langenberg P, Igbide A, Giegling I, Hartmann AM, Konte B, Friedl M, Brundin L, Groer MW, Can A, Rujescu D, Postolache TT. "Latent" infection with Toxoplasma gondii: association with trait aggression and impulsivity in healthy adults. J Psychiatr Res 2015; 60:87-94. [PMID: 25306262 DOI: 10.1016/j.jpsychires.2014.09.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 09/03/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Latent chronic infection with Toxoplasma gondii (T. gondii), a common neurotropic pathogen, has been previously linked with suicidal self-directed violence (SSDV). We sought to determine if latent infection with T. gondii is associated with trait aggression and impulsivity, intermediate phenotypes for suicidal behavior, in psychiatrically healthy adults. METHODS Traits of aggression and impulsivity were analyzed in relationship to IgG antibody seropositivity for T. gondii and two other latent neurotropic infections, herpes simplex virus 1 (HSV1) and cytomegalovirus (CMV). One thousand community-residing adults residing in the Munich metropolitan area with no Axis I or II conditions by SCID for DSM-IV (510 men, 490 women, mean age 53.6 ± 15.8, range 20-74). Plasma samples were tested for IgG antibodies to T. gondii, HSV-1 and CMV by ELISA. Self-reported ratings of trait aggression scores (Questionnaire for Measuring Factors of Aggression [FAF]) and trait impulsivity (Sensation-Seeking Scale-V [SSS-V]) were analyzed using linear multivariate methods. RESULTS T. gondii IgG seropositivity was significantly associated with higher trait reactive aggression scores among women (p < .01), but not among men. T. gondii-positivity was also associated with higher impulsive sensation-seeking (SSS-V Disinhibition) among younger men (p < .01) aged 20-59 years old (median age = 60). All associations with HSV-1 and CMV were not significant. CONCLUSIONS Aggression and impulsivity, personality traits considered as endophenotypes for SSDV, are associated with latent T. gondii infection in a gender and age-specific manner, and could be further investigated as prognostic and treatment targets in T. gondii-positive individuals at risk for SSDV.
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Affiliation(s)
- Thomas B Cook
- Department of Public Health, Mercyhurst Institute for Public Health, Mercyhurst University, Erie, PA, USA
| | - Lisa A Brenner
- Veterans Integrated Service Network (VISN) 19, Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA; Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - C Robert Cloninger
- Department of Psychiatry, Sansone Centre for Well-Being, Washington University, St. Louis, MO, USA
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ajirioghene Igbide
- DC Department of Behavioral Health, Saint Elizabeths Hospital, Psychiatry Residency Program, Washington, DC, USA
| | - Ina Giegling
- Department of Psychiatry, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Annette M Hartmann
- Department of Psychiatry, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Bettina Konte
- Department of Psychiatry, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Marion Friedl
- Department of Psychiatry, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lena Brundin
- Division of Psychiatry and Behavioral Medicine, College of Human Medicine, Michigan State University, Van Andel Research Institute, Grand Rapids, MI, USA
| | | | - Adem Can
- Department of Psychiatry, University of Maryland-Baltimore School of Medicine, Baltimore, MD, USA
| | - Dan Rujescu
- Department of Psychiatry, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Teodor T Postolache
- Veterans Integrated Service Network (VISN) 19, Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA; Department of Psychiatry, University of Maryland-Baltimore School of Medicine, Baltimore, MD, USA; Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD, USA.
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Horn M, Potvin S, Allaire JF, Côté G, Gobbi G, Benkirane K, Vachon J, Dumais A. Male inmate profiles and their biological correlates. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2014; 59:441-9. [PMID: 25161069 PMCID: PMC4143301 DOI: 10.1177/070674371405900807] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 02/01/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Borderline and antisocial personality disorders (PDs) share common clinical features (impulsivity, aggressiveness, substance use disorders [SUDs], and suicidal behaviours) that are greatly overrepresented in prison populations. These disorders have been associated biologically with testosterone and cortisol levels. However, the associations are ambiguous and the subject of controversy, perhaps because these heterogeneous disorders have been addressed as unitary constructs. A consideration of profiles of people, rather than of exclusive diagnoses, might yield clearer relationships. METHODS In our study, multiple correspondence analysis and cluster analysis were employed to identify subgroups among 545 newly convicted inmates. The groups were then compared in terms of clinical features and biological markers, including levels of cortisol, testosterone, estradiol, progesterone, and sulfoconjugated dehydroepiandrosterone (DHEA-S). RESULTS Four clusters with differing psychiatric, criminal, and biological profiles emerged. Clinically, one group had intermediate scores for each of the tested clinical features. Another group comprised people with little comorbidity. Two others displayed severe impulsivity, PD, and SUD. Biologically, cortisol levels were lowest in the last 2 groups and highest in the group with less comorbidity. In keeping with previous findings reported in the literature, testosterone was higher in a younger population with severe psychiatric symptoms. However, some apparently comparable behavioural outcomes were found to be related to distinct biological profiles. No differences were observed for estradiol, progesterone, or DHEA-S levels. CONCLUSIONS The results not only confirm the importance of biological markers in the study of personality features but also demonstrate the need to consider the role of comorbidities and steroid coregulation.
