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D'Iorio A, Benedetto GLD, Santangelo G. A meta-analysis on the neuropsychological correlates of Borderline Personality Disorder: An update. Neurosci Biobehav Rev 2024; 165:105860. [PMID: 39173987 DOI: 10.1016/j.neubiorev.2024.105860] [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: 03/05/2024] [Revised: 06/28/2024] [Accepted: 08/16/2024] [Indexed: 08/24/2024]
Abstract
Previous research on Borderline Personality Disorder (BPD) demonstrated dysfunction across a broad range of cognitive domains. However, the limited number of neuropsychological studies on BPD and their occasionally conflicting results have precluded a clear characterization of the neuropsychological features associated with this personality disorder. Therefore, the main aim of the present study is to provide an updated overview of neuropsychological functions related to BPD. A meta-analysis of 36 studies was performed, comparing the performance of BPD patients and healthy controls (HCs) across several cognitive domains. Significant differences between BPD patients and HCs in multiple cognitive domains were found. The smallest effect size was observed for general executive function, while the largest effect sizes were found in the long-term spatial memory and inhibition domains. In conclusion, the neuropsychological profile of BPD, characterized by deficits in inhibition as well as attention, memory, and executive functions, can result in difficulties in performing everyday activities. Accordingly, assessing neuropsychological functions could assist clinicians in developing more targeted non-pharmacological treatments.
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Affiliation(s)
- Alfonsina D'Iorio
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | | | - Gabriella Santangelo
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy.
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2
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Jiang Y, Gao Y, Dong D, Sun X, Situ W, Yao S. Brain Anatomy in Boys with Conduct Disorder: Differences Among Aggression Subtypes. Child Psychiatry Hum Dev 2024; 55:3-13. [PMID: 35704134 DOI: 10.1007/s10578-022-01360-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2022] [Indexed: 11/03/2022]
Abstract
Aggression is a core feature of conduct disorder (CD), but the motivation, execution of aggression may vary. A deeper understanding of the neural substrates of aggressive behaviours is critical for effective clinical intervention. Seventy-six Boys with CD (50 with impulsive aggression (I-CD) and 26 with premeditated aggression (P-CD)) and 69 healthy controls (HCs) underwent a structural MRI scan and behavioural assessments. Whole-brain analyses revealed that, compared to HCs, the I-CD group showed significant cortical thinning in the right frontal cortex, while the P-CD group demonstrated significant folding deficits in the bilateral superior parietal cortex. Both types of aggression negatively correlated with the left amygdala volume, albeit in different ways. The present results demonstrated that the complex nature of aggression relies on differentiated anatomical substrates, highlighting the importance of exploring differential circuit-targeted interventions for CD patients.
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Affiliation(s)
- Yali Jiang
- Medical Psychological Center, the Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, 410011, Changsha, Hunan, People's Republic of China
- Department of Radiology, the Second Xiangya Hospital, Central South University, 139, Middle Renmin Road, 410011, Changsha, Hunan, People's Republic of China
- Key Laboratory of Brain, Cognition and Education Sciences, South China Normal University, Ministry of Education, Guangzhou, China
- School of Psychology, South China Normal University, Guangzhou, China
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yidian Gao
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, China
| | - Daifeng Dong
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Xiaoqiang Sun
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Weijun Situ
- Department of Radiology, the Second Xiangya Hospital, Central South University, 139, Middle Renmin Road, 410011, Changsha, Hunan, People's Republic of China.
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK.
| | - Shuqiao Yao
- Medical Psychological Center, the Second Xiangya Hospital of Central South University, No. 139, Middle Renmin Road, 410011, Changsha, Hunan, People's Republic of China.
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.
- Centre for Human Brain Health, School of Psychology, University of Birmingham, Birmingham, UK.
- Medical Psychological Center, the Second Xiangya Hospital, Central South University, Changsha, China.
- National Clinical Research Center on Psychiatry and Psychology, Changsha, China.
- Medical Psychological Institute of Central South University, Changsha, China.
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3
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Qiao X, Lu K, Yun Q, Hao N. Similarities and Distinctions between Cortical Neural Substrates That Underlie Generation of Malevolent Creative Ideas. eNeuro 2023; 10:ENEURO.0127-23.2023. [PMID: 37696664 PMCID: PMC10512885 DOI: 10.1523/eneuro.0127-23.2023] [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: 04/20/2023] [Revised: 08/30/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023] Open
Abstract
Creativity can be driven by negative intentions, and this is called malevolent creativity (MC). It is a type of creativity that serves antisocial purposes and deliberately leads to harmful or immoral results. A possible classification indicates that there are three kinds of MC in daily life: hurting people, lying, and playing tricks. This study aimed to explore similar and distinct neural substrates underlying these different kinds of MC idea generation. The participants were asked to perform different MC tasks, and their neural responses were recorded using a functional near-infrared spectroscopy device. The findings revealed that most regions within the prefrontal and temporal lobes [e.g., the right dorsolateral prefrontal cortex (rDLPFC), and right angular gyrus] were involved in the three MC tasks. However, the right frontopolar cortex (rFPC) was more activated and less coupled with the rDLPFC and right precuneus during the lying task than during the other tasks. Thus, rFPC may play an important role in constructing novel lies. In the lying task, individuals were more selfish and less compassionate. In the playing tricks and hurting people tasks, there was less neural coupling between the rDLPFC and the left inferior frontal gyrus/right inferior parietal lobule than that in the lying task. This may imply that selfish motivation is released when individuals try to ignore victims' distress or generate aggressive tricks in hurting people or playing tricks tasks. These findings indicate that the three kinds of MC idea generation involve common cortical regions related to creative idea generation and moral judgment, whereas differences in cortical responses exist because of their unique features.
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Affiliation(s)
- Xinuo Qiao
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, People's Republic of China
| | - Kelong Lu
- School of Mental Health, Wenzhou Medical University, Wenzhou Zhejiang, 325035, People's Republic of China
| | - Qiang Yun
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, People's Republic of China
| | - Ning Hao
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, People's Republic of China
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4
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Yang X, Yang G, Wang R, Wang Y, Zhang S, Wang J, Yu C, Ren Z. Brain glucose metabolism on [18F]-FDG PET/CT: a dynamic biomarker predicting depression and anxiety in cancer patients. Front Oncol 2023; 13:1098943. [PMID: 37305568 PMCID: PMC10248443 DOI: 10.3389/fonc.2023.1098943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 05/17/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives To explore the correlation between the incidence rates of depression and anxiety and cerebral glucose metabolism in cancer patients. Methods The experiment subjects consisted of patients with lung cancer, head and neck tumor, stomach cancer, intestinal cancer, breast cancer and healthy individuals. A total of 240 tumor patients and 39 healthy individuals were included. All subjects were evaluated by the Hamilton depression scale (HAMD) and Manifest anxiety scale (MAS), and were examined by whole body Positron Emission Tomography/Computed Tomography (PET/CT) with 18F-fluorodeoxyglucose (FDG). Demographic, baseline clinical characteristics, brain glucose metabolic changes, emotional disorder scores and their relations were statistically analyzed. Results The incidence rates of depression and anxiety in patients with lung cancer were higher than those in patients with other tumors, and Standard uptake values (SUVs) and metabolic volume in bilateral frontal lobe, bilateral temporal lobe, bilateral caudate nucleus, bilateral hippocampus, left cingulate gyrus were lower than those in patients with other tumors. We also found that poor pathological differentiation, and advanced TNM stage independently associated with depression and anxiety risk. SUVs in the bilateral frontal lobe, bilateral temporal lobe, bilateral caudate nucleus, bilateral hippocampus, left cingulate gyrus were negatively correlated with HAMD and MAS scores. Conclusion This study revealed the correlation between brain glucose metabolism and emotional disorders in cancer patients. The changes in brain glucose metabolism were expected to play a major role in emotional disorders in cancer patients as psychobiological markers. These findings indicated that functional imaging can be applied for psychological assessment of cancer patients as an innovative method.
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Affiliation(s)
- Xue Yang
- Department of Neurology, Affiliated Hospital of Jiangnan University, Jiangnan University, Wuxi, Jiangsu, China
| | - Guangxia Yang
- Department of Rheumatology, Affiliated Hospital of Jiangnan University, Jiangnan University, Wuxi, Jiangsu, China
| | - Ruojun Wang
- Department of Neurology, Affiliated Hospital of Jiangnan University, Jiangnan University, Wuxi, Jiangsu, China
| | - Yanjuan Wang
- Department of Nuclear Medicine, Affiliated Hospital of Jiangnan University, Jiangnan University, Wuxi, Jiangsu, China
| | - Shengyi Zhang
- Department of Neurology, Affiliated Hospital of Jiangnan University, Jiangnan University, Wuxi, Jiangsu, China
| | - Jian Wang
- Department of Orthopaedics, The Ninth People’s Hospital of Wuxi, Affiliated to Suzhou University, Wuxi, Jiangsu, China
| | - Chunjing Yu
- Department of Nuclear Medicine, Affiliated Hospital of Jiangnan University, Jiangnan University, Wuxi, Jiangsu, China
| | - Zeqin Ren
- Department of Rehabilitation, The First Affiliated Hospital of Dali University, Dali, Yunnan, China
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Yu J, Hua L, Cao X, Chen Q, Zeng X, Yuan Z, Wang Y. Construction of an individualized brain metabolic network in patients with advanced non-small cell lung cancer by the Kullback-Leibler divergence-based similarity method: A study based on 18F-fluorodeoxyglucose positron emission tomography. Front Oncol 2023; 13:1098748. [PMID: 36969017 PMCID: PMC10036828 DOI: 10.3389/fonc.2023.1098748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/13/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundLung cancer has one of the highest mortality rates of all cancers, and non-small cell lung cancer (NSCLC) accounts for the vast majority (about 85%) of lung cancers. Psychological and cognitive abnormalities are common in cancer patients, and cancer information can affect brain function and structure through various pathways. To observe abnormal brain function in NSCLC patients, the main purpose of this study was to construct an individualized metabolic brain network of patients with advanced NSCLC using the Kullback-Leibler divergence-based similarity (KLS) method.MethodsThis study included 78 patients with pathologically proven advanced NSCLC and 60 healthy individuals, brain 18F-FDG PET images of these individuals were collected and all patients with advanced NSCLC were followed up (>1 year) to confirm their overall survival. FDG-PET images were subjected to individual KLS metabolic network construction and Graph theoretical analysis. According to the analysis results, a predictive model was constructed by machine learning to predict the overall survival of NSLCL patients, and the correlation with the real survival was calculated.ResultsSignificant differences in the degree and betweenness distributions of brain network nodes between the NSCLC and control groups (p<0.05) were found. Compared to the normal group, patients with advanced NSCLC showed abnormal brain network connections and nodes in the temporal lobe, frontal lobe, and limbic system. The prediction model constructed using the abnormal brain network as a feature predicted the overall survival time and the actual survival time fitting with statistical significance (r=0.42, p=0.012).ConclusionsAn individualized brain metabolic network of patients with NSCLC was constructed using the KLS method, thereby providing more clinical information to guide further clinical treatment.
