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Humpston CS, Woodward TS. Soundless voices, silenced selves: are auditory verbal hallucinations in schizophrenia truly perceptual? Lancet Psychiatry 2024:S2215-0366(24)00061-0. [PMID: 38631367 DOI: 10.1016/s2215-0366(24)00061-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 04/19/2024]
Abstract
In much contemporary psychiatric training and practice, there is a strong emphasis on the audible or perceptual quality and externality of auditory verbal hallucinations in clinical assessments. A typical question during clinical assessment is asking whether the voices that a person hears sound identical to the way the clinician's voice is heard. In this Personal View, we argue that the most important factor in auditory verbal hallucinations in schizophrenia spectrum psychoses is a loss of first-person authority, and that a perceptual quality is not required for it to be this kind of hallucination. We draw on evidence from cognitive neuroscience showing that the activation of brain networks retrieved during capture of auditory verbal hallucinations that were experienced when a patient was in a functional MRI scanner does not match activation of networks retrieved during auditory perception. We propose that, despite early writings by Esquirol and Schneider that defined auditory verbal hallucinations as beliefs in perception rather than true perception, cognitive neuroscience, psychiatric training and practice, and patients adopting clinical vocabulary have been strongly influenced by the progression of the diagnostic criteria for schizophrenia, which increasingly place emphasis on language, such as the "full force" of a true perception. We hold that this change has resulted in an unhelpful top-down influence on the field, imposing perceptual qualities on auditory verbal hallucinations, and leading to misunderstandings and inaccuracies in clinical practice and patients' self-reports, and misinterpretations in cognitive neuroscience. We encourage a revision of the definition of auditory verbal hallucinations to move away from the necessity for auditory perception, and towards beliefs in perception due to the loss of first-person authority.
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Affiliation(s)
- Clara S Humpston
- Department of Psychology, University of York, York, UK; School of Psychology, University of Birmingham, Birmingham, UK.
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; BC Mental Health and Substance Use Services Research Institute, Vancouver, BC, Canada
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2
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Chanen AM, Kerslake R, Berubé FA, Nicol K, Jovev M, Yuen HP, Betts JK, McDougall E, Nguyen AL, Cavelti M, Kaess M. Psychopathology and psychosocial functioning among young people with first-episode psychosis and/or first-presentation borderline personality disorder. Schizophr Res 2024; 266:12-18. [PMID: 38359514 DOI: 10.1016/j.schres.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/01/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND One in five young people with first-episode psychosis (FEP) also presents with borderline personality disorder (BPD) features. Among people diagnosed with BPD, auditory verbal hallucinations occur in 29-50 % and delusions in 10-100 %. Co-occurrence of psychotic symptoms and BPD is associated with greater clinical severity and greater difficulty accessing evidence based FEP care. This study aimed to investigate psychotic symptoms and psychosocial functioning among young people presenting to an early intervention mental health service. METHOD According to the presence or absence of either FEP or BPD, 141 participants, aged 15-25 years, were assigned to one of four groups: FEP, BPD, combined FEP + BPD, or clinical comparison (CC) participants with neither FEP nor BPD. Participants completed semi-structured diagnostic interviews and interviewer and self-report measures of psychopathology and psychosocial functioning. RESULTS The FEP + BPD group had significantly more severe psychopathology and poorer psychosocial functioning than the FEP group on every measure, apart from intensity of hallucinations. Comparing the FEP or BPD groups, the BPD group had greater psychopathology, apart from intensity of psychotic symptoms, which was significantly greater in the FEP group. These two groups did not significantly differ in their overall psychosocial functioning. Compared with CC young people, both the FEP + BPD and BPD groups differed significantly on every measure, with medium to large effect sizes. CONCLUSIONS Young people with co-occurring FEP and BPD experience more severe difficulties than young people with either diagnosis alone. This combination of psychosis and severe personality pathology has been longitudinally associated with poorer outcomes among adults and requires specific clinical attention.
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Affiliation(s)
- Andrew M Chanen
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Richard Kerslake
- Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom.
| | - Felix-Antoine Berubé
- Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montreal, Canada.
| | - Katie Nicol
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Martina Jovev
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Hok Pan Yuen
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Jennifer K Betts
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Emma McDougall
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Ai-Lan Nguyen
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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3
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Pelizza L, Leuci E, Quattrone E, Azzali S, Paulillo G, Pupo S, Pellegrini P, Gammino L, Biancalani A, Menchetti M. Borderline personality disorder vs. schizophrenia spectrum disorders in young people recruited within an "Early Intervention in Psychosis" service: clinical and outcome comparisons. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01772-5. [PMID: 38472469 DOI: 10.1007/s00406-024-01772-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 01/28/2024] [Indexed: 03/14/2024]
Abstract
Borderline Personality Disorder (BPD) is under-recognized in First-Episode Psychosis (FEP) and its psychotic manifestations are difficult to differentiate from Schizophrenia Spectrum Disorders (SSD). The aim of this investigation was to compare clinical, sociodemographic, and outcome characteristics between FEP patients with BPD vs. FEP subjects with SSD both at baseline and across a 2-year follow-up period. Participants completed the Health of the Nation Outcome Scale (HoNOS), the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) scale both at entry and every 12 months during the follow-up. A mixed-design ANOVA model was conducted to investigate the temporal stability of clinical scores within and between the two subgroups. Among 356 FEP participants, 49 had a BPD diagnosis. Compared to FEP/SSD (n = 307), FEP/BPD patients showed higher prevalence of employment, current substance use, and past attempted suicide. They had a lower equivalent dose of antipsychotic medication at entry and lower levels of negative symptoms. Finally, they had a higher 2-year drop-out rate and a significant improvement in psychopathological scores limited to the first year of treatment. BPD as categorical entity represents a FEP subgroup with specific clinical challenges. Appropriate treatment guidelines for this FEP subgroup are thus needed.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Psychiatry Institute, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy.
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 43100, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Simona Pupo
- Division of Pain Medicine, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Lorenzo Gammino
- Department of Mental Health and Pathological Addictions, Azienda USL di Bologna, Via Castiglione 29, 40124, Bologna, Italy
| | - Arianna Biancalani
- Department of Biomedical and Neuromotor Sciences, Psychiatry Institute, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Psychiatry Institute, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy
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Tschoeke S, Steinert T, Knoblauch H. Forensic aspects of dissociative positive symptoms in trauma-related disorders and borderline personality disorder. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 94:101973. [PMID: 38460238 DOI: 10.1016/j.ijlp.2024.101973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/26/2024] [Accepted: 02/26/2024] [Indexed: 03/11/2024]
Abstract
A psychotically motivated act or an act committed under impaired insight and control of action in the midst of an acute psychosis is the standard for lack of criminal responsibility. There is now increasing evidence that positive symptoms, particularly in the form of hallucinations and delusions, in trauma-related disorders and borderline personality disorder (BPD) are comparable to positive symptoms in psychotic disorders, posing a challenge for differential diagnosis and forensic assessment of the relevance of positive symptoms to insight and self-control. Due to the indistinguishability of the phenomena, there is both a risk of misdiagnosis of a psychotic disorder and also trivialization with the use of pseudo-hallucinations or quasi-psychotic labels. Essential phenomenological differences that may be helpful in forensic assessments are the usually preserved reality testing in trauma-related disorders and BPD, as well as differences in psychopathological symptom constellations. Because of these differences relevant to forensic assessments, it seems useful to distinguish trauma-related disorders and BPD with positive symptoms from psychotic disorders.
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Affiliation(s)
- Stefan Tschoeke
- Clinic for Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany; Centres for Psychiatry Suedwuerttemberg, Ravensburg, Germany.
| | - Tilman Steinert
- Clinic for Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany; Centres for Psychiatry Suedwuerttemberg, Ravensburg, Germany
| | - Hans Knoblauch
- Clinic for Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany; Centres for Psychiatry Suedwuerttemberg, Ravensburg, Germany
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Jongeneel A, Delespaul P, Tromp N, Scheffers D, van der Vleugel B, de Bont P, Kikkert M, Croes CF, Staring AB, Riper H, van der Gaag M, van den Berg D. Effects on voice hearing distress and social functioning of unguided application of a smartphone app - A randomized controlled trial. Internet Interv 2024; 35:100717. [PMID: 38328276 PMCID: PMC10847757 DOI: 10.1016/j.invent.2024.100717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 12/27/2023] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
Background Temstem is a smartphone app developed with and for clinical voice hearing individuals with the aim to reduce their voice hearing distress and improve social functioning. Methods A randomized controlled trial with adult outpatients suffering from distressing and frequent auditory verbal hallucinations (AVH) was conducted. Participants were randomized to unguided 'Temstem+AVH monitoring' or unguided 'AVH monitoring only' (control condition). Assessments were performed at baseline, post-intervention (week 5-6), and follow-up (week 9-10). Primary outcomes were voice hearing distress and social functioning, as measured with Experience Sampling Method (ESM), consisting of multiple daily questionnaires during six days. In addition, voices and mood were self-monitored with help of a daily reflective questionnaire. Analyses were linear regression models (intention-to-treat). Results 44 Participants were allocated to Temstem and 45 to the control condition. No significant differences between the groups were found on both primary outcomes. Conclusion Our results do not support the effectiveness of stand-alone use of Temstem versus symptom monitoring on voice hearing distress or social functioning in voice hearing individuals. In order to potentially improve effectiveness of an mHealth tool in a population of people with frequent and distressing voices, we recommend to involve persons with lived experience in all stages of development and research; to thoroughly test the (technological) usability before performing an RCT; to test whether guidance of a therapist is needed to optimize effectiveness; and to provide prompts to remind the user to actually use the tool.
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Affiliation(s)
- Alyssa Jongeneel
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Netherlands
- Research Centre, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN Den Haag, Netherlands
| | - Philippe Delespaul
- School of MentalHealth and NeuroSciences, Maastricht University, Maastricht, Netherlands
- Mondriaan Mental Health Centre, Maastricht, Heerlen, Netherlands
| | - Nynke Tromp
- Department of Industrial Design, Delft University of Technology, Landbergstraat 15, 2628 CE Delft, Netherlands
| | - Dorien Scheffers
- Research Centre, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN Den Haag, Netherlands
| | - Berber van der Vleugel
- Community Mental Health Service, GGZ Noord-Holland Noord, Alkmaar, Netherlands
- Viersprong Institute for Personality Disorders, Amsterdam, Netherlands
| | - Paul de Bont
- Department of Early Intervention Psychosis, Mental Health Organisation GGZ Oost Brabant, Land van Cuijck en Noord Limburg, Boxmeer, Netherlands
| | | | - Carlos F. Croes
- GGz Centraal Mental Health Institution, Amersfoort, Netherlands
| | | | - Heleen Riper
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Netherlands
- Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, Netherlands
| | - Mark van der Gaag
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Netherlands
| | - David van den Berg
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Netherlands
- Research Centre, Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN Den Haag, Netherlands
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6
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Tschöke S, Knauer Y, Flammer E, Usemann P, Uhlmann C. Psychotic Experiences and Daily Functioning in Borderline Personality Disorder and Schizophrenia. J Nerv Ment Dis 2024; 212:187-189. [PMID: 38412244 DOI: 10.1097/nmd.0000000000001755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT Psychotic experiences have been shown to be comparable in borderline personality disorder (BPD) and schizophrenia. Preliminary evidence suggests differences in the impact of psychotic experiences on daily functioning. Therefore, in this study, we aimed to investigate the role of psychotic experiences in daily functioning in BPD compared with schizophrenia. We performed post hoc analyses on data from 23 inpatients with BPD and 21 inpatients with schizophrenia, for whom results from the Psychotic Symptom Rating Scales were available. No differences were found in frequency, intensity, and disruption of life in relation to auditory verbal hallucinations and the amount of preoccupation and conviction with regard to delusions. Significant differences were found in the disruption of life due to delusions. The results emphasize that the quality of psychotic experiences in BPD and schizophrenia is comparable, but the impact of delusions on daily life is different, which may improve differential diagnosis.