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Affiliation(s)
- Mathilde Horn
- Researcher, Philippe-Pinel Institute of Montreal, Mental Health University Institute of Montreal, Department of Psychiatry, University of Montreal, Montreal, Quebec; Psychiatrist and Researcher, University Medical Centre, Functional Neuroscience and Disorders Laboratory, Lille North of France University, Lille, France
| | - Stephane Potvin
- Researcher, Mental Health University Institute of Montreal, Department of Psychiatry, University of Montreal, Montreal, Quebec
| | | | - Gilles Côté
- Director, Research Centre, Philippe-Pinel Institute of Montreal, Montreal, Quebec; Professor, Department of Psychology, University of Quebec at Trois-Rivières, Trois-Rivières, Quebec
| | - Gabriella Gobbi
- Associate Professor, Department of Psychiatry, McGill University and McGill University Health Centre, Montreal, Quebec
| | - Karim Benkirane
- Clinical Biochemist, Maisonneuve-Rosemont Hospital, Biochemistry Laboratory, Department of Biochemistry, University of Montreal, Montreal, Quebec
| | - Jeanne Vachon
- Research Coordinator, Philippe-Pinel Institute of Montreal, Montreal, Quebec
| | - Alexandre Dumais
- Psychiatrist and Researcher, Philippe-Pinel Institute of Montreal, Mental Health University Institute of Montreal, Department of Psychiatry, University of Montreal, Montreal, Quebec
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Borderline personality features as a predictor of forms and functions of aggression during middle childhood: Examining the roles of gender and physiological reactivity. Dev Psychopathol 2014; 26:789-804. [DOI: 10.1017/s095457941400039x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe present longitudinal investigation examined borderline personality features as a predictor of aggression 1 year later. Moderation by physiological reactivity and gender was also explored. One hundred ninety-six children (M = 10.11 years, SD = 0.64) participated in a laboratory stress protocol in which their systolic blood pressure, diastolic blood pressure, and skin conductance reactivity to recounting a relational stressor (e.g., threats to relationships or exclusion) were assessed. Teachers provided reports on subtypes of aggressive behavior (i.e., reactive relational, proactive relational, reactive physical, and proactive physical), and children completed a self-report measure of borderline personality features. Path analyses indicated that borderline personality features predicted increases in reactive relational aggression and proactive relational aggression among girls who evinced heightened physiological reactivity to interpersonal stress. In contrast, borderline personality features predicted decreases in proactive physical aggression in girls. Findings suggest that borderline personality features promote engagement in relationally aggressive behaviors among girls, particularly in the context of emotional dysregulation.
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Coppens CM, de Boer SF, Buwalda B, Koolhaas JM. Aggression and aspects of impulsivity in wild-type rats. Aggress Behav 2014; 40:300-8. [PMID: 24464354 DOI: 10.1002/ab.21527] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Accepted: 12/06/2013] [Indexed: 12/23/2022]
Abstract
Aggression is closely related to impulsive behavior both in humans and in animals. To avoid potential negative consequences, aggressive behavior is kept in control by strong inhibitory mechanisms. Failure of these inhibitory mechanisms results in violent behavior. In the present experiments, we investigated whether aggressive behavior is related to impulsive behavior. Furthermore, we investigated if violent behavior can be distinguished from "normal" aggressive behavior in terms of impulsivity levels. We used rats of the wild-type Groningen strain, rats of this strain differ widely in their level of offensive aggression expressed toward an unfamiliar intruder male, ranging from no aggression at all to very high levels of intense and sometimes violent behavior. Violent behavior was displayed by some of the animals that were given repeated winning experience. We used behavioral performance in an unpredictable operant conditioning paradigm for food reinforcement (variable interval 15) and performance in a differential-reinforcement of low rate (DRL-60s) responding as determinants for impulsivity. We predicted that offensive aggression is correlated with behavioral flexibility measured by the VI-15 procedure and that aggressive behavior is characterized by low behavioral inhibition on the DRL task. In addition we expected that violent animals would be characterized by extremely low levels of behavioral inhibition on the DRL task. We showed that the level of offensive aggression indeed positively correlated with VI-15 performance. In addition, we showed that behavioral performance on the DRL procedure is similar in low and high aggressive rats. However, violent animals can be dissociated by a lower efficiency of lever pressing on a DRL-60s schedule of reinforcement.
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Affiliation(s)
- Caroline M. Coppens
- Department of Behavioral Physiology; University of Groningen; Groningen The Netherlands
| | - Sietse F. de Boer
- Department of Behavioral Physiology; University of Groningen; Groningen The Netherlands
| | - Bauke Buwalda
- Department of Behavioral Physiology; University of Groningen; Groningen The Netherlands
| | - Jaap M. Koolhaas
- Department of Behavioral Physiology; University of Groningen; Groningen The Netherlands
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Tomko RL, Brown WC, Tragesser SL, Wood PK, Mehl MR, Trull TJ. Social context of anger in borderline personality disorder and depressive disorders: findings from a naturalistic observation study. J Pers Disord 2014; 28:434-48. [PMID: 22984859 DOI: 10.1521/pedi_2012_26_064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anger and affective instability are key features of borderline personality disorder (BPD). Given the dynamic nature of affect, it is ideally studied using ambulatory assessment (AA). Recently, several major studies have examined affective instability via momentary self-report, using electronic diaries, which participants can use throughout their daily routine. The present study sought to complement this research by using an unobtrusive naturalistic observation method, the Electronically Activated Recorder (EAR). The EAR, which captures interpersonal behavior by periodically recording 50-second snippets of ambient sounds, was worn by 25 participants with BPD who also met the specific affective instability (AI) criterion as well as 13 participants with a depressive disorder (who did not meet criteria for AI or BPD) for three days. Trained coders listened to the captured recordings and rated participants' affect during each 50-second clip (i.e., in naturally varying social contexts). Results suggested that there were differences between diagnostic groups regarding the social context of anger, such that anger at a previous time interval predicted spending time alone in the subsequent time interval for the depressed group, but not for the BPD group. As an ambulatory observational method, the EAR offers an alternative to self-report and can provide insight into the naturalistic expression of emotions in BPD.