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Affiliation(s)
- Jie Yu
- Department of Nuclear Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Lin Hua
- Faculty of Health Sciences, University of Macau, Macau, Macau SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macau, Macau SAR, China
| | - Xiaoling Cao
- Department of Nuclear Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Qingling Chen
- Department of Nuclear Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Xinglin Zeng
- Faculty of Health Sciences, University of Macau, Macau, Macau SAR, China
| | - Zhen Yuan
- Faculty of Health Sciences, University of Macau, Macau, Macau SAR, China
- Centre for Cognitive and Brain Sciences, University of Macau, Macau, Macau SAR, China
- *Correspondence: Zhen Yuan, ; Ying Wang,
| | - Ying Wang
- Department of Nuclear Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, Sun Yat-sen University, Zhuhai, Guangdong, China
- *Correspondence: Zhen Yuan, ; Ying Wang,
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6
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Sims E, Nelson KJ, Sisti D. Borderline personality disorder, therapeutic privilege, integrated care: is it ethical to withhold a psychiatric diagnosis? JOURNAL OF MEDICAL ETHICS 2022; 48:801-804. [PMID: 34261801 DOI: 10.1136/medethics-2021-107216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/22/2021] [Indexed: 06/13/2023]
Abstract
Once common, therapeutic privilege-the practice whereby a physician withholds diagnostic or prognostic information from a patient intending to protect the patient-is now generally seen as unethical. However, instances of therapeutic privilege are common in some areas of clinical psychiatry. We describe therapeutic privilege in the context of borderline personality disorder, discuss the implications of diagnostic non-disclosure on integrated care and offer recommendations to promote diagnostic disclosure for this patient population.
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Affiliation(s)
- Erika Sims
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Katharine J Nelson
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical Center, Minneapolis, Minnesota, USA
| | - Dominic Sisti
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Bak S, Jeong Y, Yeu M, Jeong J. Brain-computer interface to predict impulse buying behavior using functional near-infrared spectroscopy. Sci Rep 2022; 12:18024. [PMID: 36289356 PMCID: PMC9606125 DOI: 10.1038/s41598-022-22653-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 10/18/2022] [Indexed: 01/24/2023] Open
Abstract
As the rate of vaccination against COVID-19 is increasing, demand for overseas travel is also increasing. Despite people's preference for duty-free shopping, previous studies reported that duty-free shopping increases impulse buying behavior. There are also self-reported tools to measure their impulse buying behavior, but it has the disadvantage of relying on the human memory and perception. Therefore, we propose a Brain-Computer Interface (BCI)-based brain signal processing methodology to supplement these limitations and to reduce ambiguity and conjecture of data. To achieve this goal, we focused on the brain's prefrontal cortex (PFC) activity, which supervises human decision-making and is closely related to impulse buying behavior. The PFC activation is observed by recording signals using a functional near-infrared spectroscopy (fNIRS) while inducing impulse buying behavior in virtual computing environments. We found that impulse buying behaviors were not only higher in online duty-free shops than in online regular stores, but the fNIRS signals were also different on the two sites. We also achieved an average accuracy of 93.78% in detecting impulse buying patterns using a support vector machine. These results were identical to the people's self-reported responses. This study provides evidence as a potential biomarker for detecting impulse buying behavior with fNIRS.
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Affiliation(s)
- SuJin Bak
- grid.222754.40000 0001 0840 2678Department of Brain and Cognitive Engineering, Korea University, Seoul, 02841 South Korea
| | - Yunjoo Jeong
- grid.222754.40000 0001 0840 2678Center for Research in Marketing in School of Business at Korea University, Seoul, 02841 South Korea
| | - Minsun Yeu
- grid.267370.70000 0004 0533 4667College of Business Administration, University of Ulsan, Ulsan, 44610 South Korea
| | - Jichai Jeong
- grid.222754.40000 0001 0840 2678Department of Brain and Cognitive Engineering, Korea University, Seoul, 02841 South Korea
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8
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Möhler E. Personality Disorders and Development. Brain Sci 2022; 12:brainsci12080983. [PMID: 35892424 PMCID: PMC9332276 DOI: 10.3390/brainsci12080983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Eva Möhler
- Department of Child and Adolescent Psychiatry, Saarland University Hospital, G-66421 Homburg, Germany
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9
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Cattarinussi G, Delvecchio G, Moltrasio C, Ferro A, Sambataro F, Brambilla P. Effects of pharmacological treatments on neuroimaging findings in borderline personality disorder: A review of FDG-PET and fNIRS studies. J Affect Disord 2022; 308:314-321. [PMID: 35429522 DOI: 10.1016/j.jad.2022.04.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 03/23/2022] [Accepted: 04/10/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) is a serious mental condition characterized by instability in identity, interpersonal relationships, emotion regulation and impulsivity. These symptoms seem to be associated to specific brain alterations, which have been largely investigated. In particular, positron emission tomography (PET) and functional near-infrared spectroscopy (fNIRS) have demonstrated abnormalities in brain metabolism and hemodynamics in BPD, specifically in the fronto-limbic system. However, the role of medications on brain metabolism and hemodynamics in BPD is still largely unknown. METHODS We conducted a search on PubMed, Scopus and Web of Science of PET and fNIRS studies exploring the effect of medications on brain metabolism and hemodynamics in BPD. A total of 10 studies met the inclusion criteria. RESULTS Overall, PET studies showed an effect of psychotropic agents on brain metabolism, especially in frontal and temporal areas. Also, higher metabolic rates in frontal areas were found to correlate with clinical improvements. In contrast, fNIRS investigations reported an inconclusive or absent effects on brain hemodynamics in BPD patients. LIMITATIONS The small sample size, the elevated percentage of women, the heterogeneity in pharmacological agents and the presence of comorbidities limit the conclusions of the present review. CONCLUSIONS Serotoninergic agents and second-generation antipsychotics produce changes in frontal and temporal metabolism in BPD, which appear to correlate with clinical improvements. Differently, brain hemodynamics do not seem to be significantly affected by the most commonly prescribed drugs in BPD, suggesting that the therapeutic actions of medications are not mediated by changes in neural hemodynamics.
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Affiliation(s)
- Giulia Cattarinussi
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Giuseppe Delvecchio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Chiara Moltrasio
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Adele Ferro
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabio Sambataro
- Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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10
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Anselmo A, Lucifora C, Rusconi P, Martino G, Craparo G, Salehinejad MA, Vicario CM. Can we rewire criminal mind via non-invasive brain stimulation of prefrontal cortex? Insights from clinical, forensic and social cognition studies. CURRENT PSYCHOLOGY 2022; 42:1-11. [PMID: 35600259 PMCID: PMC9107958 DOI: 10.1007/s12144-022-03210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2022] [Indexed: 11/28/2022]
Abstract
Non-compliance with social and legal norms and regulations represents a high burden for society. Social cognition deficits are frequently called into question to explain criminal violence and rule violations in individuals diagnosed with antisocial personality disorder (APD), borderline personality disorder (BPD), and psychopathy. In this article, we proposed to consider the potential benefits of non-invasive brain stimulation (NIBS) to rehabilitate forensic population. We focused on the effects of NIBS of the prefrontal cortex, which is central in social cognition, in modulating aggression and impulsivity in clinical disorders, as well as in forensic population. We also addressed the effect of NIBS on empathy, and theory of mind in non-clinical and/or prison population. The reviewed data provide promising evidence on the beneficial effect of NIBS on aggression/impulsivity dyscontrol and social cognitive functions, suggesting its relevance in promoting reintegration of criminals into society.
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Affiliation(s)
- Anna Anselmo
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, via Concezione 6-8, 98121 Messina, Italy
| | - Chiara Lucifora
- Institute of Cognitive Sciences and Technologies, National Research Council (ISTC-CNR), Roma, RM Italy
| | - Patrice Rusconi
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, via Concezione 6-8, 98121 Messina, Italy
| | - Gabriella Martino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giuseppe Craparo
- Faculty of Human and Social Sciences, UKE-Kore University of Enna, Cittadella Universitaria, 94100 Enna, Italy
| | - Mohammad A. Salehinejad
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
| | - Carmelo M. Vicario
- Dipartimento di Scienze Cognitive, Psicologiche, Pedagogiche e Degli Studi Culturali, Università di Messina, via Concezione 6-8, 98121 Messina, Italy
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Chu J, Zheng K, Yi J. Aggression in borderline personality disorder: A systematic review of neuroimaging studies. Prog Neuropsychopharmacol Biol Psychiatry 2022; 113:110472. [PMID: 34742774 DOI: 10.1016/j.pnpbp.2021.110472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 09/30/2021] [Accepted: 10/31/2021] [Indexed: 01/30/2023]
Abstract
Aggressive behaviors are prevalent among patients with Borderline Personality Disorder (BPD). Neuroimaging studies have linked aggression in BPD patients to neurochemical, structural, functional, and metabolic alterations in various brain regions, especially in frontal-limbic areas. This systematic review summarizes current neuroimaging results on aggression among BPD patients and provides an overview of relevant brain mechanisms. A systematic search of PubMed and Web of Science databases, in addition to manual check of references, identified thirty-two eligible articles, including two magnetic resonance spectrum (MRS), thirteen structural magnetic resonance imaging (sMRI), six functional magnetic resonance imaging (fMRI), and eleven positron emission tomography (PET) studies. The reviewed studies have highlighted the abnormalities in prefrontal cortices and limbic structures including amygdala and hippocampus. Less studies have zoomed in the roles of parietal and temporal regions or taken a network perspective. Connectivity studies have shed light on the importance of the frontal-limbic interactions in regulating aggression. Conflicted findings might be attributed to disparity in controlling gender, anatomical subdivisions, and comorbidities, which shall be considered in future studies.
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Affiliation(s)
- Jun Chu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute, Central South University, Changsha, Hunan, China
| | - Kaili Zheng
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute, Central South University, Changsha, Hunan, China
| | - Jinyao Yi
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Medical Psychological Institute, Central South University, Changsha, Hunan, China; National Clinical Research Center for Mental Disorders, Changsha 410011, China.
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12
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Girasek H, Nagy VA, Fekete S, Ungvari GS, Gazdag G. Prevalence and correlates of aggressive behavior in psychiatric inpatient populations. World J Psychiatry 2022; 12:1-23. [PMID: 35111577 PMCID: PMC8783168 DOI: 10.5498/wjp.v12.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.
