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Vanwoerden S, Vine V, Byrd AL, Jennings JR, Stepp SD. The role of youths' cardiac autonomic balance and parental responses to youth emotion in vulnerability to borderline personality disorder development. Dev Psychopathol 2024; 36:993-1004. [PMID: 36911980 PMCID: PMC10497715 DOI: 10.1017/s095457942300024x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
Developmental models of borderline personality disorder (BPD) emphasize the effects of youths' biological vulnerabilities and their experiences of parental responses to emotion, as well as the interaction between these two elements. The current study evaluated the independent and interactive effects of two indices of autonomic nervous system response and parental responses to youth negative emotions on severity and exacerbation of youths' BPD features during the transition to adolescence. The sample consisted of 162 psychiatric youth (10-14 years; 47.2% female) and their parents. At baseline, youth and their parents completed a lab-based conflict discussion during which parasympathetic and sympathetic nervous system response were measured and indices of sympathetic-parasympathetic balance and coactivation/coinhibition were calculated. Youth also reported on supportive and non-supportive parental responses. At baseline and after 9 months, youth self-reported on their BPD features. Results demonstrated that shifting toward sympathetic dominance independently predicted exacerbation of BPD across 9 months. Additionally, fewer experiences of supportive parental responses and more non-supportive parental responses were associated with greater severity of BPD features in youth. This study highlights the role of autonomic response to parent-child conflict as well as the significance of parental responses to youth emotion for the development of BPD during this developmental window.
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Affiliation(s)
| | - Vera Vine
- Queens University, Department of Psychology
| | - Amy L. Byrd
- University of Pittsburgh, Department of Psychiatry
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2
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Goreis A, Prillinger K, Bedus C, Lipp R, Mayer A, Nater UM, Koenig J, Plener PL, Kothgassner OD. Physiological stress reactivity and self-harm: A meta-analysis. Psychoneuroendocrinology 2023; 158:106406. [PMID: 37783020 DOI: 10.1016/j.psyneuen.2023.106406] [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: 05/17/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Self-harm is associated with alterations in the psychobiological stress response. Specifically, the reactivity of the autonomic nervous system (ANS) and the endocrine hypothalamic-pituitary-adrenal (HPA) axis may differ in individuals who engage in self-harm. However, evidence in this regard is inconsistent. BACKGROUND We conducted a preregistered random-effects meta-analysis of sympathetic ANS, parasympathetic ANS, sympathetic-parasympathetic, i.e., mixed-influence ANS, and HPA axis reactivity following laboratory stress exposure in individuals who engage in self-harm and controls. Stress exposure consisted of paradigms using either social-evaluative (e.g., TSST), emotional (e.g., negatively valenced visual stimuli), or physical (e.g., cold pressor test) challenges. A total of 29 studies (self-harm: n = 954, controls: n = 1122, 74% females) were included in the analysis. RESULTS Regarding ANS reactivity to stress, no differences emerged between the two groups. However, parasympathetic ANS activity was lower before stress (g = -0.30, CI -0.51 to -0.09) and after stressor cessation (g = 0.54, CI -1.07 to -0.01) in the self-harm group compared to controls. Regarding HPA axis reactivity, individuals who engage in self-harm showed significantly lower cortisol responses to stress than did controls (g = -0.26, CI -0.45 to -0.08). After stressor cessation (i.e., during stress recovery), cortisol was also lower in individuals who engage in self-harm compared to controls (g = -0.26, CI -0.43 to -0.08). CONCLUSIONS Lower basal parasympathetic ANS activity and flattened cortisol responses indicate dysregulation of psychobiological stress systems in individuals who engage in self-harm. A better understanding of the psychobiological underpinnings of self-harm may allow for the establishment of biomarkers of risk stratification and treatment monitoring in affected individuals.
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Affiliation(s)
- Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Karin Prillinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Carolin Bedus
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Ronja Lipp
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Anna Mayer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Urs M Nater
- Faculty of Psychology, University of Vienna, Vienna, Austria; University Research Platform "The Stress of Life - Processes and Mechanisms Underlying Everyday Life Stress", University of Vienna, Vienna, Austria
| | - Julian Koenig
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Cologne, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria; Department of Child and Adolescent Psychiatry and Psychotherapy, Medical University of Ulm, Ulm, Germany
| | - Oswald D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria; Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria.