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Vicario CM. Aggression traits in youth psychopathy: the key role of serotonin. Front Psychiatry 2014; 5:25. [PMID: 24672490 PMCID: PMC3955848 DOI: 10.3389/fpsyt.2014.00025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/02/2014] [Indexed: 11/13/2022] Open
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Weber NS, Fisher JA, Cowan DN, Postolache TT, Larsen RA, Niebuhr DW. Descriptive epidemiology and underlying psychiatric disorders among hospitalizations with self-directed violence. PLoS One 2013; 8:e59818. [PMID: 23555791 PMCID: PMC3608546 DOI: 10.1371/journal.pone.0059818] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 02/19/2013] [Indexed: 12/02/2022] Open
Abstract
Background Suicide claims over one million lives worldwide each year. In the United States, 1 per 10,000 persons dies from suicide every year, and these rates have remained relatively constant over the last 20 years. There are nearly 25 suicide attempts for each suicide, and previous self-directed violence is a strong predictor of death from suicide. While many studies have focused on suicides, the epidemiology of non-fatal self-directed violence is not well-defined. Objective We used a nationally representative survey to examine demographics and underlying psychiatric disorders in United States (US) hospitalizations with non-fatal self-directed violence (SDV). Method International Classification of Disease, 9th Revision (ICD-9) discharge diagnosis data from the National Hospital Discharge Survey (NHDS) were examined from 1997 to 2006 using frequency measures and adjusted logistic regression. Results The rate of discharges with SDV remained relatively stable over the study time period with 4.5 to 5.7 hospitalizations per 10,000 persons per year. Excess SDV was documented for females, adolescents, whites, and those from the Midwest or West. While females had a higher likelihood of self-poisoning, both genders had comparable proportions of hospitalizations with SDV resulting in injury. Over 86% of the records listing SDV also included psychiatric disorders, with the most frequent being affective (57.8%) and substance abuse (37.1%) disorders. The association between psychiatric disorders and self-injury was strongest for personality disorders for both males (OR = 2.1; 95% CI = 1.3–3.4) and females (OR = 3.8; 95% CI = 2.7–5.3). Conclusion The NHDS provides new insights into the demographics and psychiatric morbidity of those hospitalized with SDV. Classification of SDV as self-injury or self-poisoning provides an additional parameter useful to epidemiologic studies.
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Affiliation(s)
- Natalya S Weber
- Preventive Medicine Program, Walter Reed Army Institute of Research, Silver Spring, Maryland, United States of America.
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Abstract
OBJECTIVE Borderline personality disorder (BPD) is commonly characterized by self-directed aggressive behavior, although the literature indicates that externalized aggressive behavior may be present. The simultaneous examination of multiple types of externalized aggressive behavior in individuals with BPD and the exploration of such relationships in a primary care population have not, to our knowledge, been undertaken; this is the focus of the present study. METHODS Using a cross-sectional approach in a consecutive sample of 335 internal medicine outpatients, we explored through a self-report survey the relation between 21 externalized aggressive behaviors and BPD symptomatology, using two self-report measures for assessment: the borderline personality disorder scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). RESULTS Scores on the measure for externalized aggressive behavior correlated strongly with scores on the PDQ-4 (r = 0.60; P < 0.001) and the SHI (r = 0.67; P < 0.001) and were statistically significantly greater among respondents who exceeded the cutoff scores for BPD symptomatology on both the PDQ-4 and the SHI as compared with respondents who did not exceed these scores. CONCLUSIONS In addition to self-directed aggressive behavior, individuals with BPD symptomatology also exhibit various externalized aggressive behaviors.
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Scherer A, Eberle N, Boecker M, Vögele C, Gauggel S, Forkmann T. The negative affect repair questionnaire: factor analysis and psychometric evaluation in three samples. BMC Psychiatry 2013; 13:16. [PMID: 23302222 PMCID: PMC3558324 DOI: 10.1186/1471-244x-13-16] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 12/22/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Negative affect and difficulties in its regulation have been connected to several adverse psychological consequences. While several questionnaires exist, it would be important to have a theory-based measure that includes clinically relevant items and shows good psychometric properties in healthy and patient samples. This study aims at developing such a questionnaire, combining the two Gross [1] scales Reappraisal and Suppression with an additional response-focused scale called Externalizing Behavioral Strategies covering clinically relevant items. METHODS The samples consisted of 684 students (mean age = 23.3, SD = 3.5; 53.6% female) and 369 persons with mixed mental disorders (mean age = 36.0 SD = 14.6; 71.2% female). Items for the questionnaire were derived from existing questionnaires and additional items were formulated based on suggestions by clinical experts. All items start with "When I don't feel well, in order to feel better…". Participants rated how frequently they used each strategy on a 5-point Likert scale. Confirmatory Factor Analyses were conducted to verify the factor structure in two separate student samples and a clinical sample. Group comparisons and correlations with other questionnaires were calculated to ensure validity. RESULTS After modification, the CFA showed good model fit in all three samples. Reliability scores (Cronbach's α) for the three NARQ scales ranged between .71 and .80. Comparisons between students and persons with mental disorders showed the postulated relationships, as did comparisons between male and female students and persons with or without Borderline Personality Disorder. Correlations with other questionnaires suggest the NARQ's construct validity. CONCLUSIONS The results indicate that the NARQ is a psychometrically sound and reliable measure with practical use for therapy planning and tracking of treatment outcome across time. We advocate the integration of the new response-focused strategy in the Gross's model of emotion regulation.