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7
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Tseng ST, Georgiades A. A phenomenological comparison of auditory hallucinations between borderline personality disorder and schizophrenia: A systematic review. Clin Psychol Psychother 2024; 31:e2958. [PMID: 38358078 DOI: 10.1002/cpp.2958] [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: 12/10/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVE Borderline personality disorder (BPD) with auditory hallucinations (AHs) may inadvertently be misdiagnosed with a primary psychotic disorder, such as schizophrenia (SZ). This misidentification can lead to challenges in providing effective psychological treatment. This review therefore aims to identify the phenomenological characteristics of AHs in BPD in comparison to SZ, as well as psychological interventions that explicitly target AHs in BPD. METHODS A systematic review was conducted to summarise the existing evidence base regarding the phenomenological similarities and differences of AHs in BPD and SZ, along with the identification of psychological interventions for AHs in BPD. RESULTS Eighteen studies were eligible for inclusion. Compared to the SZ group, BPD clients were characterised by more persistent and repetitive AHs, significantly more voice-related distress and appraisals of omnipotence, and an earlier age of onset of AHs. The BPD group also reported more severe depression and anxiety, a higher incidence of childhood trauma, and more negative self-schema. Cognitive Behaviour Therapy Coping Strategy Enhancement (CBT-CSE) might be a promising intervention to reduce AH-related distress in BPD, although further studies are required to determine its effectiveness. CONCLUSION In order to prevent misdiagnosis of AHs in BPD, the DSM-5 may need to acknowledge the broader and more frequent occurrence of psychosis symptoms in BPD clients. Such clarification may enhance diagnostic practices and facilitate more timely access to treatment. There is also a need to develop and trial psychological interventions that explicitly target AHs in BPD.
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Affiliation(s)
- Shih-Ting Tseng
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
| | - Anna Georgiades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
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8
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Blom JD, van Veen RJB, van Rooijen EHC, Slotema CW. The Diagnostic Spectrum of Sexual Hallucinations. Harv Rev Psychiatry 2024; 32:1-14. [PMID: 38181099 DOI: 10.1097/hrp.0000000000000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
ABSTRACT Sexual hallucinations are little known, yet often extremely burdening, phenomena. In this systematic review, we summarize what is known about their phenomenology, prevalence, etiopathology, ensuing distress, and treatment options. Sexual hallucinations can be experienced as genital or orgasmic sensations, although other sensory modalities can also be involved. With the notable exception of orgasmic auras in the context of epilepsy, sexual hallucinations tend to be distressing and embarrassing in nature. Our analysis of 79 studies (together describing 390 patients) indicates that sexual hallucinations are more frequent in women than in men, with a sex ratio of 1.4:1, and that they are most prevalent in schizophrenia spectrum disorders, with rates ranging from 1.4% in recently admitted patients to 44% in chronically hospitalized patients. Other underlying conditions include epilepsy, the incubus phenomenon (possibly the most prevalent cause in the general population, associated with sleep paralysis), narcolepsy, and sedative use. As regards the sedative context, we found more medicolegal than purely medical cases, which sadly underlines that not all sexually explicit sensations experienced in anesthesia practice are indeed hallucinations. In the absence of evidence-based treatment protocols for sexual hallucinations, practice-based guidelines tend to focus on the underlying condition. Further research is needed, especially in the fields of substance abuse, posttraumatic stress disorder, and borderline personality disorder, where only anecdotal information on sexual hallucinations is available. Moreover, awareness of sexual hallucinations among health professionals needs to be improved in order to facilitate counseling, diagnosis, and treatment.
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Affiliation(s)
- Jan Dirk Blom
- From the Parnassia Psychiatric Institute, The Hague, the Netherlands; Institute of Psychology, Leiden University (Dr. Blom); Department of Psychiatry, University Medical Center Groningen, Groningen, the Netherlands (Dr. Blom); Department of Psychology, Education & Child Studies, Erasmus University Rotterdam (Dr. Slotema)
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9
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Tschöke S, Kratzer L. Psychotic experiences in trauma-related disorders and borderline personality disorder. Lancet Psychiatry 2023; 10:5-6. [PMID: 36526345 DOI: 10.1016/s2215-0366(22)00399-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/08/2022] [Accepted: 11/08/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Stefan Tschöke
- Clinic for Psychiatry and Psychotherapy I (Weissenau), Ulm University, Ulm, Germany; Centres for Psychiatry Südwürttemberg, Ravensburg 88190, Germany.
| | - Leonhard Kratzer
- Department of Psychotraumatology, Clinic St Irmingard, Prien am Chiemsee, Germany
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10
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Marschall TM, Koops S, Brederoo SG, Cabral J, Ćurčić-Blake B, Sommer IEC. Time varying dynamics of hallucinations in clinical and non-clinical voice-hearers. Neuroimage Clin 2023; 37:103351. [PMID: 36805417 PMCID: PMC9969260 DOI: 10.1016/j.nicl.2023.103351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/24/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
Auditory verbal hallucinations (AVH) are frequently associated with psychotic disorders, yet also occur in non-clinical voice-hearers. AVH in this group are similar to those within clinical voice-hearers in terms of several phenomenological aspects, but non-clinical voice-hearers report to have more control over their AVH and attribute less emotional valence to them. These dissimilarities may stem from differences on the neurobiological level, as it is still under debate whether the mechanisms involved in AVH are the same in clinical and non-clinical voice-hearers. In this study, 21 clinical and 21 non-clinical voice-hearers indicated the onset and offsets of AVH during an fMRI scan. Using a method called leading eigenvector dynamics analysis (LEiDA), we examined time-varying dynamics of functional connectivity involved in AVH with a sub-second temporal resolution. We assessed differences between groups, and between hallucination and rest periods in dwell time, switching frequency, probability of occurrence, and transition probabilities of nine recurrent states of functional connectivity with a permutation ANOVA. Deviations in dwell times, switching frequencies, and switch probabilities in the hallucination period indicated more erratic dynamics during this condition regardless of their clinical status. Post-hoc analyses of the dwell times exhibited the most distinct differences between the rest and hallucination condition for the non-clinical sample, suggesting stronger differences between the two conditions in this group. Overall, these findings suggest that the neurobiological mechanisms involved in AVH are similar in clinical and non-clinical individuals.
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Affiliation(s)
- Theresa M Marschall
- University of Groningen, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands.
| | - Sanne Koops
- University of Groningen, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne G Brederoo
- University of Groningen, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Joana Cabral
- Centre for Eudaimonia and Human Flourishing, Linacre College, University of Oxford, Oxford, UK; Life and Health Sciences Research Institute, School of Medicine, University of Minho, Braga, Portugal
| | - Branislava Ćurčić-Blake
- University of Groningen, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Iris E C Sommer
- University of Groningen, Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
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11
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Brewin CR, Phillips K, Morton J, Mason AJC, Saunders R, Longden E. Multiplicity in the experience of voice-hearing: A phenomenological inquiry. J Psychiatr Res 2022; 156:564-569. [PMID: 36368246 DOI: 10.1016/j.jpsychires.2022.10.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 10/17/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022]
Abstract
Although it is recognized that voice-hearers often report a large number and variety of voices there have been few investigations of this multiplicity. Understanding the phenomenology of voice-hearing can provide a firm foundation for theorizing about its causes. In this international online survey of voice-hearers, details were elicited of the content of up to five utterances associated with up to five voices from each respondent. The contents were independently rated and associated with characteristics of each voice such as its perceived age, whether it had changed over time, and whether it was of a familiar person. We investigated predictors (e.g., diagnoses, voice gender, age first heard) of utterance negativity, length, and whether voices referred to themselves. The average number of voices reported was approximately four. The majority were perceived as male and had negative content. Child-aged voices were significantly less negative than all other voices except those perceived as being elderly. Multi-level analyses indicated that there was significant variability at the level of different utterances within voices but variability was more prominent at the level of different voices within an individual. The data were inconsistent with general cognitive models for hearing voices such as the misattribution of inner speech and were more congruent with a dissociation model of voice-hearing. Our findings support approaches based on subtype or dimensional methods of classifying voices, and additionally indicate that research and clinical assessment may benefit from more systematic assessment of multiplicity.
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Affiliation(s)
| | | | | | | | | | - Eleanor Longden
- Greater Manchester Mental Health NHS Foundation Trust, University of Manchester, UK
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12
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Felsenheimer AK, Kieckhäfer C, Rapp AM. Irony detection in patients with borderline personality disorder: an experimental study examining schizotypal traits, response biases and empathy. Borderline Personal Disord Emot Dysregul 2022; 9:24. [PMID: 36192806 PMCID: PMC9531442 DOI: 10.1186/s40479-022-00194-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/15/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In verbal irony we often convey meanings that oppose the literal words. To look behind these words, we need to integrate perspectives of ourselves, others, and their beliefs about us. Although patients with borderline personality disorder (BPD) experience problems in social cognition and schizotypal symptoms, research on irony comprehension mainly focused on the schizophrenic spectrum. Accounting for possible negative biases in BPD, the current study examined the detection of praising and critical irony in a text messaging interface. METHODS The cross-sectional study included 30 patients and 30 matched controls, who completed measures of cognitive and affective empathy (Interpersonal Reactivity Index, IRI), schizotypal (Schizotypal Personality Questionnaire; SPQ), and borderline symptoms (Borderline Symptom List; BSL-23) and the irony detection task. The irony task contained critical and praising remarks embedded in text messages. Asking for literality (ironic vs. literal) and intention ratings (critical to praising) of the stimuli, it allowed to analyze the sensitivity of literality detection as well as implicit and explicit response biases in a signal detection framework. RESULTS Borderline symptoms explained lower sensitivity for the detection of literal and ironic statements across groups. Whereas HC showed a negativity bias when implicitly asked about the literalness of the statement, patients with BPD perceived praising utterances as less praising when explicitly asked about their perceived intention. Neither empathy nor schizotypy explained outcomes beyond borderline symptoms. CONCLUSIONS This was the first study to show lower detection of verbal irony in patients with BPD. While patients were less biased when asked about the literality of a statement, they perceived praising remarks as less positive on explicit measurements. The results highlight the importance of congruent, transparent communication in promoting epistemic trust in individuals with BPD.
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Affiliation(s)
- Anne Katrin Felsenheimer
- Department of Psychiatry and Psychotherapy, University of Tübingen, 72076, Tübingen, Germany.
- Max Planck School of Cognition , Max Planck Institut for Human Cognitive and Brain Sciences , Leipzig, Germany.
| | - Carolin Kieckhäfer
- LVR Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Alexander Michael Rapp
- Department of Psychiatry and Psychotherapy, University of Tübingen, 72076, Tübingen, Germany
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13
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Chanen AM, Sharp C, Nicol K, Kaess M. Early Intervention for Personality Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:402-408. [PMID: 37200874 PMCID: PMC10187393 DOI: 10.1176/appi.focus.20220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Both the DSM-5 Section III Alternative Model for Personality Disorders and the ICD-11 have introduced a genuinely developmental approach to personality disorder. Among young people with personality disorder, compelling evidence demonstrates a high burden of disease, substantial morbidity, and premature mortality, as well as response to treatment. Yet, early diagnosis and treatment for the disorder have struggled to emerge from its identity as a controversial diagnosis to a mainstream focus for mental health services. Key reasons for this include stigma and discrimination, lack of knowledge about and failure to identify personality disorder among young people, along with the belief that personality disorder must always be addressed through lengthy and specialized individual psychotherapy programs. In fact, evidence suggests that early intervention for personality disorder should be a focus for all mental health clinicians who see young people and is feasible by using widely available clinical skills.