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McCool MW, Mochrie KD, Lothes JE, Guendner E, St. John J, Noel NE. Drug use and suicidal ideation in the daily lives of individuals in a dialectical behavior therapy program. J Clin Psychol 2023; 79:2556-2565. [PMID: 37462923 PMCID: PMC10592253 DOI: 10.1002/jclp.23564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 06/07/2023] [Accepted: 06/29/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES Substance use disorders and borderline personality disorders (BPD) often co-occur and may be concurrently treated by Dialectical Behavior Therapy (DBT). However, there is limited information on how drug use and suicidal ideation may interact in the daily lives of individuals receiving DBT treatment. METHODS This study examined the DBT diary cards of 47 individuals in a community mental health center's partial hospital and intensive outpatient program. Multilevel modeling techniques were used to examine the moderating effects of BPD symptom severity on the relationship between same day, 1-, 2-, and 3-day lagged drug use and suicidal ideation. RESULTS Results indicated a significant relationship between same-day, 1-day lagged, 2-day lagged drug use and suicidal ideation. BPD was a moderator for the relationship between 1-day lagged drug use and suicidal ideation. CONCLUSION Limitations of the study include the measure for BPD symptom severity was only collected pretreatment and the results are likely limited to the effects of cannabis use on suicidal ideation. Clinicians may need to consider the prolonged effects of drug use on suicidal ideation when conducting chain analyses on suicidal behaviors.
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Affiliation(s)
- Matison W. McCool
- The Center on Alcohol, Substance Use, And Addictions, The University of New Mexico
| | | | - John E. Lothes
- University of North Carolina Wilmington
- Delta Behavioral Health
| | - Eric Guendner
- University of North Carolina Wilmington
- Delta Behavioral Health
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Ramesh A, Nayak T, Beestrum M, Quer G, Pandit JA. Heart Rate Variability in Psychiatric Disorders: A Systematic Review. Neuropsychiatr Dis Treat 2023; 19:2217-2239. [PMID: 37881808 PMCID: PMC10596135 DOI: 10.2147/ndt.s429592] [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: 07/18/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
Introduction Heart rate variability (HRV) is a measure of the fluctuation in time interval between consecutive heart beats. Decreased heart rate variability has been shown to have associations with autonomic dysfunction in psychiatric conditions such as depression, substance abuse, anxiety, and schizophrenia, although its use as a prognostic tool remains highly debated. This study aims to review the current literature on heart rate variability as a diagnostic and prognostic tool in psychiatric populations. Methods A literature search was conducted using the MEDLINE, EMBASE, Cochrane, and PsycINFO libraries to identify full-text studies involving adult psychiatric populations that reported HRV measurements. From 1647 originally identified, 31 studies were narrowed down through an abstract and full-text screen. Studies were excluded if they enrolled adolescents or children, used animal models, enrolled patients with another primary diagnosis other than psychiatric as outlined by the diagnostic and statistical manual of mental disorders (DSM) V, or if they assessed HRV in the context of treatment rather than diagnosis. Study quality assessment was conducted using a modified Downs and Blacks quality assessment tool for observational rather than interventional studies. Data were reported in four tables: 1) summarizing study characteristics, 2) methods of HRV detection, 3) key findings and statistics, and 4) quality assessment. Results There is significant variability between studies in their methodology of recording as well as reporting HRV, which makes it difficult to meaningfully interpret data that is clinically applicable due to the presence of significant bias in existing studies. The presence of an association between HRV and the severity of various psychiatric disorders, however, remains promising. Conclusion Future studies should be done to further explore how HRV parameters may be used to enhance the diagnosis and prognosis of several psychiatric disorders.