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Affiliation(s)
- Anne Scherer
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Pauwelsstraße 19, Aachen, 52074, Germany
| | - Nicole Eberle
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Pauwelsstraße 19, Aachen, 52074, Germany
| | - Maren Boecker
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Pauwelsstraße 19, Aachen, 52074, Germany
| | - Claus Vögele
- Research Group Self-Regulation and Health, Research Unit INSIDE, University of Luxembourg, Route de Diekirch - B.P. 2, Walferdange, 7220, Luxembourg, Luxembourg
| | - Siegfried Gauggel
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Pauwelsstraße 19, Aachen, 52074, Germany
| | - Thomas Forkmann
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen, Pauwelsstraße 19, Aachen, 52074, Germany
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Schaaff N, Karch S, Segmiller F, Koch W, Reicherzer M, Mulert C, Hegerl U, Juckel G, Pogarell O. Loudness dependence of auditory evoked potentials in patients with borderline personality disorder--impact of psychopathology. Psychiatry Res 2012; 199:181-7. [PMID: 22542953 DOI: 10.1016/j.psychres.2012.03.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 03/26/2012] [Accepted: 03/27/2012] [Indexed: 10/28/2022]
Abstract
Alterations of the central serotonergic system are considered to be involved in the pathophysiology of borderline personality disorder (BPD). The loudness dependence of the N1/P2 component of auditory evoked potentials (LD) has been shown to indirectly reflect central serotonergic activity. The aim of this study was to investigate LD in patients with BPD compared to healthy controls, and to evaluate the association between LD and psychopathology such as anxiety, anger or impulsiveness. Female patients with BPD were included and compared to age- and sex-matched healthy subjects. Self-rating instruments, such as the State-Trait Anxiety Inventory (STAI), State-Trait Anger Expression Inventory (STAXI), and the Barratt Impulsiveness Scale (BIS) were used to assess clinical scores of anxiety, anger, and impulsiveness. Evoked potentials were recorded following the application of acoustic stimuli with increasing intensities; the LD was analysed using dipole source analysis. The mean LD was significantly higher in patients with BPD compared to controls. In the entire sample there were significant positive correlations of LD with state anxiety scores and STAXI subscores. The data contribute to the knowledge of neurophysiological alterations in patients with BPD, supporting the hypothesis of serotonergic dysregulation in the pathophysiology of the disorder. The significant clinical correlations suggest monoaminergic modulations of psychopathology on the symptom level.
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Affiliation(s)
- Nadine Schaaff
- Department of Psychiatry, Ludwig-Maximilian-University of Munich, Germany
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27
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Sansone RA, Farukhi S, Wiederman MW. Disruptive behaviors in the medical setting and borderline personality. Int J Psychiatry Med 2012; 41:355-63. [PMID: 22238840 DOI: 10.2190/pm.41.4.e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Borderline personality disorder (BPD) is characterized in the DSM by anger. While previous studies have examined various types of externalized aggression and violence among individuals with BPD, we are aware of no investigations of disruptive behaviors perpetrated by patients with BPD in medical settings-the focus of the present study. METHOD Using a cross-sectional, consecutive sample of internal medicine outpatients from a resident provider clinic, we surveyed 397 participants regarding 17 disruptive behaviors related to medical personnel and assessed BPD using two self-report measures, the BPD scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). RESULTS A statistically significantly greater proportion of respondents who exceeded the clinical cut-off scores for BPD on both the PDQ-4 and SHI endorsed at least one form of disruptive behavior. However, there were no differences between participants with versus without BPD symptomatology regarding the number of different forms of disruptive behaviors after that initial threshold of one such behavior was reached. Several specific disruptive behaviors were reported more often in those with BPD symptomatology (i.e., yelling, screaming, verbally threatening, and refusing to talk with medical staff as well as talking badly about medical staff to the patients' friends and family). CONCLUSIONS BPD appears to be associated with a greater likelihood of disruptive behaviors in the medical setting, but not physical threat.
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Affiliation(s)
- Randy A Sansone
- Wright State University and Kettering Medical Center, Ohio, USA.
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28
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Allen A, Links PS. Aggression in borderline personality disorder: evidence for increased risk and clinical predictors. Curr Psychiatry Rep 2012; 14:62-9. [PMID: 22033830 DOI: 10.1007/s11920-011-0244-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
This article aimed to systematically review the current literature regarding elevated risk of aggression in borderline personality disorder (BPD) and to review factors that differentiate aggressive from nonaggressive individuals with BPD. It has done so via a systematic review of the literature using Ovid MEDLINE and PsycINFO from 1980 to June 2010. Results indicate that BPD does not appear to be independently associated with increased risk of violence in the general population. History of childhood maltreatment, history of violence or criminality, and comorbid psychopathy or antisocial personality disorder appear to be predictors of violence in patients with BPD. This review concludes that the current evidence suggests that patients with BPD are not more violent than individuals in the general population. More studies are needed on factors that predict risk of aggression at an individual level.
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Affiliation(s)
- Albert Allen
- St. Michael's Hospital, 30 Bond Street, Suicide Studies Research Unit, Suite 2010e, Shuter Wing, Toronto, Ontario M5B 1W8, Canada.