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Affiliation(s)
- Andrew M Chanen
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Carla Sharp
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Katie Nicol
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Michael Kaess
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
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14
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Schandrin A, Francey S, Nguyen L, Whitty D, McGorry P, Chanen AM, O'Donoghue B. Co-occurring first-episode psychosis and borderline personality pathology in an early intervention for psychosis cohort. Early Interv Psychiatry 2022. [PMID: 36163652 DOI: 10.1111/eip.13352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 08/11/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is common among people diagnosed with first episode of psychosis (FEP), but is often under-recognized and under-researched. This study aimed to determine: (i) the prevalence of borderline personality pathology (subthreshold features and categorical disorder) in a FEP cohort (termed FEP + BPP); (ii) demographic and clinical factors associated with FEP + BPP; (iii) the symptomatic and functional outcomes. METHODS This study was conducted within the Early Psychosis Prevention and Intervention Centre (EPPIC) at Orygen over the 30-month period between 2014 and 2016. BPP was evaluated by using the Structured Clinical Interview for DSM-IV Axis II Personality Questionnaire BPD criteria. RESULTS In a cohort of 457 young people with a FEP (mean age 19.5 years, 56% male), 18.4% had borderline personality pathology (BPP). Compared with FEP alone, young people with FEP + BPP were more likely to be female, younger, Australian-born. In addition, young people with FEP + BPP were more likely to be diagnosed with Psychosis NOS, present with more severe hallucinations, and have alcohol abuse. Young people with FEP + BPP had more relationship difficulties at presentation and they were more likely to suffer of depression and to engage in self-harm throughout the follow-up. In relation to outcome, FEP + BPP was not associated with different rates of remission or relapse, however they were less likely to be admitted to hospital at presentation or involuntarily during their episode of care. CONCLUSION BPP is a common occurrence in psychotic disorders and is associated with more severe hallucinations and depression with higher risks of self-harm. Specific interventions need to be developed.
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Affiliation(s)
- Aurelie Schandrin
- Department of Adult Psychiatry, University Hospital of Nîmes, Nîmes, France.,Orygen, Parkville, Victoria, Australia
| | - Shona Francey
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,St Vincents University Hospital Elm Park, Dublin, Ireland
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15
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Merrett Z, Castle DJ, Thomas N, Toh WL, Beatson J, Broadbear J, Rao S, Rossell SL. Comparison of the Phenomenology of Hallucination and Delusion Characteristics in People Diagnosed With Borderline Personality Disorder and Schizophrenia. J Pers Disord 2022; 36:413-430. [PMID: 35913767 DOI: 10.1521/pedi.2022.36.4.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hallucinations and delusions in borderline personality disorder (BPD) are understudied. The authors explore the phenomenology of multisensory hallucinations and delusions in individuals with BPD and compare them to those in individuals with schizophrenia spectrum disorders (SSD). Clinical psychopathology was also explored. Eighty-nine adults participated and were categorized into four groups: BPD with voices, BPD without voices, SSD with high BPD traits, and SSD with low BPD traits. Among individuals with BPD, 81% reported visual and tactile hallucinations, 75% reported olfactory hallucinations, and 94% experienced delusions. When comparing BPD with and without voices, there were no significant differences in nonpsychotic psychopathology. Slight differences were found when hallucinations in BPD were compared with hallucinations in SSD, but overall the experiences were similar across diagnoses. The BPD group also reported significantly higher rates of paranoia/suspiciousness and delusions of guilt than the SSD group. Multisensory hallucinations and delusions occur in BPD and should be explored when treating people with BPD.
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Affiliation(s)
- Zalie Merrett
- Centre for Mental Health, Swinburne University, Melbourne, Australia (S. L. R.)
| | - David J Castle
- Centre for Complex Interventions, Centre for Addictions and Mental Health, University of Toronto, Toronto, Canada
| | - Neil Thomas
- Centre for Mental Health, Swinburne University, Melbourne, Australia (S. L. R.)
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University, Melbourne, Australia (S. L. R.)
| | - Josephine Beatson
- Spectrum Personality Disorder Service, Eastern Health, Richmond, Australia
| | - Jillian Broadbear
- Spectrum Personality Disorder Service, Eastern Health, Richmond, Australia
| | - Sathya Rao
- Spectrum Personality Disorder Service, Eastern Health, Richmond, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University, Melbourne, Australia (S. L. R.).,Department of Psychiatry, University of Toronto, Toronto, Canada (S. L. R.)
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16
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Streit F, Witt SH, Awasthi S, Foo JC, Jungkunz M, Frank J, Colodro-Conde L, Hindley G, Smeland OB, Maslahati T, Schwarze CE, Dahmen N, Schott BH, Kleindienst N, Hartmann A, Giegling I, Zillich L, Sirignano L, Poisel E, Chen CH, Nöthen MM, Mobascher A, Rujescu D, Lieb K, Roepke S, Schmahl C, Bohus M, Ripke S, Rietschel M, Andreassen OA. Borderline personality disorder and the big five: molecular genetic analyses indicate shared genetic architecture with neuroticism and openness. Transl Psychiatry 2022; 12:153. [PMID: 35411043 PMCID: PMC9001677 DOI: 10.1038/s41398-022-01912-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 02/06/2023] Open
Abstract
Both environmental (e.g. interpersonal traumatization during childhood and adolescence) and genetic factors may contribute to the development of Borderline Personality Disorder (BPD). Twin studies assessing borderline personality symptoms/features in the general population indicate that genetic factors underlying these symptoms/features are shared in part with the personality traits of the Five Factor Model (FFM) of personality-the "Big Five". In the present study, the genetic overlap of BPD with the Big Five -Openness to Experience, Conscientiousness, Extraversion, Agreeableness, and Neuroticism- was assessed. Linkage disequilibrium score regression was used to calculate genetic correlations between a genome-wide association study (GWAS) in central European populations on BPD (N = 2543) and GWAS on the Big Five (N = 76,551-122,886, Neuroticism N = 390,278). Polygenic scores (PGS) were calculated to test the association of the genetic disposition for the personality traits with BPD case-control status. Significant positive genetic correlations of BPD were found with Neuroticism (rg = 0.34, p = 6.3*10-5) and Openness (rg = 0.24, p = 0.036), but not with the other personality traits (all | rg | <0.14, all p > 0.30). A cluster and item-level analysis showed positive genetic correlations of BPD with the Neuroticism clusters "Depressed Affect" and "Worry", and with a broad range of Neuroticism items (N = 348,219-376,352). PGS analyses confirmed the genetic correlations, and found an independent contribution of the personality traits to BPD risk. The observed associations indicate a partially shared genetic background of BPD and the personality traits Neuroticism and Openness. Larger GWAS of BPD and the "Big Five" are needed to further explore the role of personality traits in the etiology of BPD.
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Affiliation(s)
- Fabian Streit
- Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Stephanie H. Witt
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany ,grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Center for Innovative Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Swapnil Awasthi
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Jerome C. Foo
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Jungkunz
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany ,grid.7497.d0000 0004 0492 0584Section for Translational Medical Ethics, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Josef Frank
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lucía Colodro-Conde
- grid.1049.c0000 0001 2294 1395QIMR Berghofer Medical Research Institute Brisbane, Brisbane, QLD Australia ,grid.1003.20000 0000 9320 7537School of Psychology, University of Queensland, Brisbane, QLD Australia ,grid.1024.70000000089150953School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD Australia
| | - Guy Hindley
- grid.55325.340000 0004 0389 8485NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ,grid.13097.3c0000 0001 2322 6764Psychosis Studies, Institute of Psychiatry, Psychology and Neurosciences, King’s College London, 16 De Crespigny Park, London, SE5 8AB United Kingdom
| | - Olav B. Smeland
- grid.55325.340000 0004 0389 8485NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway ,grid.5510.10000 0004 1936 8921Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Tolou Maslahati
- grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Charité - Medical Faculty Berlin, Berlin, Germany
| | - Cornelia E. Schwarze
- grid.7700.00000 0001 2190 4373Department of Developmental and Biological Psychology, Heidelberg University, Heidelberg, Germany
| | - Norbert Dahmen
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany
| | - Björn H. Schott
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany ,grid.418723.b0000 0001 2109 6265Leibniz Institute for Neurobiology, Magdeburg, Germany ,grid.411984.10000 0001 0482 5331Department of Psychiatry and Psychotherapy, University Medical Center Göttingen, Göttingen, Germany
| | - Nikolaus Kleindienst
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Annette Hartmann
- grid.22937.3d0000 0000 9259 8492Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Ina Giegling
- grid.22937.3d0000 0000 9259 8492Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Lea Zillich
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Lea Sirignano
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Eric Poisel
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Chi-Hua Chen
- grid.266100.30000 0001 2107 4242Department of Radiology, University of California, San Diego, CA USA
| | - Markus M. Nöthen
- grid.15090.3d0000 0000 8786 803XInstitute of Human Genetics, University Hospital Bonn, Bonn, Germany
| | - Arian Mobascher
- Department of Psychiatry and Psychotherapy, St. Elisabeth Krankenhaus Lahnstein, Lahnstein, Germany
| | - Dan Rujescu
- grid.22937.3d0000 0000 9259 8492Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Klaus Lieb
- grid.410607.4Department of Psychiatry and Psychotherapy, University Medical Center, Mainz, Germany
| | - Stefan Roepke
- grid.7468.d0000 0001 2248 7639Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Campus Benjamin Franklin, Charité - Medical Faculty Berlin, Berlin, Germany
| | - Christian Schmahl
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Martin Bohus
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany ,grid.5570.70000 0004 0490 981XDepartment of Clinical Psychology and Psychotherapy, Ruhr University Bochum, Bochum, Germany
| | - Stephan Ripke
- grid.6363.00000 0001 2218 4662Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany ,grid.66859.340000 0004 0546 1623Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research and Medical and Population Genetics Program, Cambridge, MA USA ,grid.38142.3c000000041936754XMassachusetts General Hospital and Department of Medicine, Harvard Medical School, Analytic and Translational Genetics Unit, Boston, MA USA
| | - Marcella Rietschel
- grid.7700.00000 0001 2190 4373Central Institute of Mental Health, Department of Genetic Epidemiology in Psychiatry, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Ole A. Andreassen
- grid.5510.10000 0004 1936 8921NORMENT Centre and KG Jebsen Centre for Neurodevelopmental disorders, Institute of Clinical Medicine, University of Oslo, Oslo, Norway ,grid.55325.340000 0004 0389 8485Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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17
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Uncovering hidden resting state dynamics: A new perspective on auditory verbal hallucinations. Neuroimage 2022; 255:119188. [PMID: 35398281 DOI: 10.1016/j.neuroimage.2022.119188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/25/2022] [Accepted: 03/13/2022] [Indexed: 11/24/2022] Open
Abstract
In the absence of sensory stimulation, the brain transits between distinct functional networks. Network dynamics such as transition patterns and the time the brain stays in each network link to cognition and behavior and are subject to much investigation. Auditory verbal hallucinations (AVH), the temporally fluctuating unprovoked experience of hearing voices, are associated with aberrant resting state network activity. However, we lack a clear understanding of how different networks contribute to aberrant activity over time. An accurate characterization of latent network dynamics and their relation to neurocognitive changes necessitates methods that capture the sub-second temporal fluctuations of the networks' functional connectivity signatures. Here, we critically evaluate the assumptions and sensitivity of several approaches commonly used to assess temporal dynamics of brain connectivity states in M/EEG and fMRI research, highlighting methodological constraints and their clinical relevance to AVH. Identifying altered brain connectivity states linked to AVH can facilitate the detection of predictive disease markers and ultimately be valuable for generating individual risk profiles, differential diagnosis, targeted intervention, and treatment strategies.