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Affiliation(s)
- Hunor Girasek
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Vanda Adél Nagy
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Szabolcs Fekete
- Department of Psychiatry, National Institute of Forensic Psychiatry, Budapest 1108, Hungary
- School of PhD Studies, Semmelweis University, Budapest 1085, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Australia
- Section of Psychiatry, University of Notre Dame, Fremantle 6160, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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13
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Seo EH, Yang HJ, Kim SG, Park SC, Lee SK, Yoon HJ. A Literature Review on the Efficacy and Related Neural Effects of Pharmacological and Psychosocial Treatments in Individuals With Internet Gaming Disorder. Psychiatry Investig 2021; 18:1149-1163. [PMID: 34872237 PMCID: PMC8721297 DOI: 10.30773/pi.2021.0207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Internet gaming disorder (IGD) has attracted considerable attention as a serious mental and public health issue worldwide. Currently, there are no established treatment guidelines for IGD. Herein, we review the latest findings on the efficacy and related neural effects of pharmacological and psychosocial treatments for individuals with IGD. METHODS A database search of relevant studies published between 2007 and 2020 was conducted using PubMed and Google Scholar. Twenty-seven studies were reviewed for current evidence related to the efficacy and neural effects of pharmacological and psychosocial IGD treatments. RESULTS Pharmacological studies suggest that bupropion may play a significant role in IGD. Additionally, nuclear imaging studies on IGD have demonstrated functional impairment of the dopamine system, providing a neurobiological basis for the efficacy of dopamineenhancing drugs. Among the various psychosocial interventions, current evidence suggests that cognitive behavioral therapy may be an effective intervention for IGD. Cognitive behavioral therapy and bupropion were found to influence resting-state functional connectivity within the cortico-subcortical circuit and default mode network, suggesting a possible neural mechanism. Innovative approaches, including virtual reality treatment, residential camps, voluntary abstinence, and transcranial direct current stimulation, have shown promising results. However, methodological limitations, such as the absence of proper controls, small sample sizes, short duration, inconsistency of inclusion criteria across studies, and self-report measures of outcome, hamper conclusions regarding the efficacy of treatments. CONCLUSION Ongoing basic research and clinical trials overcoming these limitations could add to the existing knowledge on IGD and contribute to the development of evidence-based treatments.
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Affiliation(s)
- Eun Hyun Seo
- Premedical Science, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Hae-Jung Yang
- Department of Psychiatry, Chosun University Hospital, Gwangju, Republic of Korea
| | - Seung-Gon Kim
- Department of Psychiatry, Chosun University Hospital, Gwangju, Republic of Korea.,Department of Psychiatry, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Seon-Cheol Park
- Department of Psychiatry, Hanyang University Guri Hospital, Guri, Republic of Korea
| | - Sang-Kyu Lee
- Department of Psychiatry, College of Medicine, Hallym University, Chuncheon, Republic of Korea
| | - Hyung-Jun Yoon
- Department of Psychiatry, Chosun University Hospital, Gwangju, Republic of Korea.,Department of Psychiatry, College of Medicine, Chosun University, Gwangju, Republic of Korea
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14
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Karas KH, Baharikhoob P, Kolla NJ. Borderline personality disorder and its symptom clusters: A review of positron emission tomography and single photon emission computed tomography studies. Psychiatry Res Neuroimaging 2021; 316:111357. [PMID: 34488007 DOI: 10.1016/j.pscychresns.2021.111357] [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: 04/22/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 01/18/2023]
Abstract
Positron emission tomography (PET) and single photon emission computed tomography (SPECT) are two neuroimaging techniques that have led to important insights into the pathophysiology of borderline personality disorder (BPD) and its symptom clusters. This paper provides the most up-to-date review of PET and SPECT studies targeting BPD. A systematic search of PET and SPECT studies using the databases PsycINFO, PubMed, and Embase was implemented, which yielded 30 articles in the end. Earlier PET studies largely reported decreased glucose metabolism in prefrontal brain regions. More recent PET research has pointed to alterations in monoaminergic systems, greater activation of the opioid system during sadness induction, as well as abnormalities of the brain endocannabinoid system in BPD. SPECT studies of BPD mainly identified changes in regional cerebral blood flow and alterations of the serotonergic system. Such PET and SPECT study abnormalities have been suggested to relate to the symptomatology of BPD, including impulsivity, aggression, and mood changes. The implications of these neuroimaging studies in terms of shedding new light on the pathophysiology of BPD and providing new avenues for drug development are discussed.
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Affiliation(s)
- Karolina H Karas
- Brain Health Imaging Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Violence Prevention Neurobiological Research Unit, CAMH, Toronto, ON, Canada
| | - Paria Baharikhoob
- Brain Health Imaging Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Violence Prevention Neurobiological Research Unit, CAMH, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Nathan J Kolla
- Brain Health Imaging Centre for Addiction and Mental Health (CAMH), Toronto, ON, Canada; Violence Prevention Neurobiological Research Unit, CAMH, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Pharmacology and Toxicology, University of Toronto, Toronto, ON, Canada; Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.
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15
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Sampedro F, Farrés CCI, Soler J, Elices M, Schmidt C, Corripio I, Domínguez-Clavé E, Pomarol-Clotet E, Salvador R, Pascual JC. Structural brain abnormalities in borderline personality disorder correlate with clinical severity and predict psychotherapy response. Brain Imaging Behav 2021; 15:2502-2512. [PMID: 33634348 DOI: 10.1007/s11682-021-00451-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2021] [Indexed: 11/24/2022]
Abstract
Although previous imaging studies in borderline personality disorder (BPD) have found brain abnormalities, the results have been inconsistent. This study aimed to investigate structural brain abnormalities using voxel-based morphometry (VBM) and cortical thickness (Cth) analyses in a large sample of patients with BPD. Additionally, we aimed to determine the correlation between structural abnormalities and clinical severity and to assess its potential value at predicting psychotherapeutic response. Sixty-one individuals with BPD and 19 healthy controls underwent magnetic resonance imaging. Participants with BPD completed several self-report clinical scales, received dialectical-behavioral therapy skills training and post-therapy changes in clinical scores were also recorded. Gray matter volume (GMV) and Cth differences between groups were compared. Within the BPD group, we further characterized the structural brain correlates of clinical severity and investigated the relationship between pre-therapy structural abnormalities and therapeutic response. As potential confounders we included age, sex, educational level, and total intracranial volume (the latter only in VBM analyses). Compared to controls, the BPD group showed a reduced GMV/Cth in prefrontal areas but increased GMV in the limbic structures (amygdala and parahippocampal regions). Prefrontal abnormalities correlated with higher baseline scores on impulsivity and general BPD severity. Increased GMV in the parahippocampal area correlated with a greater emotion dysregulation. Importantly, several baseline structural abnormalities correlated with worse response to psychotherapy. Patients with BPD showed a reduced GMV in the prefrontal areas but a greater GMV in the limbic structures. Several structural abnormalities (i.e. middle and inferior prefrontal areas, anterior insula, or parahippocampal area) correlated with clinical severity and could potentially be used as imaging biological correlates biomarkers to predict psychotherapy response.
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Affiliation(s)
- Frederic Sampedro
- Movement Disorders Unit Neurology Department Hospital de la Santa Creu i Sant Pau, IIB-Sant Pau, Barcelona, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, CIBERNED, Madrid, Spain
| | - Cristina Carmona I Farrés
- Department of Psychiatry Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Mª Claret, 167.08025, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain
| | - Joaquim Soler
- Department of Psychiatry Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Mª Claret, 167.08025, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain. .,Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, UAB, Barcelona, Spain.
| | - Matilde Elices
- Department of Psychiatry Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Mª Claret, 167.08025, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain
| | - Carlos Schmidt
- Department of Psychiatry Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Mª Claret, 167.08025, Barcelona, Spain
| | - Iluminada Corripio
- Department of Psychiatry Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Mª Claret, 167.08025, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain.,Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, UAB, Barcelona, Spain
| | - Elisabet Domínguez-Clavé
- Department of Psychiatry Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Mª Claret, 167.08025, Barcelona, Spain
| | - Edith Pomarol-Clotet
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain.,FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Raymond Salvador
- Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain.,FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
| | - Juan C Pascual
- Department of Psychiatry Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Mª Claret, 167.08025, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental. CIBERSAM, Madrid, Spain.,Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, UAB, Barcelona, Spain
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16
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Calderón-Moctezuma AR, Reyes-López JV, Rodríguez-Valdés R, Barbosa-Luna M, Ricardo-Garcell J, Espino-Cortés M, Hernández-Chan N, García-Noguez L, Roque-Roque G, Trejo-Cruz G, Cañizares-Gómez S, Hernández-Montiel H. Improvement in borderline personality disorder symptomatology after repetitive transcranial magnetic stimulation of the dorsomedial prefrontal cortex: preliminary results. ACTA ACUST UNITED AC 2021; 43:65-69. [PMID: 32876128 PMCID: PMC7861182 DOI: 10.1590/1516-4446-2019-0591] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 05/04/2020] [Indexed: 11/26/2022]
Abstract
Objective: Current treatment for borderline personality disorder (BPD) involves psychological and pharmacological interventions. However, neuromodulation techniques such as repetitive transcranial magnetic stimulation (rTMS) may positively affect BPD symptomatology. The objective of this study was to evaluate the clinical and neuropsychological effects of rTMS on the dorsomedial prefrontal cortex (DMPFC) in BPD patients. Methods: Fourteen patients with BPD were randomized into two groups (active vs. sham) for 15 sessions of rTMS on the DMPFC. Clinical effects were measured using the Borderline Symptoms List (BSL), Clinical Global Impression Scale for BPD (CGI-BPD), Borderline Evaluation of Severity over Time (BEST), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and Barratt’s Impulsiveness Scale (BIS). Neuropsychological effects were determined by a Stop-Signal Task (SST), the Wisconsin Card-Sorting Test (WCST), and the Iowa Gambling Test (IGT). Results: Within-group comparison showed significant differences (p < 0.05) in CGI-BPD (total score and six of nine psychopathologic domains), BEST, HDRS, HARS, and IGT scores for active modality. Conclusion: The 5 Hz-DMPFC rTMS technique was well tolerated and lessened the severity of BPD symptomatology, especially abandonment, affective issues, interpersonal relationships, suicidal behavior, anger, and paranoid ideation. Cognitive improvement was seen in decision-making. Additional studies are needed to fully evaluate the effects of rTMS on BPD symptomatology. Clinical Trial Registration: NCT03832777.