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29
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Abstract
This review examined aggressive behavior in Borderline Personality Disorder (BPD) and its management in adults. Aggression against self or against others is a core component of BPD. Impulsiveness is a clinical hallmark (as well as a DSM-IV-TR diagnostic criterion) of BPD, and aggressive acts by BPD patients are largely of the impulsive type. BPD has high comorbidity rates with substance use disorders, Bipolar Disorder, and Antisocial Personality Disorder; these conditions further elevate the risk for violence. Treatment of BDP includes psychodynamic, cognitive behavioral, schema therapy, dialectic behavioral, group and pharmacological interventions. Recent studies indicate that many medications, particularly atypical antipsychotics and anticonvulsants, may reduce impulsivity, affective lability as well as irritability and aggressive behavior. But there is still a lack of large, double blind, placebo controlled studies in this area.
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Affiliation(s)
- K Látalová
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic.
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30
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Garcia LF, Aluja A, Fibla J, Cuevas L, García O. Incremental effect for antisocial personality disorder genetic risk combining 5-HTTLPR and 5-HTTVNTR polymorphisms. Psychiatry Res 2010; 177:161-6. [PMID: 20363030 DOI: 10.1016/j.psychres.2008.12.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2008] [Revised: 12/04/2008] [Accepted: 12/29/2008] [Indexed: 10/19/2022]
Abstract
As the serotonin transporter gene (SLC6A4 or 5-HTT) is a key regulator of central serotonergic activity, several association studies between Antisocial Personality Disorder (APD) and the SLC6A4 polymorphisms have been conducted in the last decade. In the present study, the role of both 5-HTTLPR and 5-HTTVNTR polymorphisms of the SLC6A4 gene in APD is investigated. A sample of 147 male inmates was analyzed. APD was assessed by Aluja's Antisocial Personality Disorder Scale, a measure that correlates 0.73 with the dimensional score of DSM-IV APD and 0.62 with factor II of the Psychopathy Checklist-Revised. Inmates presenting both 5-HTTLPR S/S+S/L and 5-HTTVNTR 12/12 had a higher risk of being classified in the APD group (Odds ratio=3.48). The results also showed that the genotype and haplotype distribution was more dissimilar when extreme groups were compared with odds ratios up to 6.50. Our results supported that, in addition to the widely investigated 5-HTTLPR polymorphism, the 5-HTTVNTR polymorphism might be an interesting candidate for association studies with APD. Results also suggested that previous failures to replicate the association between serotonin transporter gene polymorphisms and APD, or similar phenotypes, could have been due to an under-representation of extremely high APD subjects in the samples analyzed.
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Affiliation(s)
- Luis F Garcia
- Department of Biological and Health Psychology, Autonomous University of Madrid, Madrid, Spain.
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31
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Abstract
Borderline personality disorder is characterized by affective instability, impulsivity, identity diffusion, and interpersonal dysfunction. Perceived rejection and loss often serve as triggers to impulsive, suicidal, and self-injurious behavior, affective reactivity, and angry outbursts, suggesting that the attachment and affiliative system may be implicated in the disorder. Neuropeptides, including the opioids, oxytocin, and vasopressin, serve a crucial role in the regulation of affiliative behaviors and thus may be altered in borderline personality disorder. While clinical data are limited, the authors propose alternative neuropeptide models of borderline personality disorder and review relevant preclinical research supporting the role of altered neuropeptide function in this disorder in the hope of stimulating more basic research and the development of new treatment approaches.
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Affiliation(s)
- Barbara Stanley
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
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32
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Swogger MT, Walsh Z, Houston RJ, Cashman-Brown S, Conner KR. Psychopathy and axis I psychiatric disorders among criminal offenders: relationships to impulsive and proactive aggression. Aggress Behav 2010; 36:45-53. [PMID: 19904752 DOI: 10.1002/ab.20330] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Both psychopathology and aggression are heterogeneous constructs. Determining which forms of psychopathology relate to risk for different classes of aggressive behavior has implications for risk recognition and management. This study examined the relationships of impulsive aggression (IA) and proactive aggression (PA) to psychopathy and symptoms of several Diagnostic and Statistical Manual Axis I disorders in a sample of criminal offenders. Results replicated prior findings from community samples of a broad relationship between psychopathology and IA. PA was related only to psychopathy. An interaction was found whereby IA was associated with impulsive-antisocial traits of psychopathy only for individuals with moderate to high levels of generalized anxiety. Results indicate that assessing and treating several Axis I disorders in offenders may decrease risk for IA. Moreover, current findings raise the possibility that generalized anxiety is a key, modifiable component of the relationship between IA and impulsive-antisocial traits.
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Affiliation(s)
- Marc T Swogger
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York 14642, USA.