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18
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Niemantsverdriet MBA, van Veen RJB, Slotema CW, Franken IHA, Verbraak MJPM, Deen M, van der Gaag M. Characteristics and stability of hallucinations and delusions in patients with borderline personality disorder. Compr Psychiatry 2022; 113:152290. [PMID: 34959004 DOI: 10.1016/j.comppsych.2021.152290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Psychotic features have been part of the description of the borderline personality disorder (BPD) ever since the concept "borderline" was introduced. However, there is still much to learn about the presence and characteristics of delusions and about the stability of both hallucinations and delusions in patients with BPD. METHODS A follow-up study was conducted in 326 BPD outpatients (median time between baseline and follow-up = 3.16 years). Data were collected via telephone (n = 267) and face-to-face interviews (n = 60) including the Comprehensive Assessment of Symptoms and History interview, Positive And Negative Syndrome Scale and the Psychotic Symptom Rating Scale. RESULTS The point prevalence of delusions was 26%, with a median strong delusion conviction. For the group as a whole, the presence and severity of both hallucinations and delusions was found to be stable at follow-up. Participants with persistent hallucinations experienced more comorbid psychiatric disorders, and they differed from those with intermittent or sporadic hallucinations with their hallucinations being characterized by a higher frequency, causing a higher intensity of distress and more disruption in daytime or social activities. CONCLUSIONS Delusions in patients with BPD occur frequently and cause distress. Contrary to tenacious beliefs, hallucinations and delusions in participants with BPD are often present in an intermittent or persistent pattern. Persistent hallucinations can be severe, causing disruption of life. Overall, we advise to refrain from terms such as "pseudo", or assume transience when encountering psychotic phenomena in patients with BPD, but rather to carefully assess these experiences and initiate a tailor-made treatment plan.
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Affiliation(s)
- Maria B A Niemantsverdriet
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands; Department of Personality Disorders, Parnassia Psychiatric Institute, The Hague, the Netherlands; Pro Persona Mental Health Care, Wolfheze, the Netherlands.
| | - Rosemarij J B van Veen
- Department of Personality Disorders, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Christina W Slotema
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands; Department of Personality Disorders, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Ingmar H A Franken
- Department of Psychology, Education & Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | | | - Mathijs Deen
- Department of Personality Disorders, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology and Amsterdam Public Health Research Institute, VU University, Amsterdam, the Netherlands
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19
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Bajouco M, Mota D. Cariprazine on Psychosis: Beyond Schizophrenia - A Case Series. Neuropsychiatr Dis Treat 2022; 18:1351-1362. [PMID: 35818373 PMCID: PMC9270979 DOI: 10.2147/ndt.s355941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 05/26/2022] [Indexed: 11/23/2022] Open
Abstract
Cariprazine is an atypical antipsychotic that has D2 and D3 partial agonism properties in addition to the usual 5-HT2A receptor antagonist action of second-generation antipsychotics. It has a distinctly higher affinity for D3 receptors, which is 10-fold higher than for D2 receptors. Cariprazine is also a 5-HT1A partial agonist, with a potential antidepressant effect. Cariprazine has been approved for treatment of both positive and negative symptoms of schizophrenia and for treatment of bipolar disorder. It could potentially be used in depression as an add-on treatment. There are few data reporting effectiveness of cariprazine in the broader spectrum of psychosis. In this paper, the authors report three cases where cariprazine was used in the treatment of psychotic conditions other than schizophrenia, namely a first episode psychosis, a case of delusional disorder, and a case of a patient with borderline personality disorder and psychotic symptoms. The authors suggest that cariprazine may be effective in the treatment of psychosis in a broader sense and should be considered a first-line treatment option.
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Affiliation(s)
- Miguel Bajouco
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Coimbra Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - David Mota
- Department of Psychiatry, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Institute of Psychological Medicine, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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20
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Belohradova Minarikova K, Prasko J, Holubova M, Vanek J, Kantor K, Slepecky M, Latalova K, Ociskova M. Hallucinations and Other Psychotic Symptoms in Patients with Borderline Personality Disorder. Neuropsychiatr Dis Treat 2022; 18:787-799. [PMID: 35422622 PMCID: PMC9005124 DOI: 10.2147/ndt.s360013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Psychotic symptoms in BPD are not uncommon, and they are diverse and phenomenologically similar to those in schizophrenia spectrum disorders. Despite their prevalence in BPD patients, knowledge about the characteristics and severity of hallucinations is limited, especially in modalities other than auditory. AIM This review summarises the causes, phenomenology, severity, and treatment options of hallucinations and other psychotic symptoms in BPD. METHODS The PubMed database was used with the following key terms: "borderline personality disorder" and 'hallucinations' and "psychotic symptoms". Articles were selected between January 1990 and May 2021. The primary keyword search yielded a total of 545 papers, of which 102 articles met the inclusion criteria and were fully screened. Papers from the primary source reference lists were also screened, assessed for eligibility, and then added to the primary documents where appropriate (n = 143). After the relevance assessment, 102 papers were included in the review. We included adult and adolescent studies to gather more recent reviews on this topic. RESULTS Hallucinations are significantly prevalent in BPD, mainly auditory, similar to schizophrenia spectrum disorders. The relationship between hallucinations and depression, anxiety, suicidality, schizotypy, and loneliness in BPD has been discovered but requires more research. Studies for treatment options for hallucinations in BPD are lacking. CONCLUSION Recognition of psychotic symptoms in patients with BPD as distinguished psychopathological phenomena instead of diminishing and overlooking them is essential in the clinical assessment and can be useful in predicting complications during treatment. More focused research in this area is needed.
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Affiliation(s)
- Kamila Belohradova Minarikova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, The Slovak Republic.,Jessenia, a.s., Rehabilitation Hospital Beroun, AKESO Holding, Beroun, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic.,Department of Pedagogy and Psychology, Faculty of Science, Humanities and education, Technical University, Liberec, The Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Krystof Kantor
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, The Slovak Republic
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
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21
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Tate AE, Sahlin H, Liu S, Lu Y, Lundström S, Larsson H, Lichtenstein P, Kuja-Halkola R. Borderline personality disorder: associations with psychiatric disorders, somatic illnesses, trauma, and adverse behaviors. Mol Psychiatry 2022; 27:2514-2521. [PMID: 35304564 PMCID: PMC9135625 DOI: 10.1038/s41380-022-01503-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 02/01/2022] [Accepted: 02/22/2022] [Indexed: 11/09/2022]
Abstract
In one of the largest, most comprehensive studies on borderline personality disorder (BPD) to date, this article places into context associations between this diagnosis and (1) 16 different psychiatric disorders, (2) eight somatic illnesses, and (3) six trauma and adverse behaviors, e.g., violent crime victimization and self-harm. Second, it examines the sex differences in individuals with BPD and their siblings. A total of 1,969,839 Swedish individuals were identified from national registers. Cumulative incidence with 95% confidence intervals (CI) was evaluated after 5 years of follow-up from BPD diagnosis and compared with a matched cohort. Associations were estimated as hazard ratios (HR) with 95% CIs from Cox regression. 12,175 individuals were diagnosed with BPD (85.3% female). Individuals diagnosed with BPD had higher cumulative incidences and HRs for nearly all analyzed indicators, especially psychiatric disorders. Anxiety disorders were most common (cumulative incidence 95% CI 33.13% [31.48-34.73]). Other notable findings from Cox regressions include psychotic disorders (HR 95% CI 24.48 [23.14-25.90]), epilepsy (3.38 [3.08-3.70]), violent crime victimization (7.65 [7.25-8.06]), and self-harm (17.72 [17.27-18.19]). HRs in males and females with BPD had overlapping CIs for nearly all indicators. This indicates that a BPD diagnosis is a marker of vulnerability for negative events and poor physical and mental health similarly for both males and females. Having a sibling with BPD was associated with an increased risk for psychiatric disorders, trauma, and adverse behaviors but not somatic disorders. Clinical implications include the need for increased support for patients with BPD navigating the health care system.
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Affiliation(s)
- Ashley E. Tate
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Hanna Sahlin
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Shengxin Liu
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Yi Lu
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Sebastian Lundström
- grid.8761.80000 0000 9919 9582Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden ,grid.8761.80000 0000 9919 9582Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Larsson
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden ,grid.15895.300000 0001 0738 8966School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Ralf Kuja-Halkola
- grid.465198.7Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
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22
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Strawson WH, Wang HT, Quadt L, Sherman M, Larsson DEO, Davies G, Mckeown BLA, Silva M, Fielding-Smith S, Jones AM, Hayward M, Smallwood J, Critchley HD, Garfinkel SN. Voice Hearing in Borderline Personality Disorder Across Perceptual, Subjective, and Neural Dimensions. Int J Neuropsychopharmacol 2021; 25:375-386. [PMID: 34940826 PMCID: PMC9154289 DOI: 10.1093/ijnp/pyab093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/24/2021] [Accepted: 12/23/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Auditory verbal hallucinations (AVH) commonly occur in the context of borderline personality disorder (BPD) yet remain poorly understood. AVH are often perceived by patients with BPD as originating from inside the head and hence viewed clinically as "pseudohallucinations," but they nevertheless have a detrimental impact on well-being. METHODS The current study characterized perceptual, subjective, and neural expressions of AVH by using an auditory detection task, experience sampling and questionnaires, and functional neuroimaging, respectively. RESULTS Perceptually, reported AVH correlated with a bias for reporting the presence of a voice in white noise. Subjectively, questionnaire measures indicated that AVH were significantly distressing and persecutory. In addition, AVH intensity, but not perceived origin (i.e., inside vs outside the head), was associated with greater concurrent anxiety. Neurally, fMRI of BPD participants demonstrated that, relative to imagining or listening to voices, periods of reported AVH induced greater blood oxygenation level-dependent activity in anterior cingulate and bilateral temporal cortices (regional substrates for language processing). AVH symptom severity was associated with weaker functional connectivity between anterior cingulate and bilateral insular cortices. CONCLUSION In summary, our results indicate that AVH in participants with BPD are (1) underpinned by aberrant perceptual-cognitive mechanisms for signal detection, (2) experienced subjectively as persecutory and distressing, and (3) associated with distinct patterns of neural activity that inform proximal mechanistic understanding. Our findings are like analogous observations in patients with schizophrenia and validate the clinical significance of the AVH experience in BPD, often dismissed as "pseudohallucinations." These highlight a need to reconsider this experience as a treatment priority.
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Affiliation(s)
- Will H Strawson
- Correspondence: Will H. Strawson, MSci, Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, BN1 9RY, UK ()
| | - Hao-Ting Wang
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK
| | - Maxine Sherman
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK,Department of Informatics, University of Sussex, UK
| | - Dennis E O Larsson
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Department of Psychology, Falmer, UK,Leverhulme Trust London, UK
| | - Geoff Davies
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | | | - Marta Silva
- Cognition and Brain Plasticity Unit, Barcelona, Catalunya, Spain,Institute of Neurosciences, University of Barcelona, Catalunya, Spain
| | - Sarah Fielding-Smith
- University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK,Oxford Health NHS Foundation Trust, Oxford, UK,Oxford Institute of Clinical Psychology Training and Research, Oxford, UK
| | - Anna-Marie Jones
- University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Mark Hayward
- Department of Psychology, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Jonathan Smallwood
- Department of Psychology, University of York, York, UK,Department of Psychology, Queen’s University, Kingston, ON, Canada
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,Sackler Centre for Consciousness Science, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK,University of Sussex, Falmer, UK,Sussex Partnership NHS Foundation Trust, Brighton, UK,Institute of Cognitive Neuroscience, University College London, London, UK
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23
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Kubera KM, Hirjak D, Wolf ND, Wolf RC. [Cognitive control in the research domain criteria system: clinical implications for auditory verbal hallucinations]. DER NERVENARZT 2021; 92:892-906. [PMID: 34342677 DOI: 10.1007/s00115-021-01175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 11/25/2022]
Abstract
Cognitive control (CC) represents one of six constructs within the research domain criteria (RDoC) domain of cognitive systems, which can be examined using different units of analyses (from genetic and molecular mechanisms to neural circuits and self-reports). The CC is defined as the ability to execute top-down control over task-specific processes and to coordinate thought and actions to achieve a specific goal. Within the field of cognitive neuroscience, recent studies provided important findings about central neuronal components of the CC network and the interactions with other relevant functional systems. In the development and maintenance of distinct psychiatrically relevant symptoms, such as auditory verbal hallucinations (AVH) or hearing voices, dysfunctional CC is thought to play an essential transdiagnostic role. This selective literature review addresses the specific and clinically relevant question of the extent to which the RDoC construct of CC has been incorporated into studies investigating the neurobiological mechanisms of AVH. In addition, an overview of the extent to which findings exploring the underlying mechanisms have been transferred into daily clinical routine is provided. Furthermore, future research perspectives and therapeutic approaches are discussed. Based on currently preferred neurobiological models of AVH, nonpharmacological strategies, such as brain stimulation techniques and psychotherapy can be derived. Further research perspectives arise in the field of interventional studies oriented towards the RDoC matrix.