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Affiliation(s)
| | - Julian V Reyes-López
- Clínica del Sistema Nervioso, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | - René Rodríguez-Valdés
- Clínica del Sistema Nervioso, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | - Mario Barbosa-Luna
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, Mexico
| | - Josefina Ricardo-Garcell
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Juriquilla, Querétaro, Mexico
| | - Marbella Espino-Cortés
- Centro Estatal de Salud Mental del Estado de Querétaro, Santiago de Querétaro, Querétaro, Mexico
| | | | - Lorena García-Noguez
- Clínica del Sistema Nervioso, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Gerardo Trejo-Cruz
- Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
| | | | - Hebert Hernández-Montiel
- Clínica del Sistema Nervioso, Departamento de Investigación Biomédica, Facultad de Medicina, Universidad Autónoma de Querétaro, Querétaro, Mexico
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17
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Efficacy of Polyunsaturated Fatty Acids (PUFAs) on Impulsive Behaviours and Aggressiveness in Psychiatric Disorders. Int J Mol Sci 2021; 22:ijms22020620. [PMID: 33435512 PMCID: PMC7826871 DOI: 10.3390/ijms22020620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 02/08/2023] Open
Abstract
It is the focus of increasing interest to investigate the effects of long-chain n-3 and long-chain n-6 polyunsaturated fatty acids (LC n-3 PUFAs; LC n-6 PUFAs) on psychiatric symptoms in a transdiagnostic perspective. There is some evidence that low levels of LC n-3 PUFAs and a higher ratio of LC n-6 to LC n-3 PUFAs in plasma and blood cells are associated with aggressive and impulsive behaviours. Therefore, implementation of LC n-3 PUFAs may produce positive effects on hostility, aggression, and impulsivity in both psychiatric and non-psychiatric samples across different stages of life. A possible mechanism of action of LC n-3 PUFAs in conditions characterized by a high level of impulsivity and aggression is due to the effect of these compounds on the serotonin system and membrane stability. Studies that evaluated the effects of LC n-3 PUFAs on impulsivity and aggressiveness indicated that addition of rather low doses of these agents to antipsychotic treatment might reduce agitation and violent behaviours in psychosis, attention deficit hyperactivity disorder, personality disorders, and impulsive control and conduct disorders. The present review is aimed at examining and discussing available data from recent trials on this topic.
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18
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Kaplan B, Yazici Gulec M, Gica S, Gulec H. The association between neurocognitive functioning and clinical features of borderline personality disorder. ACTA ACUST UNITED AC 2020; 42:503-509. [PMID: 32321061 PMCID: PMC7524408 DOI: 10.1590/1516-4446-2019-0752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/14/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To investigate the relationship between neurocognitive profiles and clinical manifestations of borderline personality disorder (BPD). METHODS Forty-five patients diagnosed with BPD and 35 healthy volunteers were included in the study. The BPD group was evaluated with the Borderline Personality Inventory for dissociative, impulsivity and suicidal dimensions. The Verbal Memory Processes Test and the Cambridge Neurophysiological Assessment Battery were administered to both the BPD and healthy control groups. RESULTS BPD patients differed from controls in sustained attention, facial emotion recognition, and deteriorated verbal memory function. A model consisting of the Dissociative Experiences Scale - Taxon (DES-T), motor impulsivity and Scale for Suicidal Behavior scores explained 52% of the variance in Borderline Personality Inventory scores. It was detected that motor impulsivity, decision-making and recognizing sadness may significantly predict DES-T scores, and response inhibition and facial emotion recognition scores may significantly predict impulsivity. CONCLUSION Our findings demonstrate that the disassociation, impulsivity, and suicidality dimensions are sufficient to represent the clinical manifestations of BPD, that they are related to neurocognitive differences, and that they interact with clinical features.
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Affiliation(s)
- Bahar Kaplan
- Department of Psychiatry, Sivas Numune Hospital, Sivas Provincial Health Directorate, Sivas, Turkey
| | - Medine Yazici Gulec
- Department of Psychiatry, University of Health Sciences Turkey, Erenkoy Mental Health and Neurological Disease Education and Research Hospital, Istanbul, Turkey
| | - Sakir Gica
- Department of Psychiatry, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Huseyin Gulec
- Department of Psychiatry, University of Health Sciences Turkey, Erenkoy Mental Health and Neurological Disease Education and Research Hospital, Istanbul, Turkey
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19
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Neural mechanisms of aggression across species. Nat Neurosci 2020; 23:1317-1328. [PMID: 33046890 DOI: 10.1038/s41593-020-00715-2] [Citation(s) in RCA: 115] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 08/31/2020] [Indexed: 12/21/2022]
Abstract
Aggression is a social behavior essential for securing resources and defending oneself and family. Thanks to its indispensable function in competition and thus survival, aggression exists widely across animal species, including humans. Classical works from Tinbergen and Lorenz concluded that instinctive behaviors including aggression are mediated by hardwired brain circuitries that specialize in processing certain sensory inputs to trigger stereotyped motor outputs. They further suggest that instinctive behaviors are influenced by an animal's internal state and past experiences. Following this conceptual framework, here we review our current understanding regarding the neural substrates underlying aggression generation, highlighting an evolutionarily conserved 'core aggression circuit' composed of four subcortical regions. We further discuss the neural mechanisms that support changes in aggression based on the animal's internal state. We aim to provide an overview of features of aggression and the relevant neural substrates across species, highlighting findings in rodents, primates and songbirds.
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20
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Lee JS. Borderline Personality Disorder in the Courtroom. PSYCHIATRY, PSYCHOLOGY, AND LAW : AN INTERDISCIPLINARY JOURNAL OF THE AUSTRALIAN AND NEW ZEALAND ASSOCIATION OF PSYCHIATRY, PSYCHOLOGY AND LAW 2020; 28:206-217. [PMID: 34712092 PMCID: PMC8547869 DOI: 10.1080/13218719.2020.1767718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The insanity defense has been criticized with consequences for individuals with real mental illness. In the United States, several states have redefined the insanity defense by excluding antisocial personality disorder from consideration for the not guilty by reason of insanity plea. Four states have eliminated the insanity defense completely. The purpose of this article is to analyze the diagnosis of borderline personality disorder, its relevance in the courtroom setting, and how this speaks to the approach of the insanity defense in general. The history of the insanity defense, impulsive nature of borderline personality disorder, and the reasons that make personality disorders controversial are reviewed. The impulsive nature, and the association to childhood trauma, dissociation, and frontolimbic abnormalities support the continued protection of borderline personality disorder under the insanity defense. Knowledge of these facts will assist the forensic psychiatrist in effectively educating the courtroom about borderline personality disorder.
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Affiliation(s)
- Jin S. Lee
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA, USA
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21
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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: 1.5] [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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22
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Schmaal L, van Harmelen AL, Chatzi V, Lippard ETC, Toenders YJ, Averill LA, Mazure CM, Blumberg HP. Imaging suicidal thoughts and behaviors: a comprehensive review of 2 decades of neuroimaging studies. Mol Psychiatry 2020; 25:408-427. [PMID: 31787757 PMCID: PMC6974434 DOI: 10.1038/s41380-019-0587-x] [Citation(s) in RCA: 183] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 10/21/2019] [Accepted: 10/29/2019] [Indexed: 01/06/2023]
Abstract
Identifying brain alterations that contribute to suicidal thoughts and behaviors (STBs) are important to develop more targeted and effective strategies to prevent suicide. In the last decade, and especially in the last 5 years, there has been exponential growth in the number of neuroimaging studies reporting structural and functional brain circuitry correlates of STBs. Within this narrative review, we conducted a comprehensive review of neuroimaging studies of STBs published to date and summarize the progress achieved on elucidating neurobiological substrates of STBs, with a focus on converging findings across studies. We review neuroimaging evidence across differing mental disorders for structural, functional, and molecular alterations in association with STBs, which converges particularly in regions of brain systems that subserve emotion and impulse regulation including the ventral prefrontal cortex (VPFC) and dorsal PFC (DPFC), insula and their mesial temporal, striatal and posterior connection sites, as well as in the connections between these brain areas. The reviewed literature suggests that impairments in medial and lateral VPFC regions and their connections may be important in the excessive negative and blunted positive internal states that can stimulate suicidal ideation, and that impairments in a DPFC and inferior frontal gyrus (IFG) system may be important in suicide attempt behaviors. A combination of VPFC and DPFC system disturbances may lead to very high risk circumstances in which suicidal ideation is converted to lethal actions via decreased top-down inhibition of behavior and/or maladaptive, inflexible decision-making and planning. The dorsal anterior cingulate cortex and insula may play important roles in switching between these VPFC and DPFC systems, which may contribute to the transition from suicide thoughts to behaviors. Future neuroimaging research of larger sample sizes, including global efforts, longitudinal designs, and careful consideration of developmental stages, and sex and gender, will facilitate more effectively targeted preventions and interventions to reduce loss of life to suicide.
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Affiliation(s)
- Lianne Schmaal
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | | | - Vasiliki Chatzi
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | | | - Yara J Toenders
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Lynnette A Averill
- Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Department of Veterans Affairs National Center for PTSD, Clinical Neurosciences Division, West Haven, CT, USA
| | - Carolyn M Mazure
- Psychiatry and Women's Health Research at Yale, Yale School of Medicine, New Haven, CT, USA
| | - Hilary P Blumberg
- Psychiatry, Radiology and Biomedical Imaging, Child Study Center, Yale School of Medicine, New Haven, CT, USA.
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23
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Kim H, Kim YK, Lee JY, Choi AR, Kim DJ, Choi JS. Hypometabolism and altered metabolic connectivity in patients with internet gaming disorder and alcohol use disorder. Prog Neuropsychopharmacol Biol Psychiatry 2019; 95:109680. [PMID: 31255649 DOI: 10.1016/j.pnpbp.2019.109680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 12/24/2022]
Abstract
Internet gaming disorder (IGD) has become the subject of growing concern as an addictive behavior and has been compared with substance/non-substance-related addiction. Although IGD show clinical impairments and social dysfunction, neurobiological alterations in IGD have not been clearly elucidated. We used 18F-fluorodeoxyglucose PET to investigate differences in glucose metabolism and metabolic connectivity in young men [thirty-six patients with IGD, twenty-six patients with alcohol use disorder (AUD) and thirty-nine healthy controls (HC)]. Compared with the HC, IGD showed hypometabolism in the anterior cingulate cortex (ACC), temporal, frontal, parietal and striatum and AUD exhibited hypometabolism in the occipital, temporal and parietal lobule. Furthermore, IGD showed negative correlations between the ACC and game duration and between the orbitofrontal cortex and impulsivity. Also, IGD had lower metabolic connectivity between temporal and limbic regions and between the motor area and occipital region. And AUD showed greater metabolic connectivity between the orbitofrontal and parietal regions, and between the somatosensory or parietal and temporal regions, but lower metabolic connectivity in the fronto-striatal or fronto-limbic regions. Our results provide evidences that hypometabolism and altered metabolic connectivity in IGD might be related to the abnormal sensory function by longtime gaming and dysfunction of impulsive/motivational states.
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Affiliation(s)
- Heejung Kim
- Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Republic of Korea; Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Yu Kyeong Kim
- Department of Nuclear Medicine, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Ji Yoon Lee
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - A Ruem Choi
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea
| | - Dai Jin Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Jung-Seok Choi
- Department of Psychiatry, SMG-SNU Boramae Medical Center, Seoul, Republic of Korea; Department of Psychiatry and Behavioral Science, Seoul National University College of Medicine, Seoul, Republic of Korea.