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Affiliation(s)
- Ashvita Ramesh
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Tanvi Nayak
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Molly Beestrum
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Giorgio Quer
- Scripps Research Translational Institute, La Jolla, CA, USA
| | - Jay A Pandit
- Scripps Research Translational Institute, La Jolla, CA, USA
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Geiss L, Beck B, Hitzl W, Hillemacher T, Hösl KM. Cardiovascular Autonomic Modulation during Metronomic Breathing and Stress Exposure in Patients with Borderline Personality Disorder. Neuropsychobiology 2022; 80:359-373. [PMID: 33582662 DOI: 10.1159/000511543] [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: 05/28/2020] [Accepted: 09/03/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Given the growing evidence of reduced heart rate variability in psychiatric diseases associated with emotional instability, we investigated cardiovascular autonomic modulation in patients with borderline personality disorder (BPD) during resting state, parasympathetic stimulation (metronomic breathing), and sympathetic stimulation (mental arithmetic stress test). METHODS In 29 BPD outpatients and 30 controls, we recorded RR-intervals (RRI), blood pressure, skin conductance levels, and respiratory frequency during resting state, metronomic breathing, stress anticipation, stress exposure, and stress recovery. We calculated baroreflex sensitivity (BRS) and parameters of heart rate variability, including the root mean square of successive differences (RMSSD), an index of cardiovagal modulation. RESULTS During resting state, BPD patients showed higher blood pressure and shorter RRI, as well as lower RMSSD and BRS than controls. Metronomic breathing increased RMSSD and BRS in BPD patients. During the stress exposure, BRS significantly decreased in controls, but not in BPD patients. Furthermore, BPD patients showed less cardioacceleration in response to stress exposure than controls. During stress recovery, we found increases in RMSSD and BRS in controls, but not in BPD patients. CONCLUSION Our data show reduced cardiovascular autonomic modulation in BPD patients during resting state, psychophysiological relaxation, and stress exposure. The results indicate a vagal modulation deficit in this cohort. Breathing techniques, such as metronomic breathing, might be helpful to reduce stress and to increase vagal tone in BPD patients.
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Affiliation(s)
- Lennard Geiss
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany,
| | - Beate Beck
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
| | - Wolfgang Hitzl
- Research Office (Biostatistics), Paracelsus Medical University, Salzburg, Austria.,Department of Ophthalmology and Optometry, Paracelsus Medical University, Salzburg, Austria.,Research Program Experimental Ophthalmology and Glaucoma Research, Paracelsus Medical University, Salzburg, Austria
| | - Thomas Hillemacher
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany.,Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Katharina M Hösl
- Department of Psychiatry and Psychotherapy, Paracelsus Medical University, Nuremberg, Germany
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Moon E, Yang M, Seon Q, Linnaranta O. Relevance of Objective Measures in Psychiatric Disorders-Rest-Activity Rhythm and Psychophysiological Measures. Curr Psychiatry Rep 2021; 23:85. [PMID: 34714422 PMCID: PMC8556205 DOI: 10.1007/s11920-021-01291-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW We present a review of recent methods of objective measurement in psychiatry and psychology with a focus on home monitoring and its utility in guiding treatment. RECENT FINDINGS For individualized diagnostics and treatment of insomnia, actigraphy can generate clinically useful graphical presentations of sleep timing and patterns. Psychophysiological measures may complement psychometrics by tracking parallel changes in physiological responses and emotional functioning, especially during therapy for trauma symptoms and emotion regulation. It seems that rather than defining universal cut-offs, an individualised range of variability could characterize treatment response. Wearable actigraphy and psychophysiological sensors are promising devices to provide biofeedback and guide treatment. Use of feasible and reliable technology during experimental and clinical procedures may necessitate defining healthy and abnormal responses in different populations and pathological states. We present a "call for action" towards further collaborative work to enable large scale use of objective measures.
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Affiliation(s)
- Eunsoo Moon
- Department of Psychiatry, Pusan National University School of Medicine, Yangsan, Republic of Korea
- Department of Psychiatry and Biomedical Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Michelle Yang
- Interdisciplinary Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Quinta Seon
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Outi Linnaranta
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Mental Health Unit, Finnish Institute for Health and Welfare, P.O. Box 30, 00271, Helsinki, Finland.
- Douglas Centre for Sleep and Biological Rhythms, Douglas Mental Health University Institute, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.