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Affiliation(s)
- Katharina M Kubera
- Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie, Universität Heidelberg, Heidelberg, Deutschland.
| | - Dusan Hirjak
- Zentralinstitut für Seelische Gesundheit, Klinik für Psychiatrie und Psychotherapie, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - Nadine D Wolf
- Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie, Universität Heidelberg, Heidelberg, Deutschland
| | - Robert C Wolf
- Zentrum für Psychosoziale Medizin, Klinik für Allgemeine Psychiatrie, Universität Heidelberg, Heidelberg, Deutschland
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24
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West ML, Guest RM, Carmel A. Comorbid early psychosis and borderline personality disorder: Conceptualizing clinical overlap, etiology, and treatment. Personal Ment Health 2021; 15:208-222. [PMID: 33955194 DOI: 10.1002/pmh.1509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 03/14/2021] [Indexed: 12/15/2022]
Abstract
Despite substantial efforts aimed at the detection and intervention for early symptoms of mental illness, there is relatively limited research on the clinical overlap between borderline personality disorder (BPD) and early psychosis, for example, clinical high risk (CHR) for psychosis, in young people. We present a narrative review of the clinical overlap between BPD and psychosis spectrum symptoms. Both conditions have unstable temporal course, and both are marked by functional impairment, increased suicide risk, and higher rates of psychiatric inpatient services. We then review evidence-based treatments for psychosis and BPD, emphasizing treatments for early presentations of these symptoms and initial research considering treatments for the overlap. Psychotherapies with the strongest empirical support include cognitive behavioral models, with BPD showing limited response to adjunctive pharmacotherapy. We end by discussing specific recommendations for future research, including longitudinal studies to determine the predictors of the course of illness and the development of treatments to target comorbid BPD and CHR symptoms.
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Affiliation(s)
- Michelle L West
- CEDAR Clinic and Research Program, Massachusetts Mental Health Center, Boston, Massachusetts, USA.,Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, University of Colorado School of Medicine (CUSOM), Aurora, Colorado, USA
| | - Ryan M Guest
- Department of Psychology, Emory University, Atlanta, Georgia, USA
| | - Adam Carmel
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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25
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Hayward M, Jones AM, Strawson WH, Quadt L, Larsson DEO, Silva M, Davies G, Fielding-Smith S, Hazell CM, Critchley HD, Garfinkel SN. A cross-sectional study of auditory verbal hallucinations experienced by people with a diagnosis of borderline personality disorder. Clin Psychol Psychother 2021; 29:631-641. [PMID: 34322956 DOI: 10.1002/cpp.2655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND The presence of auditory verbal hallucinations (AVHs) does not currently feature in the main diagnostic criteria for borderline personality disorder (BPD). However, there is accumulating evidence that a high proportion of BPD patients report longstanding and frequent AVHs which constitute a significant risk factor for suicide plans and attempts, and hospitalization. AIM This study addressed questions about the validity and phenomenology of AVHs in the context of BPD. The longer-term aim is to facilitate the development and translation of treatment approaches to address the unmet need of this population. METHOD This was a cross-sectional study, combining phenomenological and psychological assessments administered in person and online. We explored the experiences of 48 patients with a diagnosis of BPD who were hearing AVHs. RESULTS Participants gave 'consistent' reports on the measure of AVH phenomenology, suggesting that these experiences were legitimate. Similar to AVHs in a psychosis context, AVHs were experienced as distressing and appraised as persecutory. AVHs were found to be weakly associated with BPD symptoms. AVHs were also rated highly as a treatment priority by the majority of participants. CONCLUSION The findings suggest that AVH is a legitimate and distressing symptom of BPD and a treatment priority for some patients. The relative independence of AVHs from other BPD symptoms and emotional states suggests that psychological treatment may need to be targeted specifically at the symptom of AVHs. This treatment could be adapted from cognitive behaviour therapy, the psychological intervention that is recommended for the treatment of AVHs in the context of psychosis.
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Affiliation(s)
- Mark Hayward
- Sussex Partnership NHS Foundation Trust, Brighton, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | | | - Will H Strawson
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | - Lisa Quadt
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Dennis E O Larsson
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK.,Leverhulme Trust, London, UK
| | - Marta Silva
- Cognition and Brain Plasticity Unit, University of Barcelona, Barcelona, Spain.,Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Geoff Davies
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Department of Psychology, University of Sussex, Falmer, UK
| | | | - Cassie M Hazell
- Social Sciences Department, University of Westminster, London, UK
| | - Hugo D Critchley
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sackler Centre for Consciousness Science, University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Sarah N Garfinkel
- Department of Neuroscience, Brighton and Sussex Medical School (BSMS), University of Sussex, Falmer, UK.,Sussex Partnership NHS Foundation Trust, Brighton, UK.,Institute of Cognitive Neuroscience, University College London, London, UK
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26
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Morrice F, Jones AM, Burgio V, Strauss C, Hayward M. Brief coping strategy enhancement for the treatment of distressing voices in the context of borderline personality disorder: A comparison with outcomes in the context of psychosis. Clin Psychol Psychother 2021; 29:567-578. [PMID: 34255401 DOI: 10.1002/cpp.2647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 05/21/2021] [Accepted: 06/28/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Voice hearing in the context of Borderline Personality Disorder (BPD) has traditionally been regarded as transient and an experience that lacks legitimacy. Consequently, there are no evidence-based treatments for the voices reported by BPD patients. Contrary to the traditional view, there is a growing literature suggesting that voice hearing in the context of BPD can be an enduring and distressing experience which shares similarities with voice hearing in the context of psychosis. Given these similarities, the aim of this study was to explore whether brief Coping Strategy Enhancement developed in the context of psychosis can be used to treat distressing voice hearing in the context of BPD. METHOD This was a service evaluation carried out in a specialist NHS service delivering psychological therapies for distressing voices. Patients with either a BPD (n = 46) or a psychosis diagnosis (n = 125) received four sessions of Coping Strategy Enhancement (CSE). The primary outcome was voice-related distress. The pre-post outcomes for BPD patients were explored and compared with those achieved by the psychosis patients. RESULTS Both the BPD and psychosis groups experienced a significant reduction in voice-related distress after CSE compared with baseline. The interaction between diagnosis group and time was small and statistically non-significant. CONCLUSION These findings suggest a brief CSE intervention developed in the context of psychosis can be an effective starting point in the treatment of distressing voice hearing in the context of BPD. Such interventions have the potential to be integrated into broader BPD treatment programmes for those who hear voices.
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Affiliation(s)
| | - Anna-Marie Jones
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Vincenzo Burgio
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, UK.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, UK.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Hove, UK
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27
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Musiek FE, Morris S, Ichiba K, Clark L, Davidson AJ. Auditory Hallucinations: An Audiological Horizon? J Am Acad Audiol 2021; 32:195-210. [PMID: 34062609 DOI: 10.1055/s-0041-1722989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Interesting data and theories have emerged regarding auditory hallucinations (AHs) in patients with schizophrenia. The possibility that these patients may have changes in the anatomy of the auditory cortex and/or subcortical structures of the central auditory nervous system and present with deficits on audiological tests is important information to the audiology community. However, it seems clear that, in general, audiologists are not sufficiently aware of these findings. PURPOSE There are two main purposes of this article: (1) to educate audiologists about AHs related to schizophrenia and related issues, and (2) to encourage audiologists and hearing scientists to become involved in the evaluation and research of AHs. This fascinating disorder is one in which audiologists/hearing scientists are well suited to make a significant contribution. RESEARCH DESIGN A review and synthesis of the literature was conducted. Relevant literature was identified through PubMed, Google Scholar, as well as independent book chapters and article searches. Keywords driving the searches were AHs, auditory illusions, verbal and musical hallucinations, schizophrenia, and central auditory disorders. Given the currency of the topic, the information collected was primarily between 1990 and 2020. STUDY SAMPLE The review is organized around categorization, prevalence, models, mechanisms, anatomy, pathophysiology, and audiological correlates related to AHs. DATA COLLECTION AND ANALYSIS Searches were conducted using well-known search engines and manual searches by each author. This information on AHs was then analyzed collectively by the authors for useful background and relevance, as well as important for the field of audiology. RESULTS Several anatomical, physiological, and functional imaging studies have shown compromise of the auditory cortex in those with schizophrenia and AHs. Potentially related to this, are studies that demonstrated sub-par performance on behavioral audiologic measures for this unique clinical population. These findings align well with the kind of hearing disorder for which audiologists are well-trained to make significant contributions. CONCLUSION Neurobiological and audiological evidence is accumulating on patients with schizophrenia and AH potentially rendering it as both an auditory and psychiatric disorder. Audiologists should consider expanding their horizon and playing a role in the clinical investigation of this disorder.
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Affiliation(s)
- Frank E Musiek
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Sarah Morris
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Kayla Ichiba
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Liza Clark
- Department of Speech, Language, and Hearing Sciences, The University of Arizona, Tucson, Arizona
| | - Alyssa J Davidson
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, Illinois
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28
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Fung HW, Leung YHS, Mak WH, Ross CA, Ling HWH. The Need for Acknowledging the Psychosocial Aspects of Voice-Hearing Experiences: Review of Online Information and Implications for Public Mental Health Education. JOURNAL OF CONSUMER HEALTH ON THE INTERNET 2021. [DOI: 10.1080/15398285.2020.1852375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Hong Wang Fung
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yin Hang Sharo Leung
- Department of Counselling Psychology and Human Resource Development, National Chi Nan University, Nantou County, Taiwan
| | - Wing Hung Mak
- Department of Social and Behavioural Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Colin A. Ross
- The Colin A. Ross Institute for Psychological Trauma, Richardson, Texas, USA
| | - Henry Wai-Hang Ling
- The Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
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29
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Cavelti M, Thompson K, Chanen AM, Kaess M. Psychotic symptoms in borderline personality disorder: developmental aspects. Curr Opin Psychol 2021; 37:26-31. [DOI: 10.1016/j.copsyc.2020.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/02/2020] [Indexed: 12/14/2022]
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30
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Reply to Clifford, G., Dalgleish, T. and Hitchcock, C., 2018. Prevalence of auditory pseudohallucinations in adult survivors of physical and sexual trauma with chronic post-traumatic stress disorder (PTSD). Behaviour research and therapy, 111, pp.113-118. Behav Res Ther 2021; 137:103789. [PMID: 33387872 DOI: 10.1016/j.brat.2020.103789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 07/29/2020] [Accepted: 12/16/2020] [Indexed: 11/22/2022]
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31
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Barrera A, Bajorek T, Dekker R, Hothi G, Lewis A, Pearce S. A Phenomenological Exploration of the Voices Reported by Borderline Personality and Schizophrenia Patients. Psychopathology 2021; 54:159-168. [PMID: 33975316 DOI: 10.1159/000516208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/28/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Over time, there have been different views regarding the verbal auditory hallucinations (VAHs) reported by borderline personality disorder (BPD) and schizophrenia patients. More recently, their similarity has been emphasized, a view that undoubtedly has significant implications in terms of differential diagnosis and management. To explore this important issue, we undertook a detailed phenomenological assessment of persistent VAH reported by BPD and schizophrenia DSM-IV participants. METHODS The Psychotic Symptoms Rating Scale (PSYRATS), the Revised Beliefs About Voices Questionnaire (BAVQ-R), the Multidimensional Scale for Hallucinations (MSH), and a detailed clinical interview were administered to 11 BPD and 10 schizophrenia DSM-IV participants. RESULTS The VAHs of both groups were similar regarding intensity, reported as located inside or outside the head, and frequency in which they were described as a third-person phenomenon. However, the patients' stance towards their VAH was clearly different. Whilst BPD patients identified them in a clear way in terms of gender and age and disliked them, schizophrenia patients identified them more vaguely, reported them both as more disruptive but at the same time engaged with them more positively; schizophrenia patients also integrated their VAH more into delusions. DISCUSSION Whilst reporting similar intensity of their VAH, the 2 groups' stance towards them were strikingly different in that BPD participants regarded them as identifiable and unequivocally unpleasant whilst schizophrenia participants regarded them in a rather vague and ambiguous manner. Methodologically, this preliminary study suggests that in-depth phenomenological assessment can help to elucidate the differential diagnosis of VAH in these, possibly other, clinical groups. Further research is warranted to establish whether these preliminary findings are replicated on a bigger clinical sample.