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24
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Arikan MK, Metin B, Günver MG, Tarhan N. Borderline Personality and Bipolar Disorders Cannot Be Differentiated Electrophysiologically. Clin EEG Neurosci 2019; 50:383-388. [PMID: 31282204 DOI: 10.1177/1550059419860028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives. Certain studies have claimed that borderline personality disorder (BPD) could be evaluated as a subtype of bipolar disorder (BD), whereas others have argued that BPD should be regarded as an independent disorder because of its distinct clinical features. The aim of this study was to investigate if there was a difference between these 2 disorders biologically based on EEG recordings. Methods. A total of 111 subjects (11 healthy, 25 BPD, 75 BD) who had resting EEG recordings were included. The EEGs were analyzed to compute absolute power values. Results. One-way analysis of variance results revealed statistically significant differences among the 3 groups on 55 out of 229 EEG variables. However, post hoc analysis indicated that all of the significant changes were between healthy and patient groups and no significant differences were found between 2 clinical groups. Conclusion. The findings suggested that these 2 clinical entities are biologically similar; however, further research should be performed to explain the basis clinical differences between the 2 disorders.
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Affiliation(s)
- Mehmet Kemal Arikan
- 1 Department of Psychology, Uskudar University, Istanbul, Turkey.,2 Kemal Arikan Clinic of Psychiatry, Istanbul, Turkey
| | - Barış Metin
- 1 Department of Psychology, Uskudar University, Istanbul, Turkey
| | - Mehmet Güven Günver
- 3 Channel Management Department Halk Hayat ve Emeklilik A. Ş., Istanbul, Turkey
| | - Nevzat Tarhan
- 1 Department of Psychology, Uskudar University, Istanbul, Turkey
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25
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Thomson ND, Beauchaine TP. Respiratory Sinus Arrhythmia Mediates Links Between Borderline Personality Disorder Symptoms and Both Aggressive and Violent Behavior. J Pers Disord 2019; 33:544-559. [PMID: 30307825 DOI: 10.1521/pedi_2018_32_358] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Although emotion dysregulation (ED) is a core symptom of borderline personality disorder (BPD), tests of associations between ED and aggression and violence-which are common to BPD-are sparse. The authors evaluated mediating effects of an autonomic vulnerability to ED on links between BPD symptoms and (a) reactive aggression, (b) proactive aggression, and (c) histories of interpersonal violence in a sample of young adults (N = 104), ages 18-22 years. Low baseline respiratory sinus arrhythmia (RSA) mediated the association between BPD symptoms and reactive aggression. In contrast, although BPD symptoms were correlated with proactive aggression, no mediational effect was found. In addition, low RSA mediated the association between BPD symptoms and histories of interpersonal violence. Collectively, these findings add evidence that neurobiological vulnerability to ED contributes to aggressive and violent behavior among those with BPD.
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Affiliation(s)
- Nicholas D Thomson
- Division of Acute Care Surgical Services, Department of Surgery, Virginia Commonwealth University Health, Richmond, Virginia, and University of Durham, Durham, UK
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26
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Soloff PH, Chowdury A, Diwadkar VA. Affective interference in borderline personality disorder: The lethality of suicidal behavior predicts functional brain profiles. J Affect Disord 2019; 252:253-262. [PMID: 30991253 PMCID: PMC6563825 DOI: 10.1016/j.jad.2019.04.050] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 01/11/2019] [Accepted: 04/08/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Negative affective interference with executive cognition is associated with emotion dysregulation and behavioral dyscontrol in BPD, including a diathesis to suicidal and self-injurious behavior. While clinically well described, the neural basis of affective interference with central executive network function, and resulting suicidal behavior is poorly understood. METHOD In an fMRI study, 23 BPD suicide attempters completed an affectively modified Continuous Performance Task(X-CPT), in which targets and distractors were rendered on Negative, Positive and Neutral Ekman faces, with a Distorted image as a behavioral baseline. Responses to targets were contextualized by the affective context of the face. Lethality Rating Scale scores (LRS) were modeled as the primary regressor of interest on activation peaks, with HamD scores covaried. RESULTS In the Negative vs. Neutral contrast, LRS scores were inversely related to activation in the ACC, parietal precuneus, BG and OFC, with no positive relationships. Results were similar in the Negative vs Positive contrast. In the Neutral vs. Positive contrast, activations were much less extensive, with mixed positive and negative relationships. Contextualizing responses based on the effects of valence decreased participant's ability to distinguish between targets and distracters; however, no differences were observed between valence contexts. fMRI-estimated effects were not confounded by differences in behavioral sensitivity across contexts. LIMITATIONS In this female-only sample, possible gender differences were not addressed. CONCLUSIONS With negative affective interference, increased lethality of suicidal behavior in BPD predicted diminished neural activation in areas critical to executive cognitive function. Therapies diminishing affective interference may reduce risk of suicidal behavior.
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Affiliation(s)
- Paul H. Soloff
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, Pa
| | - Asadur Chowdury
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
| | - Vaibhav A. Diwadkar
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, MI
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27
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Albert J, López-Martín S, Arza R, Palomares N, Hoyos S, Carretié L, Díaz-Marsá M, Carrasco JL. Response inhibition in borderline personality disorder: Neural and behavioral correlates. Biol Psychol 2019; 143:32-40. [PMID: 30772405 DOI: 10.1016/j.biopsycho.2019.02.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 11/18/2018] [Accepted: 02/09/2019] [Indexed: 11/16/2022]
Abstract
Although response inhibition is thought to be important in borderline personality disorder (BPD), little is known about its neurophysiological basis. This study aimed to provide insight into this issue by capitalizaing on the high temporal resolution of electroencephalography and information provided by source localization methods. To this end, twenty unmedicated patients with BPD and 20 healthy control subjects performed a modified go/no-go task designed to better isolate the brain activity specifically associated with response inhibition. Event-related potentials (ERP) were measured and further analyzed at the scalp and source levels. Patients with BPD made more commission errors (failed inhibitions) than control subjects. Scalp ERP data showed that both groups displayed greater frontocentral P3 amplitude for no-go (response inhbition) than for go trials (response execution). However, source reconstruction data revealed that patients with BPD activated posterior parietal regions (precuneus) to inhibit their responses, whereas controls activated prefrontal regions (presupplementary motor area, preSMA). This dissociation was supported by a significant Region (precuneus, preSMA) x Trial Type (no-go, go) x Group (BPD, control) interaction. These findings extend our understanding of the neurophysiological basis of abnormal response inhibition in BPD, suggesting that patients with BPD recruit different brain regions for inhibiting prepotent responses compared to controls. Future research in larger, medication-naïve samples of patients with BPD is required to confirm and extend these findings.
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Affiliation(s)
- Jacobo Albert
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain; Instituto Pluridisciplinar, Universidad Complutense de Madrid, Madrid, Spain.
| | - Sara López-Martín
- Centro Neuromottiva, Madrid, Spain; Universidad Rey Juan Carlos, Madrid, Spain
| | - Rocío Arza
- Hospital Clínico San Carlos, Cibersam, Madrid, Spain
| | | | - Sandra Hoyos
- Universidad Católica del Uruguay, Montevideo, Uruguay
| | - Luis Carretié
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
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28
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Stanley B, Perez-Rodriguez MM, Labouliere C, Roose S. A Neuroscience-Oriented Research Approach to Borderline Personality Disorder. J Pers Disord 2018; 32:784-822. [PMID: 29469663 DOI: 10.1521/pedi_2017_31_326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Traditionally, the study of personality disorders had been based on psychoanalytic or behavioral models. Over the past two decades, there has been an emerging neuroscience model of borderline personality disorder (BPD) grounded in the concept of BPD as a condition in which dysfunctional neural circuits underlie its pathological dimensions, some of which include emotion dysregulation (broadly encompassing affective instability, negative affectivity, and hyperarousal), abnormal interpersonal functioning, and impulsive aggression. This article, initiated at a joint Columbia University- Cornell University Think Tank on BPD with representation from the Icahn School of Medicine at Mount Sinai, suggests how to advance research in BPD by studying the dimensions that underlie BPD in addition to studying the disorder as a unitary diagnostic entity. We suggest that linking the underlying neurobiological abnormalities to behavioral symptoms of the disorder can inform a research agenda to better understand BPD with its multiple presentations.
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Affiliation(s)
- Barbara Stanley
- Department of Psychiatry, Columbia University, New York City
| | | | | | - Steven Roose
- Department of Psychiatry, Columbia University, New York City.,New York State Psychiatric Institute, New York City
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29
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Porta M, Servello D, Dell'Osso B, Dina CZ, Bona A, Alleva GC. Critical aspects in the legal defence of patients with Tourette's Syndrome: An Italian case series. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 61:1-5. [PMID: 30454556 DOI: 10.1016/j.ijlp.2018.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 07/16/2018] [Accepted: 08/14/2018] [Indexed: 06/09/2023]
Abstract
Tourette's syndrome (TS) is a developmental neurobehavioral disorder with childhood onset and relevant burden in terms of disability and reduced quality of life. In Italy the biological basis of this syndrome is still frequently ignored and TS is often recognised as a psychiatric manifestation, or even it is not recognised as pathology, which may result in inadequate treatment, social isolation and improper hospitalization. Indeed, the organic medical nature of TS needs to be taken into great consideration in evaluating causality of committing crimes in affected patients. In addition, delaying the diagnosis and consequently proper treatment has a devastating impact on social as well as legal aspects in patients with TS. The present report is aimed to present an Italian case series of 4 TS patients who faced legal problems related to their mental condition, in the intent to add further evidence, raise the level of awareness and encourage further investigation in the field, as in most of the cases, patients' illness was not taken into adequate account by the Justice. The relevant law is discussed in detail.
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Affiliation(s)
- Mauro Porta
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy
| | - Domenico Servello
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy
| | - Bernardo Dell'Osso
- Department of Psychiatry, Ca Granda Clinical and Research Foundation, Maggiore Policlinico Hospital, University of Milan, 8 S. Barnaba Street, 20100 Milan, Italy; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA.
| | - Carlotta Zanaboni Dina
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy.
| | - Alberto Bona
- Department of Functional Neurosurgery and Tourette Syndrome Center, Galeazzi Clinical and Research Hospital, 4 R. Galeazzi Street, 20100 Milan, Italy
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30
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Orbitofrontal overactivation in reward processing in borderline personality disorder: the role of non-suicidal self-injury. Brain Imaging Behav 2018; 12:217-228. [PMID: 28247156 DOI: 10.1007/s11682-017-9687-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Borderline Personality Disorder (BPD) is a disabling and difficult-to-treat mental disease. One of its core features is a significant difficulty in affect regulation, which is often accompanied by Non-Suicidal Self-Injury (NSSI). It is suggested that this type of behavior elicits positive emotions and mitigates emotional distress, and therefore can ultimately be reinforced and promoted. In spite of the high prevalence of NSSI behaviors (also in non-BPD samples), their role in modulating reward-related processes has not yet been investigated in BPD patients. In the present study, this lack of research was addressed. A large sample of BPD patients (N = 40), divided into two groups depending on the presence of NSSI, and a group of matched healthy controls underwent functional Magnetic Resonance Imaging (fMRI) while performing a gambling task. Patients who committed NSSI acts exhibited enhanced activation of the orbitofrontal cortex following an unexpected reward, when compared with controls and BPD patients with no NSSI behavior. In addition, the NSSI group showed diminished functional connectivity between the left orbitofrontal cortex and the right parahippocampal gyrus. These findings might suggest impaired ability to update reward associations of potential choices when both BPD and NSSI are present. We propose that the presence of NSSI involves alterations in the reward system independently of BPD, and thus can be considered as a possible phenotype for reward-related alterations.