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33
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McCloskey MS, New AS, Siever LJ, Goodman M, Koenigsberg HW, Flory JD, Coccaro EF. Evaluation of behavioral impulsivity and aggression tasks as endophenotypes for borderline personality disorder. J Psychiatr Res 2009; 43:1036-48. [PMID: 19232640 PMCID: PMC2853811 DOI: 10.1016/j.jpsychires.2009.01.002] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 12/22/2008] [Accepted: 01/12/2009] [Indexed: 11/26/2022]
Abstract
Borderline personality disorder (BPD) is marked by aggression and impulsive, often self-destructive behavior. Despite the severe risks associated with BPD, relatively little is known about the disorder's etiology. Identification of genetic correlates (endophenotypes) of BPD would improve the prospects of targeted interventions for more homogeneous subsets of borderline patients characterized by specific genetic vulnerabilities. The current study evaluated behavioral measures of aggression and impulsivity as potential endophenotypes for BPD. Subjects with BPD (N=127), a non cluster B personality disorder (OPD N=122), or healthy volunteers (HV N=112) completed self report and behavioral measures of aggression, motor impulsivity and cognitive impulsivity. Results showed that BPD subjects demonstrated more aggression and motor impulsivity than HV (but not OPD) subjects on behavioral tasks. In contrast, BPD subjects self-reported more impulsivity and aggression than either comparison group. Subsequent analyses showed that among BPD subjects behavioral aggression was associated with self-reported aggression, while behavioral and self-report impulsivity measures were more modestly associated. Overall, the results provide partial support for the use of behavioral measures of aggression and motor impulsivity as endophenotypes for BPD, with stronger support for behavioral aggression measures as an endophenotype for aggression within BPD samples.
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Affiliation(s)
- Michael S McCloskey
- Department of Psychiatry and Behavioral Neuroscience, The Pritzker School of Medicine, The University of Chicago, 5841 South Maryland Avenue, Chicago, IL 60637, United States.
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34
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35
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Aluja A, Garcia LF, Blanch A, De Lorenzo D, Fibla J. Impulsive-disinhibited personality and serotonin transporter gene polymorphisms: association study in an inmate's sample. J Psychiatr Res 2009; 43:906-14. [PMID: 19121834 DOI: 10.1016/j.jpsychires.2008.11.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2008] [Revised: 11/13/2008] [Accepted: 11/18/2008] [Indexed: 10/21/2022]
Abstract
The association between different impulsive-disinhibited personality traits with 5-HTTLPR and 5-HTTVNTR genetic polymorphisms was examined in an imprisoned male sample. Higher scores of the impulsive-disinhibited personality traits tended to be associated with carrying one or two copies of the 5-HTTPLR S allele (S/S homozygous and S/L heterozygous), and carrying two copies of the 5-HTTVNTR 12 allele (12/12 homozygous). Genotype, allele, haplotype and extended genotype distribution between low and high impulsive-disinhibited groups confirmed this association. Allele S and genotypes S/S+S/L at the 5-HTTLPR locus and allele 12 and genotype 12/12 at the 5-HTTVNTR locus were overrepresented in the high scoring group. Accordingly, allele S and allele 12 conferred a trend for risk to be in the high scoring group with an odds ratio (OR) of 1.8 (p < 0.035) and 1.7 (p < 0.014), respectively. In addition, extended genotype distribution shows that those S allele carriers (S/S homozygote and S/L heterozygote) that were also 12/12 homozygote, were overrepresented in the high scoring group (OR = 3.2; p < 0.004). The main risk of being in the high scoring group was assigned to those carrying two copies of the S-12 haplotype (OR = 5.7; p < 0.0007). We discuss the possible relationship between the two genetic serotonin polymorphisms and the personality impulsive-disinhibited traits investigated.
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Affiliation(s)
- Anton Aluja
- Department of Pedagogy and Psychology, University of Lleida, Avada Estudi General 4, Campus de Cappont, 25100 Lleida, Catalonia, Spain.
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36
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Männynsalo L, Putkonen H, Lindberg N, Kotilainen I. Forensic psychiatric perspective on criminality associated with intellectual disability: a nationwide register-based study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2009; 53:279-288. [PMID: 19250388 DOI: 10.1111/j.1365-2788.2008.01125.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Contrasting views exist over the association of intellectual disability (ID) and criminal offending. This nationwide study attempts to shed further light to expand understanding to substantiate the relation between socio-demographic characteristics, psychiatric co-morbidity and criminal behaviour among the Finnish forensic population with ID. METHOD We reviewed all forensic psychiatric examination reports of individuals with ID who underwent a pre-trial forensic psychiatric evaluation in Finland during an 11-year period (1996-2006). RESULTS One-third of the offenders had been regularly and sufficiently treated as outpatients. Half of the offenders had previous criminality, and the single most common crime was arson. Almost half of the offenders were diagnosed with alcohol abuse/dependence and two-thirds with any substance abuse/dependence. Furthermore, almost half were intoxicated during the index crime. Antisocial personality disorder was diagnosed in 25% of the offenders. Almost half of the offenders were placed in involuntary special care for the ID, which lasted ca 2 years. Among the last-mentioned, two-thirds of the nursing care plans lacked recommended structure. CONCLUSIONS The offenders with so-called triple diagnosis - substance abuse, mental illness and ID - form a small subgroup of criminal offenders with complex needs. The results of the present study underline the importance of close, long-term cooperation among specialists in the field of ID, addiction service, mental health services and forensic psychiatry.
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Affiliation(s)
- L Männynsalo
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.
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37
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Lindberg N, Tani P, Putkonen H, Sailas E, Takala P, Eronen M, Virkkunen M. Female impulsive aggression: a sleep research perspective. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2009; 32:39-42. [PMID: 19095304 DOI: 10.1016/j.ijlp.2008.11.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The rate of violent crimes among girls and women appears to be increasing. One in every five female prisoners has been reported to have antisocial personality disorder. However, it has been quite unclear whether the impulsive, aggressive behaviour among women is affected by the same biological mechanisms as among men. Psychiatric sleep research has attempted to identify diagnostically sensitive and specific sleep patterns associated with particular disorders. Most psychiatric disorders are typically characterized by a severe sleep disturbance associated with decreased amounts of slow wave sleep (SWS), the physiologically significant, refreshing part of sleep. Among men with antisocial behaviour with severe aggression, on the contrary, increased SWS has been reported, reflecting either specific brain pathology or a delay in the normal development of human sleep patterns. In our preliminary study among medication-free, detoxified female homicidal offenders with antisocial personality disorder, the same profound abnormality in sleep architecture was found. From the perspective of sleep research, the biological correlates of severe impulsive aggression seem to share similar features in both sexes.