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Affiliation(s)
- Alvaro Barrera
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, United Kingdom
| | - Tomasz Bajorek
- Psychological Medicine, John Radcliffe Hospital, Oxford, United Kingdom
| | | | - Gurjiven Hothi
- Central and North West London NHS Foundation Trust, London, United Kingdom
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32
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Corbeil O, Bérubé FA, Artaud L, Roy MA. Détecter et traiter les troubles comorbides aux premiers épisodes psychotiques : un levier pour le rétablissement. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088187ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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33
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Zandersen M, Parnas J. Exploring schizophrenia spectrum psychopathology in borderline personality disorder. Eur Arch Psychiatry Clin Neurosci 2020; 270:969-978. [PMID: 31289925 PMCID: PMC7599140 DOI: 10.1007/s00406-019-01039-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022]
Abstract
We have previously argued that the current borderline personality disorder (BPD) diagnosis is over-inclusive and clinically and conceptually impossible to distinguish from the schizophrenia spectrum disorders. This study involves 30 patients clinically diagnosed with BPD as their main diagnosis by three BPD dedicated outpatient treatment facilities in Denmark. The patients underwent a careful and time-consuming psychiatric evaluation involving several senior level clinical psychiatrists and researchers and a comprehensive battery of psychopathological scales. The study found that the vast majority of patients (67% in DSM-5 and 77% in ICD-10) in fact met the criteria for a schizophrenia spectrum disorder, i.e., schizophrenia (20%) or schizotypal (personality) disorder (SPD). The schizophrenia spectrum group scored significantly higher on the level of disorders of core self as measured by the Examination of Anomalous Self-Experiences Scale (EASE). The BPD criterion of "identity disturbance" was significantly correlated with the mean total score of EASE. These findings are discussed in the light of changes from prototypical to polythetic diagnostic systems. We argue that the original prototypes/gestalts informing the creation of BPD and SPD have gone into oblivion during the evolution of polythetic criteria.
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Affiliation(s)
- Maja Zandersen
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendbyoestervej 160, 2605, Broendby, Denmark.
| | - Josef Parnas
- Mental Health Centre Glostrup, University Hospital of Copenhagen, Broendbyoestervej 160, 2605, Broendby, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Subjectivity Research, University of Copenhagen, Copenhagen, Denmark
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34
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Mourgues C, Negreira AM, Quagan B, Mercan NE, Niles H, Kafadar E, Bien C, Kamal F, Powers AR. Development of Voluntary Control Over Voice-Hearing Experiences: Evidence From Treatment-Seeking and Non-Treatment-Seeking Voice-Hearers. SCHIZOPHRENIA BULLETIN OPEN 2020; 1:sgaa052. [PMID: 33196043 PMCID: PMC7643545 DOI: 10.1093/schizbullopen/sgaa052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Voluntary control over voice-hearing experiences is one of the most consistent predictors of functioning among voice-hearers. However, control over voice-hearing experiences is likely to be more nuanced and variable than may be appreciated through coarse clinician-rated measures, which provide little information about how control is conceptualized and developed. We aimed to identify key factors in the evolution of control over voice-hearing experiences in treatment-seeking (N = 7) and non-treatment-seeking (N = 8) voice-hearers. Treatment-seeking voice-hearers were drawn from local chapters of the Connecticut Hearing Voices Network, and non-treatment-seeking voice-hearers were recruited from local spiritually oriented organizations. Both groups participated in a clinical assessment, and a semi-structured interview meant to explore the types of control exhibited and how it is fostered. Using Grounded Theory, we identified that participants from both groups exerted direct and indirect control over their voice-hearing experiences. Participants that developed a spiritual explanatory framework were more likely to exert direct control over the voice-hearing experiences than those that developed a pathologizing framework. Importantly, despite clear differences in explanatory framework and distress because of their experiences, both groups underwent similar trajectories to develop control and acceptance over their voice-hearing experiences. Understanding these factors will be critical in transforming control over voice-hearing experiences from a phenomenological observation to an actionable route for clinical intervention.
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Affiliation(s)
- Catalina Mourgues
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Alyson M Negreira
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Brittany Quagan
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | | | - Halsey Niles
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT.,Yale University School of Medicine, New Haven, CT
| | | | - Claire Bien
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT
| | - Faria Kamal
- Department of Psychiatry, Columbia University, New York, NY
| | - Albert R Powers
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven CT.,Yale University School of Medicine, New Haven, CT.,Department of Psychology, Yale University, New Haven, CT
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35
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Schutte MJL, Linszen MMJ, Marschall TM, Ffytche DH, Koops S, van Dellen E, Heringa SM, Slooter AJC, Teunisse R, van den Heuvel OA, Lemstra AW, Foncke EMJ, Slotema CW, de Jong J, Rossell SL, Sommer IEC. Hallucinations and other psychotic experiences across diagnoses: A comparison of phenomenological features. Psychiatry Res 2020; 292:113314. [PMID: 32731082 DOI: 10.1016/j.psychres.2020.113314] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/15/2020] [Accepted: 07/19/2020] [Indexed: 01/19/2023]
Abstract
Although psychotic experiences are prevalent across many psychiatric, neurological, and medical disorders, investigation of these symptoms has largely been restricted to diagnostic categories. This study aims to examine phenomenological similarities and differences across a range of diagnoses. We assessed frequency, severity and phenomenology of psychotic experiences in 350 outpatients including; participants with schizophrenia spectrum disorders, hearing impairment, Parkinson's disease, Lewy Body Dementia, Alzheimer's disease, visual impairment, posttraumatic stress disorder, borderline personality disorder, and participants with recent major surgery. Psychotic phenomena were explored between these groups using the Questionnaire for Psychotic Experiences (QPE). Participants with major psychiatric disorders reported a combination of several psychotic experiences, and more severe experiences compared to all other disorders. Participants with recent major surgery or visual impairment experienced isolated visual hallucinations. Participants with hearing impairment reported isolated auditory hallucinations, whereas the neurodegenerative disorders reported visual hallucinations, occasionally in combination with hallucinations in another modality or delusions. The phenomenology between neurodegenerative disorders, and within major psychiatric disorders showed many similarities. Our findings indicate that the phenomenology of psychotic experiences is not diagnosis specific, but may rather point to the existence of various subtypes across diagnoses. These subtypes could have a different underlying etiology requiring specific treatment.
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Affiliation(s)
- Maya J L Schutte
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands
| | - Mascha M J Linszen
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands
| | - Theresa M Marschall
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands.
| | - Dominic H Ffytche
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Sanne Koops
- Department of Neurology, University Medical Center Utrecht & Brain Center Rudolf Magnus, Utrecht, the Netherlands
| | - Edwin van Dellen
- Department of Psychiatry, University Medical Center Utrecht & Brain Center Rudolf Magnus, Utrecht, the Netherlands
| | - Sophie M Heringa
- Department of Psychiatry, University Medical Center Utrecht & Brain Center Rudolf Magnus, Utrecht, the Netherlands
| | - Arjen J C Slooter
- Department of Intensive Care Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Rob Teunisse
- Department of Geriatric Psychiatry, Dimence, Deventer, the Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry and Department of Anatomy & Neurosciences, VU University Medical Center, Amsterdam, the Netherlands
| | - Afina W Lemstra
- Department of Neurology, VU university medical center, Amsterdam, the Netherlands
| | - Elisabeth M J Foncke
- Department of Neurology, VU university medical center, Amsterdam, the Netherlands
| | | | - Joop de Jong
- Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University & Voices Clinic, Monash Alfred Psychiatry Research Centre, Melbourne, Australia
| | - Iris E C Sommer
- Department of Biomedical Sciences of Cells and Systems, University Medical Center Groningen, Groningen, the Netherlands
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36
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Toh WL, Thomas N, Hollander Y, Rossell SL. On the phenomenology of auditory verbal hallucinations in affective and non-affective psychosis. Psychiatry Res 2020; 290:113147. [PMID: 32569924 DOI: 10.1016/j.psychres.2020.113147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/02/2020] [Accepted: 05/25/2020] [Indexed: 12/16/2022]
Abstract
Phenomenological comparisons of auditory verbal hallucinations (AVHs) in affective versus non-affective psychosis have not been adequately documented. The current study aimed to: a) comprehensively describe AVH phenomenology by diagnosis and mood state, b) investigate significant predictors of voice-related distress and functional impairment, and c) conduct qualitative thematic analysis of participants' experiences. Participants were diagnosed with: a) bipolar disorder (n = 31), b) major depressive disorder (n = 34), c) schizophrenia (n = 50), or d) schizoaffective disorder (n = 26). Current voice-hearers were also subdivided into prevailing mood states: a) euthymic (n = 23), b) depressed (n = 51), or c) mania-mixed (n = 12). An in-depth, semi-structured interview was conducted, accompanied by mixed-methods analyses. Of the 34 AVH characteristics, significant group differences across diagnoses were identified only for frequency, number of voices, form of address, perceived location, level of conviction, beliefs regarding origin, and functional interference. Random forests modelling (RFM) showed experienced distress and functional interference were best predicted by discrete AVH variables. Qualitative thematic analysis revealed first-order themes: a) content, b) form, c) function, and d) non-voice. There were more similarities than differences in the phenomenology of AVHs across diagnoses, yet significant predictors of voice-related distress and functional impairment differed across affective and non-affective psychosis. This has important nosological and therapeutic applications.
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Affiliation(s)
- Wei Lin Toh
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Melbourne, Australia.
| | - Neil Thomas
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Melbourne, Australia
| | - Yitzchak Hollander
- Psychiatric Intensive Care Service, Alfred Hospital, Melbourne Australia
| | - Susan Lee Rossell
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Melbourne, Australia; Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
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37
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Aguilar-Ortiz S, Salgado-Pineda P, Vega D, Pascual JC, Marco-Pallarés J, Soler J, Brunel C, Martin-Blanco A, Soto A, Ribas J, Maristany T, Sarró S, Rodríguez-Fornells A, Salvador R, McKenna PJ, Pomarol-Clotet E. Evidence for default mode network dysfunction in borderline personality disorder. Psychol Med 2020; 50:1746-1754. [PMID: 31456534 DOI: 10.1017/s0033291719001880] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Although executive and other cognitive deficits have been found in patients with borderline personality disorder (BPD), whether these have brain functional correlates has been little studied. This study aimed to examine patterns of task-related activation and de-activation during the performance of a working memory task in patients with the disorder. METHODS Sixty-seven DSM-IV BPD patients and 67 healthy controls underwent fMRI during the performance of the n-back task. Linear models were used to obtain maps of within-group activations and areas of differential activation between the groups. RESULTS On corrected whole-brain analysis, there were no activation differences between the BPD patients and the healthy controls during the main 2-back v. baseline contrast, but reduced activation was seen in the precentral cortex bilaterally and the left inferior parietal cortex in the 2-back v. 1-back contrast. The patients showed failure of de-activation affecting the medial frontal cortex and the precuneus, plus in other areas. The changes did not appear to be attributable to previous history of depression, which was present in nearly half the sample. CONCLUSIONS In this study, there was some, though limited, evidence for lateral frontal hypoactivation in BPD during the performance of an executive task. BPD also appears to be associated with failure of de-activation in key regions of the default mode network.