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31
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Mancke F, Herpertz SC, Hirjak D, Knies R, Bertsch K. Amygdala structure and aggressiveness in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2018; 268:417-427. [PMID: 27878376 DOI: 10.1007/s00406-016-0747-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 11/06/2016] [Indexed: 12/29/2022]
Abstract
Aggressiveness is considered an important clinical feature of borderline personality disorder (BPD) and has been associated with alterations of the amygdala. However, studies that analyzed the exact location of amygdala alterations associated with aggressiveness in BPD or that systematically compared female and male BPD patients are missing. In the current study, we therefore investigated a sex-mixed sample of BPD patients and healthy volunteers and applied an automated segmentation method that allows the study of both, alterations of amygdala volume and localized amygdala shape. Volumetric results revealed no difference in amygdala volume between BPD patients and healthy volunteers, but a trend for a positive association between volume of the right amygdala and aggressiveness in male BPD patients. Analyses of amygdala shape showed a trend for a group by sex interaction effect in the left laterobasal amygdala, without a difference in subgroup analyses. Finally, regions of the left superficial and laterobasal amygdala of male BPD patients were positively associated with aggressiveness. In sum, our results emphasize the need to consider sex-specific effects and demonstrate a link between male BPD patients' aggressiveness and amygdala regions that are particularly related to social information processing and associative emotional learning.
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Affiliation(s)
- Falk Mancke
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany.
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany
| | - Dusan Hirjak
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Rebekka Knies
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Voßstraße 2, 69115, Heidelberg, Germany
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32
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Yang P, Tao R, He C, Liu S, Wang Y, Zhang X. The Risk Factors of the Alcohol Use Disorders-Through Review of Its Comorbidities. Front Neurosci 2018; 12:303. [PMID: 29867316 PMCID: PMC5958183 DOI: 10.3389/fnins.2018.00303] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Accepted: 04/18/2018] [Indexed: 01/01/2023] Open
Abstract
Alcohol use disorders (AUDs) represent a severe, world-wide problem, and are usually comorbid with psychiatric disorders, comorbidity increases the risks associated with AUDs, and results in more serious consequences for patients. However, currently the underlying mechanisms of comorbid psychiatric disorders in AUDs are not clear. Studies investigating comorbidity could help us understand the neural mechanisms of AUDs. In this review, we explore three comorbidities in AUDs, including schizophrenia, major depressive disorder (MDD), and personality disorders (PDs). They are all co-morbidities of AUDs with rate of 33.7, 28, and 50–70%, respectively. The rate is significantly higher than other diseases. Therefore we review and analyze relevant literature to explore whether these three diseases are the risk factors of AUDs, focusing on studies assessing cognitive function and those using neural imaging. We found that memory deficits, impairment of cognitive control, negative emotion, and impulsivity may increase an individual's vulnerability to AUDs. This comorbidity may indicate the neural basis of AUDs and reveal characteristics associated with different types of comorbidity, leading to further development of new treatment approaches for AUDs.
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Affiliation(s)
- Ping Yang
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China
| | - Rui Tao
- Department of Substance-Related Disorders, Anhui Mental Health Center, Hefei, China
| | - Chengsen He
- Department of Medical Psychology, Chaohu Clinical Medical College, Anhui Medical University, Hefei, China
| | - Shen Liu
- Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Chinese Academy of Sciences, Hefei, China
| | - Ying Wang
- Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Chinese Academy of Sciences, Hefei, China
| | - Xiaochu Zhang
- Key Laboratory of Brain Function and Disease, School of Life Sciences, University of Science and Technology of China, Chinese Academy of Sciences, Hefei, China
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33
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Kim S, Kim JS, Jin MJ, Im CH, Lee SH. Dysfunctional frontal lobe activity during inhibitory tasks in individuals with childhood trauma: An event-related potential study. Neuroimage Clin 2017; 17:935-942. [PMID: 29527497 PMCID: PMC5842757 DOI: 10.1016/j.nicl.2017.12.034] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 11/17/2022]
Abstract
Background Individuals who experience childhood trauma are vulnerable to various psychological and behavioral problems throughout their lifetime. This study aimed to investigate whether individuals with childhood trauma show altered frontal lobe activity during response inhibition tasks. Methods In total, 157 healthy individuals were recruited and instructed to perform a Go/Nogo task during electroencephalography recording. Source activities of N2 and P3 of Nogo event-related potentials (ERP) were analyzed. The Childhood Trauma Questionnaire (CTQ) and Barratt Impulsivity Scale (BIS) were applied. Individuals were divided into three groups based on their total CTQ score: low CTQ, middle CTQ, and high CTQ groups. Results The high CTQ group exhibited significantly higher BIS scores than the low CTQ group. P3 amplitudes of the differences between Nogo and Go ERP waves exhibited higher mean values in the low CTQ than the high CTQ group, with trending effects. In Nogo-P3, the source activities of the right anterior cingulate cortex, bilateral medial frontal cortex (MFC), bilateral superior frontal gyrus (SFG), and right precentral gyrus were significantly lower in the high CTQ than the low CTQ group. Motor impulsivity showed a significant negative correlation with activities of the bilateral MFC and SFG in Nogo-P3 conditions. Conclusions Our study revealed that individuals with childhood trauma have inhibitory failure and frontal lobe dysfunction in regions related to Nogo-P3.
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Affiliation(s)
- Sungkean Kim
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea
| | - Ji Sun Kim
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Cheonan, 31151, Republic of Korea
| | - Min Jin Jin
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychology, Chung-Ang University, Seoul, Republic of Korea
| | - Chang-Hwan Im
- Department of Biomedical Engineering, Hanyang University, Seoul, Republic of Korea.
| | - Seung-Hwan Lee
- Clinical Emotion and Cognition Research Laboratory, Inje University, Goyang, Republic of Korea; Department of Psychiatry, Inje University, Ilsan-Paik Hospital, Goyang, Republic of Korea.
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34
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Genetic and environmental influences on the codevelopment among borderline personality disorder traits, major depression symptoms, and substance use disorder symptoms from adolescence to young adulthood. Dev Psychopathol 2017; 30:49-65. [PMID: 28420454 DOI: 10.1017/s0954579417000463] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Although borderline personality disorder (BPD) traits decline from adolescence to adulthood, comorbid psychopathology such as symptoms of major depressive disorder (MDD), alcohol use disorder (AUD), and drug use disorders (DUDs) likely disrupt this normative decline. Using a longitudinal sample of female twins (N = 1,763), we examined if levels of BPD traits were correlated with changes in MDD, AUD, and DUD symptoms from ages 14 to 24. A parallel process biometric latent growth model examined the contributions of genetic and environmental factors to the relationships between developmental components of these phenotypes. Higher BPD trait levels predicted a greater rate of increase in AUD and DUD symptoms, and higher AUD and DUD symptoms predicted a slower rate of decline of BPD traits from ages 14 to 24. Common genetic influences accounted for the associations between BPD traits and each disorder, as well as the interrelationships of AUD and DUD symptoms. Both genetic and nonshared environmental influences accounted for the correlated levels between BPD traits and MDD symptoms, but solely environmental influences accounted for the correlated changes between the two over time. Results indicate that higher levels of BPD traits may contribute to an earlier onset and faster escalation of AUD and DUD symptoms, and substance use problems slow the normative decline in BPD traits. Overall, our data suggests that primarily genetic influences contribute to the comorbidity between BPD features and substance use disorder symptoms. We discuss our data in the context of two major theories of developmental psychopathology and comorbidity.
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35
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Mancke F, Herpertz SC, Kleindienst N, Bertsch K. Emotion Dysregulation and Trait Anger Sequentially Mediate the Association Between Borderline Personality Disorder and Aggression. J Pers Disord 2017; 31:256-272. [PMID: 27064852 DOI: 10.1521/pedi_2016_30_247] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Emotion dysregulation and trait anger are seen as central aspects of aggression in borderline personality disorder (BPD); their interplay in aggression of BPD, however, remains unclear. Using a cross-sectional design, we conducted a mediation analysis in a well-characterized sample of female and male BPD patients (n = 95). We found that emotion dysregulation and trait anger sequentially mediate the association between BPD and aggression. In accordance with major theories of BPD, emotion dysregulation may thus constitute an underlying factor that gives rise to anger and in turn to aggression in BPD. These findings may help to develop mechanism-based anti-aggressive interventions for patients with BPD, which should target emotion dysregulation and anger proneness.
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Affiliation(s)
- Falk Mancke
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Sabine C Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Nikolaus Kleindienst
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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36
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Amad A, Radua J. Resting-state meta-analysis in Borderline Personality Disorder: Is the fronto-limbic hypothesis still valid? J Affect Disord 2017; 212:7-9. [PMID: 28131003 DOI: 10.1016/j.jad.2017.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/16/2017] [Accepted: 01/19/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Ali Amad
- King's College London, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Univ. Lille, CNRS, CHU LILLE, UMR9193-PsychiC-SCALab, Pôle de Psychiatrie, F-59000 Lille, France.
| | - Joaquim Radua
- FIDMAG Germanes Hospitalàries, Sant Boi de Llobregat, Barcelona, Spain; Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; Karolinska Institutet, Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Stockholm, Sweden; King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Kuniishi H, Ichisaka S, Matsuda S, Futora E, Harada R, Hata Y. Chronic Inactivation of the Orbitofrontal Cortex Increases Anxiety-Like Behavior and Impulsive Aggression, but Decreases Depression-Like Behavior in Rats. Front Behav Neurosci 2017; 10:250. [PMID: 28167902 PMCID: PMC5253363 DOI: 10.3389/fnbeh.2016.00250] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 12/22/2016] [Indexed: 11/13/2022] Open
Abstract
The orbitofrontal cortex (OFC) is involved in emotional processing, and orbitofrontal abnormalities have often been observed in various affective disorders. Thus, chronic dysfunction of the OFC may cause symptoms of affective disorders, such as anxiety, depression and impulsivity. Previous studies have investigated the effect of orbitofrontal dysfunction on anxiety-like behavior and impulsive aggression in rodents, but the results are inconsistent possibly reflecting different methods of OFC inactivation. These studies used either a lesion of the OFC, which may affect other brain regions, or a transient inactivation of the OFC, whose effect may be restored in time and not reflect effects of chronic OFC dysfunction. In addition, there has been no study on the effect of orbitofrontal inactivation on depression-like behavior in rodents. Therefore, the present study examined whether chronic inactivation of the OFC by continuous infusion of a GABAA receptor agonist, muscimol, causes behavioral abnormalities in rats. Muscimol infusion inactivated the ventral and lateral part of the OFC. Following a week of OFC inactivation, the animals showed an increase in anxiety-like behavior in the open field test and light-dark test. Impulsive aggression was also augmented in the chronically OFC-inactivated animals because they showed increased frequency of fighting behavior induced by electric foot shock. On the other hand, chronic OFC inactivation reduced depression-like behavior as evaluated by the forced swim test. Additionally, it did not cause a significant change in corticosterone secretion in response to restraint stress. These data suggest that orbitofrontal neural activity is involved in the regulation of anxiety- and depression-like behaviors and impulsive aggression in rodents.