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38
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Oumaya M, Friedman S, Pham A, Abou Abdallah T, Guelfi JD, Rouillon F. Personnalité borderline, automutilations et suicide : revue de la littérature. Encephale 2008; 34:452-8. [PMID: 19068333 DOI: 10.1016/j.encep.2007.10.007] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Accepted: 10/08/2007] [Indexed: 10/22/2022]
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39
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de Barros DM, de Pádua Serafim A. Association between personality disorder and violent behavior pattern. Forensic Sci Int 2008; 179:19-22. [DOI: 10.1016/j.forsciint.2008.04.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2006] [Revised: 09/12/2007] [Accepted: 04/12/2008] [Indexed: 01/13/2023]
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40
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Abstract
Inpatient aggression jeopardizes the safety of psychiatric clinicians and patients. A minority of psychiatric inpatients is responsible for most of inpatient assaults; this subset of repetitively assaultive patients warrants greater attention in the form of systematic study. In developing treatment approaches for assaultive inpatients, it is important to characterize the primary motivation driving aggressive behavior. There are many pharmacologic agents and psychotherapeutic approaches available to address inpatients who engage in impulsive and psychotic violence, but the treatment of inpatients with antisocial or psychopathy personality remain limited, and further study is needed. To protect the safety of patients and staff, criminal prosecution of inpatient assaults is clinically justified if an assailant continues to be aggressive despite appropriate clinical interventions or commits an act of planned aggression so egregious that prosecution is the only reasonable alternative.
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Affiliation(s)
- Cameron Quanbeck
- Division of Psychiatry and the Law, University of California, Davis Medical Center, 2230 Stockton Boulevard, Second Floor, Sacramento, CA 95817, USA.
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41
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Loew TH, Nickel MK, Muehlbacher M, Kaplan P, Nickel C, Kettler C, Fartacek R, Lahmann C, Buschmann W, Tritt K, Bachler E, Mitterlehner F, Pedrosa Gil F, Leiberich P, Rother WK, Egger C. Topiramate treatment for women with borderline personality disorder: a double-blind, placebo-controlled study. J Clin Psychopharmacol 2006; 26:61-6. [PMID: 16415708 DOI: 10.1097/01.jcp.0000195113.61291.48] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Borderline personality disorder is a common and severe psychiatric illness. The goal of this study was to determine whether topiramate can influence patients' borderline psychopathology, health-related quality of life, and interpersonal problems. Women meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Structured Clinical Interview II criteria for borderline personality disorder were randomly assigned in a 1:1 ratio to topiramate titrated from 25 to 200 mg/d (n = 28) or placebo (n = 28) for 10 weeks. Primary outcome measures were changes on the Symptom-Checklist, on the SF-36 Health Survey, and on the Inventory of Interpersonal Problems. Body weight and additional side effects were assessed weekly. According to the intent-to-treat principle, significant changes (all P < 0.001) on the somatization, interpersonal sensitivity, anxiety, hostility, phobic anxiety, and Global Severity Index scales of the Symptom Checklist were observed in the topiramate-treated subjects after 10 weeks (no significant changes on the obsessive-compulsive, depression, paranoid ideation, and psychoticism scales). In the SF-36 Health Survey, significant differences were observed on all 8 scales (all P < 0.01 or P < 0.001). In the Inventory of Interpersonal Problems, significant differences (all P < 0.001) were found in the scales for overly autocratic, overly competitive, overly introverted, and overly expressive (no significant differences in the scales for overly cold, overly subassertive/subservient, overly exploitable/compliant, and overly nurturant/friendly). Weight loss was additionally observed (p < 0.001). Topiramate appears to be a safe and effective agent in the treatment in women with borderline personality disorder. Additional weight loss can be expected.
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Affiliation(s)
- Thomas H Loew
- Department of Psychosomatic Medicine, University Clinic, Regensburg, Germany
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42
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Keele NB. The role of serotonin in impulsive and aggressive behaviors associated with epilepsy-like neuronal hyperexcitability in the amygdala. Epilepsy Behav 2005; 7:325-35. [PMID: 16103019 DOI: 10.1016/j.yebeh.2005.06.014] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Accepted: 06/15/2005] [Indexed: 11/30/2022]
Abstract
Neuronal hyperexcitability in limbic areas, especially the amygdala, is a significant underlying mechanism associated with complex partial seizures (CPS). CPS may be comorbid with emotional disturbances, especially major mood disorders, anxiety, and aggression. Anticonvulsant medications such as phenytoin are also mood-stabilizing, and have been used for treatment of behavioral dyscontrol in impulsive aggressive individuals. Because the amygdala has important functional roles in epilepsy, emotion, and behavioral control, there may be common biological mechanisms involving neuronal excitability that contribute to both seizure activity and psychopathology. This review examines physiological mechanisms in the amygdala that regulate neuronal excitability and discusses how this may underlie, in part, disturbances in emotional behavior.
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Affiliation(s)
- N Bradley Keele
- Department of Psychology and Neuroscience, Baylor University, One Bear Place No. 97334, Waco, TX 76798-7334, USA.