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Affiliation(s)
- Salvatore Aguilar-Ortiz
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Barcelona, Spain
- Departament de Psiquiatria i Medicina Legal, PhD Programme, Doctorat en Psiquiatria, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Pilar Salgado-Pineda
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
| | - Daniel Vega
- Servei de Psiquiatria i Salut Mental, Consorci Sanitari de l'Anoia, Igualada, Spain
| | - Juan C Pascual
- CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Josep Marco-Pallarés
- Faculty of Psychology, University of Barcelona, Bellvitge Hospital, Barcelona, Spain
| | - Joaquim Soler
- CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Brunel
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- Benito Menni Complex Assistencial en Salut Mental, Sant Boi de Llobregat, Barcelona, Spain
| | - Ana Martin-Blanco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Angel Soto
- Servei de Psiquiatria i Salut Mental, Consorci Sanitari de l'Anoia, Igualada, Spain
| | - Joan Ribas
- Servei de Psiquiatria i Salut Mental, Consorci Sanitari de l'Anoia, Igualada, Spain
| | - Teresa Maristany
- Hospital Sant Joan de Déu, Esplugues de Llobregrat, Barcelona, Spain
| | - Salvador Sarró
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
| | | | - Raymond Salvador
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
| | - Peter J McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
| | - Edith Pomarol-Clotet
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona, Spain
- CIBERSAM, Barcelona, Spain
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38
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Abstract
PURPOSE OF REVIEW We review recent research concerning the diagnosis and treatment of borderline personality disorder (BPD) in young people. We examine evidence for the need to define an appropriate age for detection, and the suitability of current classification methods and treatment. RECENT FINDINGS Evidence supports early detection and intervention for subsyndromal borderline pathology or categorical BPD across an extended developmental period. A range of structured treatments are effective for BPD in young people, although the role of treatment components in successful outcomes is unclear. Substantial evidence suggests that a stronger focus on functional outcomes, especially social and vocational outcomes, is warranted. Effective treatments for BPD are rarely available internationally. There is a need to assess whether less complex interventions might be developed that are scalable across health systems. A clinical staging model should be considered, addressing clinical distress and co-occurring psychopathology, as well as diagnosis.
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39
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Shinn AK, Wolff JD, Hwang M, Lebois LAM, Robinson MA, Winternitz SR, Öngür D, Ressler KJ, Kaufman ML. Assessing Voice Hearing in Trauma Spectrum Disorders: A Comparison of Two Measures and a Review of the Literature. Front Psychiatry 2020; 10:1011. [PMID: 32153431 PMCID: PMC7050446 DOI: 10.3389/fpsyt.2019.01011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/20/2019] [Indexed: 11/13/2022] Open
Abstract
Voice hearing (VH) can occur in trauma spectrum disorders (TSD) such as posttraumatic stress disorder (PTSD) and dissociative disorders. However, previous estimates of VH among individuals with TSD vary widely. In this study, we sought to better characterize the rate and phenomenology of VH in a sample of 70 women with TSD related to childhood abuse who were receiving care in a specialized trauma program. We compared the rate of VH within our sample using two different measures: 1) the auditory hallucination (AH) item in the Structured Clinical Interview for DSM-IV-TR (SCID), and 2) the thirteen questions involving VH in the Multidimensional Inventory of Dissociation (MID), a self-report questionnaire that comprehensively assesses pathological dissociation. We found that 45.7% of our sample met threshold for SCID AH, while 91.4% met criteria for MID VH. Receiver operating characteristics (ROC) analyses showed that while SCID AH and MID VH items have greater than chance agreement, the strength of agreement is only moderate, suggesting that SCID and MID VH items measure related but not identical constructs. Thirty-two patients met criteria for both SCID AH and at least one MID VH item ("unequivocal VH"), 32 for at least one MID VH item but not SCID AH ("ambiguous VH"), and 6 met criteria for neither ("unequivocal non-VH"). Relative to the ambiguous VH group, the unequivocal VH group had higher dissociation scores for child voices, and higher mean frequencies for child voices and Schneiderian voices. Our findings suggest that VH in women with TSD related to childhood abuse is common, but that the rate of VH depends on how the question is asked. We review prior studies examining AH and/or VH in TSD, focusing on the measures used to ascertain these experiences, and conclude that our two estimates are consistent with previous studies that used comparable instruments and patient samples. Our results add to growing evidence that VH-an experience typically considered psychotic or psychotic-like-is not equivalent to having a psychotic disorder. Instruments that assess VH apart from psychotic disorders and that capture their multidimensional nature may improve identification of VH, especially among patients with non-psychotic disorders.
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Affiliation(s)
- Ann K. Shinn
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jonathan D. Wolff
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
| | - Melissa Hwang
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
| | - Lauren A. M. Lebois
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
- Neurobiology of Fear Laboratory, McLean Hospital, Belmont, MA, United States
| | - Mathew A. Robinson
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
| | - Sherry R. Winternitz
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
| | - Dost Öngür
- Psychotic Disorders Division, McLean Hospital, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kerry J. Ressler
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Neurobiology of Fear Laboratory, McLean Hospital, Belmont, MA, United States
| | - Milissa L. Kaufman
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
- Dissociative Disorders and Trauma Research Program, McLean Hospital, Belmont, MA, United States
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40
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Jongeneel A, van Veen SC, Scheffers D, Riper H, van den Hout MA, van der Gaag M, van den Berg D. Linguistic dual tasking reduces emotionality, vividness and credibility of voice memories in voice-hearing individuals: Results from a controlled trial. Schizophr Res 2020; 216:249-254. [PMID: 31883929 DOI: 10.1016/j.schres.2019.11.048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/20/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
Dual taxation of the working memory during recall is an effective strategy to reduce the emotionality and vividness of visual intrusive memories and potentially changes dysfunctional beliefs associated with the memories. This study tested the hypothesis that dual tasking decreases emotionality, vividness and credibility of auditory intrusive images (i.e., memories of auditory hallucinations) with a two-level (time: pre and post; condition: dual tasking and recall only) within-subjects design. Thirty-seven voice-hearing participants selected two negative voice-hearing experiences. They recalled one of these experiences while performing a lingual dual task (i.e., language game on smartphone app) and recalled one memory without a dual task (in counterbalanced order). During the pre-test and post-test, emotionality and vividness of the voice-hearing memories were rated, as well as the credibility of the voice statements. There was a significantly greater decrease in emotionality, vividness and credibility during dual tasking than during recall only. This study provides proof of principle that the salience and credibility of the content of auditory hallucinations can be reduced by dual tasking; the clinical implications are also discussed.
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Affiliation(s)
- Alyssa Jongeneel
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081, BT, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512, HN, Den Haag, the Netherlands.
| | - Suzanne C van Veen
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584, CS, Utrecht, the Netherlands
| | | | - Heleen Riper
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081, BT, Amsterdam, the Netherlands
| | - Marcel A van den Hout
- Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584, CS, Utrecht, the Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081, BT, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512, HN, Den Haag, the Netherlands
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081, BT, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512, HN, Den Haag, the Netherlands
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41
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Cavelti M, Thompson K, Hulbert C, Betts J, Jackson H, Francey S, McCutcheon L, Chanen AM. Testing the Interpersonal-Cognitive Model of Auditory Verbal Hallucinations in Youths with Either Early-Stage Borderline Personality Disorder or First-Episode Schizophrenia Spectrum Disorder. Psychopathology 2020; 53:23-35. [PMID: 32289803 DOI: 10.1159/000505194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 12/01/2019] [Indexed: 11/19/2022]
Abstract
This is the first study to explore interpersonal schemata in outpatient youths (age 15-25 years) with early-stage borderline personality disorder (BPD) and auditory verbal hallucinations (AVH). It also aimed to replicate, in a transdiagnostic youth sample, the finding from studies of adults with AVH that negative beliefs about the self and others lead to negative appraisals of voices, which in turn elicits depression. The following 3 groups were compared: youth with BPD+AVH (n = 23), youth with schizophrenia spectrum disorder (SZ) with AVH (SZ+AVH, n = 20), and youths with BPD who did not experience AVH (BPD no AVH, n = 23). The BPD+AVH group reported more negative and fewer positive self schemata than the SZ+AVH group. They also saw themselves as being more socially inferior to others than did the SZ+AVH group, but they did not differ in appraisals of self or others, compared with the BPD no AVH group. In youths with AVH (BPD+AVH, SZ+AVH combined), the indirect effect of beliefs about self or others, via negative appraisals of voices on depression, was not significant. Instead, a significant indirect effect of negative appraisals of voices on depression, via negative beliefs about self, was found. The experience of AVH during adolescence and young adulthood, when the identity is still being formed, might have a more profound effect on the developing self than during later adulthood, when the self is more stable and resilient. Negative self-appraisals might constitute a treatment target for early intervention for youths with distressing voices, including those with BPD.
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Affiliation(s)
- Marialuisa Cavelti
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,University Hospital for Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Katherine Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Shona Francey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Louise McCutcheon
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia, .,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia, .,Orygen Youth Health, Melbourne, Victoria, Australia,
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42
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Avoiding Misdiagnosis When Auditory Verbal Hallucinations Are Present in Borderline Personality Disorder. J Nerv Ment Dis 2019; 207:1048-1055. [PMID: 31790048 DOI: 10.1097/nmd.0000000000001073] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Misdiagnosis is common for patients with a primary diagnosis of borderline personality disorder (BPD) who experience auditory verbal hallucinations (AVHs). AVHs in BPD are associated with severe BPD and high levels of suicidality. Wrongly treating these patients as though they are suffering from schizophrenia or other primary psychotic disorder and not treating BPD can cause significant iatrogenic damage. We outline a specific pattern of symptoms and phenomenology that will assist diagnostic accuracy in these cases. A focused review identified the following characteristic pattern: AVHs in BPD cannot be distinguished phenomenologically from AVH in schizophrenia, often meet the criteria for First-Rank Symptoms (FRSs), are highly stress related, and are strongly associated with dissociative experiences and childhood trauma. Formal thought disorder is uncommon, negative symptoms are usually absent, bizarre delusions are absent, affect remains reactive, and sociability is usually retained. Diagnostic accuracy can be improved by examining the overall clinical presentation and is essential to improving the prognosis for these patients.
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43
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Chanen AM, Betts J, Jackson H, McGorry P, Nelson B, Cotton SM, Bartholomeusz C, Jovev M, Ratheesh A, Davey C, Pantelis C, McCutcheon L, Francey S, Bhaduri A, Lowe D, Rayner V, Thompson K. Aripiprazole compared with placebo for auditory verbal hallucinations in youth with borderline personality disorder: Protocol for the VERBATIM randomized controlled trial. Early Interv Psychiatry 2019; 13:1373-1381. [PMID: 30689305 DOI: 10.1111/eip.12774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/15/2018] [Accepted: 12/06/2018] [Indexed: 01/11/2023]
Abstract
AIM Up to half of patients with borderline personality disorder report auditory verbal hallucinations that are phenomenologically indistinguishable from those in schizophrenia, occur early in the course of the disorder, and are enduring, distressing and disabling. In clinical practice, this symptom is widely assumed to be unresponsive to treatment with antipsychotic medication and early intervention is rarely offered. The Verbal Experiences Response in Borderline personality disorder to Aripiprazole TrIal Medication (VERBATIM) study aims to be the first controlled trial to investigate the effectiveness of conventional pharmacotherapy for this symptom in this patient group. METHOD VERBATIM is a 12-week, triple-blind, single-centre, parallel groups randomised controlled trial, with a 27-week follow-up period. Participants between the ages of 15 and 25 years receive either aripiprazole or placebo daily, commencing at 2 mg and increasing to 10 mg by day 15. Further dose escalations (up to 30 mg) may occur, as clinically indicated. This trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry ACTRN12616001192471 on 30/08/2016. RESULTS The primary outcome is severity of auditory verbal hallucinations assessed using the Psychotic Symptom Rating Scale. Secondary outcomes include the severity of general psychopathology, borderline personality pathology, social and occupational functioning and change in brain resting state connectivity. The primary endpoint is week 12 and secondary endpoint is week 39. CONCLUSION The results will inform treatment decisions for individuals with borderline personality disorder who present with auditory verbal hallucinations.