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Affiliation(s)
- Hiroshi Kuniishi
- Division of Integrative Bioscience, Institute of Regenerative Medicine and Biofunction, Tottori University Graduate School of Medical Sciences Yonago, Japan
| | - Satoshi Ichisaka
- Division of Neurobiology, School of Life Sciences, Faculty of Medicine, Tottori University Yonago, Japan
| | - Sae Matsuda
- Division of Integrative Bioscience, Institute of Regenerative Medicine and Biofunction, Tottori University Graduate School of Medical Sciences Yonago, Japan
| | - Eri Futora
- Division of Neurobiology, School of Life Sciences, Faculty of Medicine, Tottori University Yonago, Japan
| | - Riho Harada
- Division of Neurobiology, School of Life Sciences, Faculty of Medicine, Tottori University Yonago, Japan
| | - Yoshio Hata
- Division of Integrative Bioscience, Institute of Regenerative Medicine and Biofunction, Tottori University Graduate School of Medical Sciences Yonago, Japan
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De Vidovich GZ, Muffatti R, Monaco J, Caramia N, Broglia D, Caverzasi E, Barale F, D'Angelo E. Repetitive TMS on Left Cerebellum Affects Impulsivity in Borderline Personality Disorder: A Pilot Study. Front Hum Neurosci 2016; 10:582. [PMID: 27994543 PMCID: PMC5136542 DOI: 10.3389/fnhum.2016.00582] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 11/02/2016] [Indexed: 12/13/2022] Open
Abstract
The borderline personality disorder (BPD) is characterized by a severe pattern of instability in emotional regulation, interpersonal relationships, identity and impulse control. These functions are related to the prefrontal cortex (PFC), and since PFC shows a rich anatomical connectivity with the cerebellum, the functionality of the cerebellar-PFC axis may impact on BPD. In this study, we investigated the potential involvement of cerebello-thalamo-cortical connections in impulsive reactions through a pre/post stimulation design. BPD patients (n = 8) and healthy controls (HC; n = 9) performed an Affective Go/No-Go task (AGN) assessing information processing biases for positive and negative stimuli before and after repetitive transcranial magnetic stimulation (rTMS; 1 Hz/10 min, 80% resting motor threshold (RMT) over the left lateral cerebellum. The AGN task consisted of four blocks requiring associative capacities of increasing complexity. BPD patients performed significantly worse than the HC, especially when cognitive demands were high (third and fourth block), but their performance approached that of HC after rTMS (rTMS was almost ineffective in HC). The more evident effect of rTMS in complex associative tasks might have occurred since the cerebellum is deeply involved in integration and coordination of different stimuli. We hypothesize that in BPD patients, cerebello-thalamo-cortical communication is altered, resulting in emotional dysregulation and disturbed impulse control. The rTMS over the left cerebellum might have interfered with existing functional connections exerting a facilitating effect on PFC control.
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Affiliation(s)
- Giulia Zelda De Vidovich
- Department of Brain and Behavioral Sciences, University of PaviaPavia, Italy; Psychiatry Unit, Santi Paolo e Carlo Hospital of MilanMilan, Italy; Interdepartmental Center for Research on Personality Disorders, University of PaviaPavia, Italy
| | | | - Jessica Monaco
- Department of Brain and Behavioral Sciences, University of PaviaPavia, Italy; Brain Connectivity Center, C. Mondino National Neurological InstitutePavia, Italy
| | - Nicoletta Caramia
- Department of Brain and Behavioral Sciences, University of PaviaPavia, Italy; Brain Connectivity Center, C. Mondino National Neurological InstitutePavia, Italy
| | - Davide Broglia
- Interdepartmental Center for Research on Personality Disorders, University of Pavia Pavia, Italy
| | - Edgardo Caverzasi
- Interdepartmental Center for Research on Personality Disorders, University of Pavia Pavia, Italy
| | - Francesco Barale
- Interdepartmental Center for Research on Personality Disorders, University of Pavia Pavia, Italy
| | - Egidio D'Angelo
- Department of Brain and Behavioral Sciences, University of PaviaPavia, Italy; Brain Connectivity Center, C. Mondino National Neurological InstitutePavia, Italy
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Kogan-Goloborodko O, Brügmann E, Repple J, Habel U, Clemens B. Experimentally Assessed Reactive Aggression in Borderline Personality Disorder. PLoS One 2016; 11:e0166737. [PMID: 27851804 PMCID: PMC5112922 DOI: 10.1371/journal.pone.0166737] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/02/2016] [Indexed: 11/24/2022] Open
Abstract
Approximately 73% of patients suffering from Borderline personality disorder (BPD) exhibit aggressive behaviour, which severely hinders therapeutic work and clinical improvement. Because the underlying mechanisms of aggression in BPD are not yet completely understood, additional research in this domain has a high clinical and scientific relevance. We employed a modified version of the Taylor Aggression Paradigm (mTAP), in order to examine for the first time whether this task can be used to differentiate between BPD patients and healthy controls with regard to reactive aggression. In the mTAP, the amount of money subtracted by a virtual opponent was categorized into 'low' (10-20 cents) and 'high' (80-100 cents) provocations, enabling us to compare how much money BPD patients and healthy controls subtracted (i.e., how aggressively participants responded) following high and low provocation trials. Our results showed that, compared to healthy controls, BPD patients showed higher overall aggression, higher aggression after high provocation trials, as well as a larger difference between high and low provocation trials. This finding was corroborated by a neuropsychological assessment, demonstrating higher levels of aggression and impulsivity in BPD patients. Interestingly, reactive aggression in the mTAP was positively correlated with symptom severity and impulsivity in BPD patients. We suggest that the mTAP provides a valuable tool allowing psychiatrists to quantify reactive aggression in BPD. Therefore, clinicians and researchers might consider this task, as a short experimental measure of reactive aggression, either in future studies or to aid diagnostic assessment during clinical practice.
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Affiliation(s)
- Olga Kogan-Goloborodko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Elisabeth Brügmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
| | - Jonathan Repple
- Department of Psychiatry, University of Münster, Münster, Germany
| | - Ute Habel
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
- JARA – BRAIN Institute I, Aachen, Germany
| | - Benjamin Clemens
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical School, RWTH Aachen University, Aachen, Germany
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Fang L, Yao Z, An J, Chen X, Xie Y, Zhao H, Mao J, Liang W, Ma X. Topological Organization of Metabolic Brain Networks in Pre-Chemotherapy Cancer with Depression: A Resting-State PET Study. PLoS One 2016; 11:e0166049. [PMID: 27832148 PMCID: PMC5104370 DOI: 10.1371/journal.pone.0166049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 10/21/2016] [Indexed: 12/14/2022] Open
Abstract
This study aimed to investigate the metabolic brain network and its relationship with depression symptoms using 18F-fluorodeoxyglucose positron emission tomography data in 78 pre-chemotherapy cancer patients with depression and 80 matched healthy subjects. Functional and structural imbalance or disruption of brain networks frequently occur following chemotherapy in cancer patients. However, few studies have focused on the topological organization of the metabolic brain network in cancer with depression, especially those without chemotherapy. The nodal and global parameters of the metabolic brain network were computed for cancer patients and healthy subjects. Significant decreases in metabolism were found in the frontal and temporal gyri in cancer patients compared with healthy subjects. Negative correlations between depression and metabolism were found predominantly in the inferior frontal and cuneus regions, whereas positive correlations were observed in several regions, primarily including the insula, hippocampus, amygdala, and middle temporal gyri. Furthermore, a higher clustering efficiency, longer path length, and fewer hubs were found in cancer patients compared with healthy subjects. The topological organization of the whole-brain metabolic networks may be disrupted in cancer. Finally, the present findings may provide a new avenue for exploring the neurobiological mechanism, which plays a key role in lessening the depression effects in pre-chemotherapy cancer patients.
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Affiliation(s)
- Lei Fang
- Department of radiology, Qilu Hospital, First Affiliated Hospital of Shandong University, 107 Cultural West Road, Jinan, 250012, Shandong Province, P.R.China
- PET/CT Center, Affiliated Lanzhou General Hospital of Lanzhou Military Area Command, 333 South Binhe Road, Lanzhou, 730050, Gansu Province, P.R.China
| | - Zhijun Yao
- School of Information Science and Engineering, Lanzhou University, Lanzhou, Gansu Province, 730000, P.R.China
| | - Jianping An
- Nuclear Medicine Department, Affiliated Lanzhou General Hospital of Lanzhou Military Area Command, 333 South Binhe Road, Lanzhou, 730050, Gansu Province, P.R.China
| | - Xuejiao Chen
- School of Information Science and Engineering, Lanzhou University, Lanzhou, Gansu Province, 730000, P.R.China
| | - Yuanwei Xie
- School of Information Science and Engineering, Lanzhou University, Lanzhou, Gansu Province, 730000, P.R.China
| | - Hui Zhao
- Nuclear Medicine Department, Affiliated Lanzhou General Hospital of Lanzhou Military Area Command, 333 South Binhe Road, Lanzhou, 730050, Gansu Province, P.R.China
| | - Junfeng Mao
- PET/CT Center, Affiliated Lanzhou General Hospital of Lanzhou Military Area Command, 333 South Binhe Road, Lanzhou, 730050, Gansu Province, P.R.China
| | - Wangsheng Liang
- PET/CT Center, Affiliated Lanzhou General Hospital of Lanzhou Military Area Command, 333 South Binhe Road, Lanzhou, 730050, Gansu Province, P.R.China
| | - Xiangxing Ma
- Department of radiology, Qilu Hospital, First Affiliated Hospital of Shandong University, 107 Cultural West Road, Jinan, 250012, Shandong Province, P.R.China
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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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Park SH, Park HS, Kim SE. Regional Cerebral Glucose Metabolism in Novelty Seeking and Antisocial Personality: A Positron Emission Tomography Study. Exp Neurobiol 2016; 25:185-90. [PMID: 27574485 PMCID: PMC4999424 DOI: 10.5607/en.2016.25.4.185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/08/2016] [Accepted: 07/08/2016] [Indexed: 12/31/2022] Open
Abstract
Novelty seeking (NS) and antisocial personality (ASP) are commonly exhibited by those who suffer from addictions, such as substance abuse. NS has been suggested to be a fundamental aspect of ASP. To investigate the neurobiological substrate of NS and ASP, we tested the relationship between regional cerebral glucose metabolism and the level of NS, determining the differences between individuals with and without ASP. Seventy-two healthy adults (43 males, mean age±SD=38.8±16.6 years, range=20~70 years; 29 females, 44.2±20.1 years, range=19~72 years) underwent resting-state brain positron emission tomography (PET) 40 minutes after (18)F-fluorodeoxyglucose (FDG) injection. Within 10 days of the FDG PET study, participants completed Cloninger's 240-item Temperament and Character Inventory (TCI) to determine NS scores. Participants with and without ASP were grouped according to their TCI profiles. Statistical parametric mapping analysis was performed using the FDG PET and TCI profile data. NS scores positively correlated with metabolism in the left anterior cingulate gyrus and the insula on both sides of the brain and negatively correlated with metabolism in the right pallidum and putamen. Participants with ASP showed differences in cerebral glucose metabolism across various cortical and subcortical regions, mainly in the frontal and prefrontal areas. These data demonstrate altered regional cerebral glucose metabolism in individuals with NS and ASP and inform our understanding of the neurobiological substrates of problematic behaviors and personality disorders.