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43
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Lindberg N, Tani P, Virkkunen M, Porkka-Heiskanen T, Appelberg B, Naukkarinen H, Salmi T. Quantitative electroencephalographic measures in homicidal men with antisocial personality disorder. Psychiatry Res 2005; 136:7-15. [PMID: 16026854 DOI: 10.1016/j.psychres.2005.05.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2004] [Revised: 03/24/2005] [Accepted: 05/16/2005] [Indexed: 11/19/2022]
Abstract
Many symptoms of antisocial personality disorder have been proposed to be related to decreased daytime vigilance. To explore this hypothesis, quantitative analyses were conducted of the electroencephalographic (EEG) activity of drug-free and detoxified homicidal male offenders with antisocial personality disorder as the primary diagnosis. Subjects comprised 16 men recruited from a forensic psychiatric examination in a special ward of a university psychiatric hospital. Fifteen healthy age- and gender-matched controls with no criminal record or history of physical violence consisted of hospital staff and students. An overall reduction of alpha power was observed in the waking EEG of offenders. A bilateral increase in occipital delta and theta power was also found in these individuals. This study provides further support to the growing evidence of brain dysfunction in severe aggressive behavior. Homicidal offenders with antisocial personality disorder seem to have difficulties in maintaining normal daytime arousal. Decreased vigilance, together with social and psychological variables, may explain their aberrant behavior in everyday life. New studies are, however, needed to specify the vigilance problems of this patient group.
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Affiliation(s)
- Nina Lindberg
- Institute of Clinical Medicine, Department of Psychiatry, University of Helsinki, Lapinlahti Hospital, Lapinlahdentie, P.O. Box 320, 00029 HUS, Helsinki, Finland.
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Abstract
Self-mutilation is common in borderline personality disorder, but this pattern of behavior does not usually carry suicidal intent. Instead, it serves other functions, including regulation of dysphoric affect, communication of distress, expression of emotions, and coping with dissociative states. Multiple causal factors, including biological, psychological, and social risks, influence thresholds for self-mutilation. Management of this behavior can be informed by understanding its psychological functions.
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Affiliation(s)
- Joel Paris
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada.
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45
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Helfritz LE, Stanford MS. Personality and psychopathology in an impulsive aggressive college sample. Aggress Behav 2005. [DOI: 10.1002/ab.20103] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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46
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Critchfield KL, Levy KN, Clarkin JF. The relationship between impulsivity, aggression, and impulsive-aggression in borderline personality disorder: an empirical analysis of self-report measures. J Pers Disord 2004; 18:555-70. [PMID: 15615667 DOI: 10.1521/pedi.18.6.555.54795] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Impulsivity has been repeatedly identified as a key construct in BPD; however, its precise definition seems to vary especially regarding the overlap with aggression. The term impulsive-aggression , also generally seen as central to an understanding of BPD, seems to address itself to the interface between the two, but has itself been used inconsistently in the literature, sometimes having reference to a unitary phenotypic dimension, and at other times suggesting some combination of distinct traits. This study examined the relationship between multiple measures of impulsivity, aggression, and impulsive-aggression in a BPD sample ( N = 92) in order to clarify the relationship between these measured constructs in this clinical population. Results show little relationship between measures of aggression and impulsivity in BPD, with measures of impulsive-aggression correlating strongly with measures of aggression only. Implications of the present results for future research and clinical work with BPD are discussed.
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Affiliation(s)
- Kenneth L Critchfield
- New York Presbyterian Hospital, Joan and Sanford I. Weill Cornell Medical College, USA.
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47
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Lindberg N, Tani P, Appelberg B, Naukkarinen H, Rimón R, Porkka-Heiskanen T, Virkkunen M. Human impulsive aggression: a sleep research perspective. J Psychiatr Res 2003; 37:313-24. [PMID: 12765854 DOI: 10.1016/s0022-3956(03)00041-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Impulsive aggression is commonly associated with personality disorders, in particular antisocial and borderline personality disorders as well as with conduct disorder and intermittent explosive disorder. The relationship between impulsive aggression and testosterone is well established in many studies. One of the aims of this study was to characterize the relationship between earlier-mentioned different categorical psychiatric diagnosis describing human impulsive aggression and sleep using polysomnography and spectral power analysis. Another aim was to study the relationship between serum testosterone and sleep in persons with severe aggressive behaviour. Subjects for the study were 16 males charged with highly violent offences and ordered for a pretrial forensic psychiatric examination. The antisocials with borderline personality disorder comorbidity had significantly more awakenings and lower sleep efficiency compared with the subjects with only antisocial personality disorder. The subjects with severe conduct disorder in childhood anamnesis had higher amount of S4 sleep and higher relative theta and delta power in this sleep stage compared with males with only mild or moderate conduct disorder. The same kind of sleep architecture was associated with intermittent explosive disorder. In subgroups with higher serum testosterone levels also the amount of S4 sleep and the relative theta and delta power in this sleep stage were increased. The study gives further support to the growing evidence of brain dysfunction predisposing to severe aggressive behaviour and strengthens the view that there are different subpopulations of individuals with antisocial personality varying in impulsiveness. The differences in impulsiveness are reflected in sleep architecture as well.
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Affiliation(s)
- Nina Lindberg
- Department of Psychiatry, University of Helsinki, Helsinki, Finland.
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Biancosino B, Facchi A, Marmai L, Grassi L. Gabapentin treatment of impulsive-aggressive behaviour. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2002; 47:483-4. [PMID: 12085684 DOI: 10.1177/070674370204700514] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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