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Affiliation(s)
- Andrew M Chanen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Jennifer Betts
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sue M Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cali Bartholomeusz
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martina Jovev
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Christopher Davey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Louise McCutcheon
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Shona Francey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Amit Bhaduri
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Danielle Lowe
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria Rayner
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine Thompson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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44
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Abstract
OBJECTIVE Auditory verbal hallucinations (AVH) frequently co-occur with borderline personality disorder (BPD) and can lead to misdiagnosis with schizophrenia (SCZ) or other primary psychotic disorders. Misdiagnosis is more common when AVH meet criteria for Schneiderian first rank symptoms (FRS). This paper's objective is to improve diagnostic accuracy by outlining particular clinical features that can assist the distinction between BPD and psychotic disorders in these cases. CONCLUSION The overall clinical presentation when AVH occur in BPD can assist in determining a primary diagnosis of BPD when frank psychotic disorder is absent. AVH in BPD cannot be distinguished phenomenologically from AVH in SCZ. Clinical experience and increasing research suggest that AVH in BPD are often dissociative in origin and highly correlated with the presence of FRS, elevated levels of dissociation and a history of childhood trauma. When AVH occur in BPD in the absence of co-occurring psychotic disorder, formal thought disorder is usually absent, negative symptoms minimal or absent, bizarre symptoms absent, affect reactive and the patient retains sociability. Psychotropic medication may be less effective for the AVH in these cases, while they may improve or remit during psychotherapy for BPD.
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Affiliation(s)
- Josephine Beatson
- Spectrum, Statewide Service for Personality Disorder, Eastern Health, Richmond, VIC, Australia
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45
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Niemantsverdriet MBA, Slotema CW, van der Veen FM, van der Gaag M, Sommer IEC, Deen M, Franken IHA. Sensory processing deficiencies in patients with borderline personality disorder who experience auditory verbal hallucinations. Psychiatry Res 2019; 281:112545. [PMID: 31536946 DOI: 10.1016/j.psychres.2019.112545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 08/29/2019] [Accepted: 08/29/2019] [Indexed: 11/25/2022]
Abstract
Auditory verbal hallucinations (AVH) are common in patients with borderline personality disorder (BPD). We examined two candidate mechanisms of AVH in patients with BPD, suggested to underlie sensory processing systems that contribute to psychotic symptoms in patients with schizophrenia; sensory gating (P50 ratio and P50 difference) and change detection (mismatch negativity; MMN). Via electroencephalographic recordings P50 amplitude, P50 ratio, P50 difference and MMN amplitude were compared between 23 borderline patients with and 25 without AVH, and 26 healthy controls. Borderline patients with AVH had a significantly lower P50 difference compared with healthy controls, whereas no difference was found between borderline patients without AVH and healthy controls. The groups did not differ on MMN amplitude. The impaired sensory gating in patients with borderline personality disorder who experience AVH implies that P50 sensory gating deficiencies may underlie psychotic vulnerability in this specific patient group. Patients with borderline personality disorder with or without AVH did not have problems with auditory change detection. This may explain why they are spared from the poor outcome associated with negative symptoms and symptoms of disorganization in patients with chronic schizophrenia.
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Affiliation(s)
- Maria B A Niemantsverdriet
- Department of Personality Disorders, Parnassia Psychiatric Institute, Lijnbaan 4, The Hague, VA, 2512, the Netherlands.
| | - Christina W Slotema
- Department of Personality Disorders, Parnassia Psychiatric Institute, Lijnbaan 4, The Hague, VA, 2512, the Netherlands
| | - Frederik M van der Veen
- Institute of Psychology, Erasmus University Rotterdam, Mandeville Building, Rotterdam, DR, 1738, 3000, the Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology and Amsterdam Public Health Research Institute, VU University, Van der Boechorststraat 7, Amsterdam, BT, 1081, the Netherlands
| | - Iris E C Sommer
- Department of Neuroscience, University Medical Center Groningen, Antonius Deusinglaan 1, Groningen, AD, 9700, the Netherlands
| | - Mathijs Deen
- Department of Personality Disorders, Parnassia Psychiatric Institute, Lijnbaan 4, The Hague, VA, 2512, the Netherlands
| | - Ingmar H A Franken
- Institute of Psychology, Erasmus University Rotterdam, Mandeville Building, Rotterdam, DR, 1738, 3000, the Netherlands
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46
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Cavelti M, Thompson KN, Hulbert C, Betts J, Jackson H, Francey S, Homan P, Chanen AM. Exploratory comparison of auditory verbal hallucinations and other psychotic symptoms among youth with borderline personality disorder or schizophrenia spectrum disorder. Early Interv Psychiatry 2019; 13:1252-1262. [PMID: 30485670 DOI: 10.1111/eip.12763] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 08/13/2018] [Accepted: 11/04/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study explored phenomenological aspects of auditory verbal hallucinations (AVH) and other psychotic symptoms among youth with borderline personality disorder (BPD). METHODS Sixty-eight outpatients, aged 15 to 25 years, were categorized into three groups according to their primary Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnosis and AVH symptom profile; BPD + AVH (n = 23), schizophrenia spectrum disorder (SZ) + AVH (n = 22) and BPD with no AVH (n = 23). RESULTS No differences in AVH were found between BPD + AVH and SZ + AVH. Compared with SZ + AVH, BPD + AVH scored lower on delusions and difficulty in abstract thinking and higher on hostility. BPD + AVH reported more severe self-harm, paranoid ideation, dissociation, anxiety and stress than BPD no AVH. CONCLUSIONS This study replicates, in a sample of youth, the finding from studies of adults that AVH in BPD are indistinguishable from those in SZ, when assessed with the Psychotic Symptom Rating Scales (PSYRATS). Clinicians should specifically enquire about AVH among youth with BPD. When present, AVH appear to be an indicator of a more severe form of BPD.
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Affiliation(s)
- Marialuisa Cavelti
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia.,University Hospital for Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Shona Francey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Philipp Homan
- Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY, USA.,Division of Psychiatry Research, Zucker Hillside Hospital, Northwell Health, New York, NY, USA.,Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USA
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Melbourne, Victoria, Australia
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47
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Thompson KN, Cavelti M, Chanen AM. Psychotic symptoms in adolescents with borderline personality disorder features. Eur Child Adolesc Psychiatry 2019; 28:985-992. [PMID: 30511234 DOI: 10.1007/s00787-018-1257-2] [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: 04/23/2018] [Accepted: 11/14/2018] [Indexed: 02/08/2023]
Abstract
Psychotic symptoms have been found to be relatively common among adults with borderline personality disorder (BPD), and to be a marker of BPD severity, but are not recognised in daily clinical practice in these patients. This study is the first to examine the prevalence of psychotic symptoms in 15-18-year olds with BPD features. It was hypothesised that adolescents with full-threshold BPD would have significantly more psychotic symptoms than adolescents with sub-threshold BPD features, and that both these groups would have significantly more psychotic symptoms than adolescents with no BPD features. A total of 171 psychiatric outpatients, aged 15-18 years, were assessed using a structured interview for DSM-IV personality disorder and categorised into three groups: no BPD features (n = 48), sub-threshold BPD features (n = 80), and full-threshold BPD (n = 43). The groups were compared on measures of psychopathology and functioning (e.g. Youth Self Report, Symptom Check List-90-R, SOFAS). Adolescents with full-threshold BPD reported more psychotic symptoms than the sub-threshold BPD group (p < .001), and both these groups reported more psychotic symptoms than those with no BPD features (p < .001). Adolescents with full-threshold BPD reported more confusion (p < .01), paranoia (p < .001), visual hallucinations (p < .001) and strange thoughts (p < .01), than the other two groups. Psychotic symptoms predicted group membership, determined by BPD severity, after adjusting for other psychopathology and functional impairment (p < .01). Assessment of unusual perceptual experiences, paranoia or odd thoughts is highly clinically relevant in adolescents with BPD features, as these symptoms are associated with a more severe clinical presentation of BPD.
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Affiliation(s)
- Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Marialuisa Cavelti
- Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, VIC, 3052, Australia. .,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia. .,Orygen Youth Health, Melbourne, Australia.
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48
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Abstract
The 'eating disorder voice' experience has been reported by both clinicians and by patients with eating disorders (ED) as an important feature of eating psychopathology, however this has only become an area of research in the last decade. The main aim of this paper was to systematically review and synthesize the available literature on this topic. Systematic searches of seven electronic databases were performed up to June 2018. Thirteen peer-reviewed articles were identified. Findings suggested that the existence of an 'ED voice' is often recognized by patients with eating disorders and that this voice has a powerful, negative and omnipotent nature. Feelings of entrapment and defeat are commonly experienced in response to it and patients appear ambivalent towards it. The negative characteristics and responses to the voice are associated with eating disorder symptoms. Addressing the eating disorder voice using relational and interpersonal approaches has the potential to improve clinical and treatment outcomes for patients with eating disorders.
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Affiliation(s)
- Viviana Aya
- a Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience , King's College London , London , UK
| | - Kubra Ulusoy
- b MSc Mental Studies, Institute of Psychiatry Psychology and Neuroscience , King's College London , London , UK
| | - Valentina Cardi
- a Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience , King's College London , London , UK
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49
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Abstract
The status of borderline personality disorder (BPD) as a diagnostic category is a matter of continuing controversy. In the United States, BPD is one of the most frequent diagnoses of psychiatric inpatients, and a similar tendency emerges in Europe. Nearly all theoretical aspects of BPD have been questioned, including its very position as a personality disorder. In this article, we trace the evolution of the borderline concept from the beginning of the 20th century to the current psychometric research. We argue that the status of BPD is fraught with conceptual difficulties, including an unrecognized semantic drift of major phenomenological terms (e.g., identity), a lack of general principles for the distinction of BPD and the major psychiatric syndromes (e.g., schizophrenia spectrum disorders), and insufficient definitions of key nosological concepts. These difficulties illustrate general problems in today's psychiatry that require consideration.
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Affiliation(s)
- Maja Zandersen
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark
| | - Mads Gram Henriksen
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Denmark
| | - Josef Parnas
- Mental Health Centre Glostrup, Institute of Clinical Medicine, University Hospital of Copenhagen, Denmark.,Center for Subjectivity Research, University of Copenhagen, Denmark
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50
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Slotema CW, Bayrak H, Linszen MMJ, Deen M, Sommer IEC. Hallucinations in patients with borderline personality disorder: characteristics, severity, and relationship with schizotypy and loneliness. Acta Psychiatr Scand 2019; 139:434-442. [PMID: 30712290 DOI: 10.1111/acps.13012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE In patients with borderline personality disorder (BPD), data are lacking on characteristics and severity of hallucinations in modalities other than the auditory (verbal) type. The same applies to relationships between hallucinations and the severity of depression, anxiety, schizotypy, and loneliness. METHODS In 60 female patients with BPD (37 also with hallucinations), this cross-sectional study explored characteristics and severity of (i) hallucinations and (ii) schizotypal features, (iii) severity of depression and anxiety, and (iv) loneliness, and the relationships between hallucinations and the other characteristics. RESULTS In patients with hallucinations, 80% experienced hallucinations in more than one modality; in the different modalities, the characteristics of the hallucinations were similar. The criteria for loneliness were fulfilled in 81% and 48% of patients with and without hallucinations. Compared to patients with BPD without hallucinations, the presence of hallucinations was associated with higher scores for depression, anxiety, loneliness, and schizotypy. Furthermore, the severity of hallucinations showed a positive correlation with the severity of loneliness and schizotypy. CONCLUSION Patients with BPD experienced hallucinations with characteristics similar to the more frequently studied auditory (verbal) hallucinations. Higher scores for schizotypy and loneliness indicate that patients with hallucinations had more characteristics of cluster A personality disorders.
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Affiliation(s)
- C W Slotema
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - H Bayrak
- Health Center Medicaya, The Hague, The Netherlands
| | - M M J Linszen
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Deen
- Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - I E C Sommer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Neuroscience, University Medical Center Groningen, Groningen, The Netherlands
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