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Affiliation(s)
- So Hyeon Park
- Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 16229, Korea.; Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea
| | - Hyun Soo Park
- Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 16229, Korea.; Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea.; Advanced Institutes of Convergence Technology, Suwon 16229, Korea
| | - Sang Eun Kim
- Department of Transdisciplinary Studies, Graduate School of Convergence Science and Technology, Seoul National University, Seoul 16229, Korea.; Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam 13620, Korea.; Advanced Institutes of Convergence Technology, Suwon 16229, Korea
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Congdon E, Canli T. The Endophenotype of Impulsivity: Reaching Consilience Through Behavioral, Genetic, and Neuroimaging Approaches. ACTA ACUST UNITED AC 2016; 4:262-81. [PMID: 16585800 DOI: 10.1177/1534582305285980] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Impulsivity is a multidimensional construct with implications for understanding the etiology and treatment of multiple forms of psychopathology. As a multidimensional construct, however, the processes underlying impulsivity, particularly behavioral inhibition, must be separated to allow for investigations into its neurogenetic bases. Evidence from both animal and human studies supports the role of dopamine in impulsivity, and neuroimaging research is elucidating brain regions involved in behavioral inhibition. Evidence is now emerging that suggests an interaction between dopamine system genes and frontal brain regions in underlying individual differences in behavioral inhibition. However, to reach a comprehensive understanding of the neurogenetic bases of behavioral inhibition, an appropriate framework is required. Therefore, it is proposed that by identifying intervening variables more sensitive to the effects of genetic variation, known as an endophenotype approach, we will be able to overcome many of the methodological limitations that prevent a better understanding at present.
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Affiliation(s)
- Eliza Congdon
- Department of Psychology, Stony Brook University, NY, USA
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45
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Neuropsychological deficits in BPD patients and the moderator effects of co-occurring mental disorders: A meta-analysis. Clin Psychol Rev 2016; 44:1-12. [DOI: 10.1016/j.cpr.2015.11.009] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/04/2015] [Accepted: 11/19/2015] [Indexed: 01/18/2023]
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46
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The Pathogenesis and Treatment of Emotion Dysregulation in Borderline Personality Disorder. ScientificWorldJournal 2015; 2015:179276. [PMID: 26380355 PMCID: PMC4563094 DOI: 10.1155/2015/179276] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 05/21/2015] [Accepted: 05/24/2015] [Indexed: 11/25/2022] Open
Abstract
Uncontrollable emotional lability and impulsivity are a paramount phenomenon of Borderline Personality Disorder (BPD). This paper aims to review theories that entertain emotion dysregulation as the core deficit of BPD and a key factor in the etiology of BPD, in order, then, to propose the author's own theory, which arguably transcends certain limitations of the earlier ones. The author asserts that his psychodynamic theory explains the symptoms of BPD more thoroughly and it inspires a more parsimonious interpretation of brain imaging findings. In closing, the author draws implications of the proposed theory for clinical practice. He reports an efficacy study for treatment of emotion dysregulation based on that theory.
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47
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Affective context interferes with brain responses during cognitive processing in borderline personality disorder: fMRI evidence. Psychiatry Res 2015; 233:23-35. [PMID: 25982488 PMCID: PMC4465042 DOI: 10.1016/j.pscychresns.2015.04.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 01/21/2015] [Accepted: 04/21/2015] [Indexed: 01/18/2023]
Abstract
Emotion dysregulation in borderline personality disorder (BPD) is associated with loss of cognitive control in the face of intense negative emotion. Negative emotional context may interfere with cognitive processing through the dysmodulation of brain regions involved in regulation of emotion, impulse control, executive function and memory. Structural and metabolic brain abnormalities have been reported in these regions in BPD. Using novel fMRI protocols, we investigated the neural basis of negative affective interference with cognitive processing targeting these regions. Attention-driven Go No-Go and X-CPT (continuous performance test) protocols, using positive, negative and neutral Ekman faces, targeted the orbital frontal cortex (OFC) and the anterior cingulate cortex (ACC), respectively. A stimulus-driven Episodic Memory task, using images from the International Affective Pictures System, targeted the hippocampus (HIP). Participants comprised 23 women with BPD, who were compared with 15 healthy controls. When Negative>Positive faces were compared in the Go No-Go task, BPD subjects had hyper-activation relative to controls in areas reflecting task-relevant processing: the superior parietal/precuneus and the basal ganglia. Decreased activation was also noted in the OFC, and increased activation in the amygdala (AMY). In the X-CPT, BPD subjects again showed hyper-activation in task-relevant areas: the superior parietal/precuneus and the ACC. In the stimulus-driven Episodic Memory task, BPD subjects had decreased activation relative to controls in the HIP, ACC, superior parietal/precuneus, and dorsal prefrontal cortex (dPFC) (for encoding), and the ACC, dPFC, and HIP for retrieval of Negative>Positive pictures, reflecting impairment of task-relevant functions. Negative affective interference with cognitive processing in BPD differs from that in healthy controls and is associated with functional abnormalities in brain networks reported to have structural or metabolic abnormalities. Task demands exert a differential effect on the cognitive response to negative emotion in BPD compared with control subjects.
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48
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Abstract
Rates of self-inflicted injury among adolescents have risen in recent years, yet much remains to be learned about the pathophysiology of such conduct. Self-injuring adolescents report high levels of both impulsivity and depression behaviorally. Aberrant neural responding to incentives, particularly in striatal and prefrontal regions, is observed among both impulsive and depressed adolescents, and may mark common vulnerability to symptoms of anhedonia, irritability, and low positive affectivity. To date, however, no studies have examined associations between central nervous system reward responding and self-injury. In the current study, self-injuring (n = 19) and control (n = 19) adolescent females, ages 13-19 years, participated in a monetary incentive delay task in which rewards were obtained on some trials and losses were incurred on others. Consistent with previous findings from impulsive and depressed samples, self-injuring adolescents exhibited less activation in both striatal and orbitofrontal cortex regions during anticipation of reward than did controls. Self-injuring adolescents also exhibited reduced bilateral amygdala activation during reward anticipation. Although few studies to date have examined amygdala activity during reward tasks, such findings are common among adults with mood disorders and borderline personality disorder. Implications for neural models of impulsivity, depression, heterotypic comorbidity, and development of both self-injury and borderline personality traits are discussed.
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Ochoa JG, Stolyarova A, Kaur A, Hart EE, Bugarin A, Izquierdo A. Post-training depletions of basolateral amygdala serotonin fail to disrupt discrimination, retention, or reversal learning. Front Neurosci 2015; 9:155. [PMID: 26029036 PMCID: PMC4426727 DOI: 10.3389/fnins.2015.00155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 04/15/2015] [Indexed: 02/01/2023] Open
Abstract
In goal-directed pursuits, the basolateral amygdala (BLA) is critical in learning about changes in the value of rewards. BLA-lesioned rats show enhanced reversal learning, a task employed to measure the flexibility of response to changes in reward. Similarly, there is a trend for enhanced discrimination learning, suggesting that BLA may modulate formation of stimulus-reward associations. There is a parallel literature on the importance of serotonin (5HT) in new stimulus-reward and reversal learning. Recent postulations implicate 5HT in learning from punishment. Whereas, dopaminergic involvement is critical in behavioral activation and reinforcement, 5HT may be most critical for aversive processing and behavioral inhibition, complementary cognitive processes. Given these findings, a 5HT-mediated mechanism in BLA may mediate the facilitated learning observed previously. The present study investigated the effects of selective 5HT lesions in BLA using 5,7-dihydroxytryptamine (5,7-DHT) vs. infusions of saline (Sham) on discrimination, retention, and deterministic reversal learning. Rats were required to reach an 85% correct pairwise discrimination and single reversal criterion prior to surgery. Postoperatively, rats were then tested on the (1) retention of the pretreatment discrimination pair, (2) discrimination of a novel pair, and (3) reversal learning performance. We found statistically comparable preoperative learning rates between groups, intact postoperative retention, and unaltered novel discrimination and reversal learning in 5,7-DHT rats. These findings suggest that 5HT in BLA is not required for formation and flexible adjustment of new stimulus-reward associations when the strategy to efficiently solve the task has already been learned. Given the complementary role of orbitofrontal cortex in reward learning and its interconnectivity with BLA, these findings add to the list of dissociable mechanisms for BLA and orbitofrontal cortex in reward learning.
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Affiliation(s)
- Jesus G Ochoa
- Department of Psychology, University of California, Los Angeles Los Angeles, CA, USA ; Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA
| | - Alexandra Stolyarova
- Department of Psychology, University of California, Los Angeles Los Angeles, CA, USA ; Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA
| | - Amandeep Kaur
- Department of Psychology, University of California, Los Angeles Los Angeles, CA, USA ; Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA
| | - Evan E Hart
- Department of Psychology, University of California, Los Angeles Los Angeles, CA, USA ; Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA
| | - Amador Bugarin
- Department of Psychology, University of California, Los Angeles Los Angeles, CA, USA ; Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA
| | - Alicia Izquierdo
- Department of Psychology, University of California, Los Angeles Los Angeles, CA, USA ; Brain Research Institute, University of California, Los Angeles Los Angeles, CA, USA
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de Almeida RMM, Cabral JCC, Narvaes R. Behavioural, hormonal and neurobiological mechanisms of aggressive behaviour in human and nonhuman primates. Physiol Behav 2015; 143:121-35. [DOI: 10.1016/j.physbeh.2015.02.053] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 02/25/2015] [Accepted: 02/28/2015] [Indexed: 12/27/2022]
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