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Weise S, Parzer P, Fürer L, Zimmermann R, Schmeck K, Resch F, Kaess M, Koenig J. Autonomic nervous system activity and dialectical behavioral therapy outcome in adolescent borderline personality pathology. World J Biol Psychiatry 2021; 22:535-545. [PMID: 33522370 DOI: 10.1080/15622975.2020.1858155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We aimed to investigate whether pre-treatment cardiac autonomic nervous system (ANS) activity, indexed by heart rate (HR) and heart rate variability (HRV) predicts clinical outcome and therapy drop-outs in adolescents with borderline personality (BPD) pathology receiving dialectical behavioural therapy (DBT-A). We further tested for an association between changes in ANS function and clinical outcome over time. Traumatic experiences were considered as potential confounding factor. METHODS N = 43 (95.4% female, Mage = 15.5 years) adolescents fulfilling at least sub-threshold criteria for BPD (≥3) were investigated before and after outpatient DBT-A as well as at follow-up. N = 10 patients dropped out of treatment (<50% of treatment sessions). Latent growth curve models were used for analyses. RESULTS Greater pre-treatment resting HRV significantly predicted clinical improvement (decrease in BPD pathology/increase of global functioning) over time. Pre-treatment ANS activity was unrelated to treatment drop-out. Further, changes in ANS activity over treatment were associated with changes in clinical outcome. CONCLUSION This study is the first providing evidence that pre-treatment HRV predicts and is related to treatment response in adolescent borderline personality pathology. Implications for the use of ANS measures in clinical practice and directions for future research are discussed.
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Affiliation(s)
- Sindy Weise
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Peter Parzer
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Lukas Fürer
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Ronan Zimmermann
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Klaus Schmeck
- Child and Adolescent Psychiatric Research Department, Psychiatric University Hospitals, University of Basel, Basel, Switzerland
| | - Franz Resch
- Clinic for Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Michael Kaess
- Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.,University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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Maiß C, Engemann L, Kern K, Flasbeck V, Mügge A, Lücke T, Brüne M. Cardiac parasympathetic activity in female patients with borderline personality disorder predicts approach/avoidance behavior towards angry faces. Biol Psychol 2021; 163:108146. [PMID: 34252482 DOI: 10.1016/j.biopsycho.2021.108146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 12/21/2022]
Abstract
Among other features, Borderline Personality Disorder (BPD) is characterized by difficulties in regulating affiliative behavior. Here, we examined the association of heart rate variability (HRV) with approach/avoidance behavior in BPD. Accordingly, HRV parameters (RMSSD and HF-HRV) were measured in 42 female patients with BPD and 50 controls before performing an Approach Avoidance Task (AAT). Half of participants were previously exposed to social exclusion in a virtual ball-tossing game. Overall, HRV was lower in patients with BPD compared to controls. Moreover, low HRV was associated with attenuated approach for angry faces with an averted gaze. Following social exclusion, the BPD group showed the largest approach to happy faces and the least approach for angry faces, a pattern which differed from controls and patients in the control condition. Our findings indicate an association of cardiac parasympathetic activity with social behavior. Moreover, social exclusion may foster avoidance of angry faces in BPD patients.
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Affiliation(s)
- Clara Maiß
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Luisa Engemann
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Katharina Kern
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Vera Flasbeck
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany
| | - Andreas Mügge
- Bergmannsheil Bochum, Medical Clinic II, Department of Cardiology and Angiology, Ruhr University, Bochum, Germany
| | - Thomas Lücke
- St. Josef-Hospital, University Hospital of Pediatrics and Adolescent Medicine, Department of Neuropediatrics and Social Pediatrics, Ruhr University Bochum, Germany
| | - Martin Brüne
- LWL University Hospital Bochum, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University, 44791, Bochum, NRW, Germany.
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Koenig J, Thayer JF, Kaess M. Psychophysiological concomitants of personality pathology in development. Curr Opin Psychol 2020; 37:129-133. [PMID: 33461056 DOI: 10.1016/j.copsyc.2020.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 11/19/2020] [Accepted: 12/07/2020] [Indexed: 11/28/2022]
Abstract
Psychophysiological research methods allow important insights into normative and pathological functioning of the human organism. This position paper briefly reviews existing studies, investigating the psychophysiological concomitants of personality pathology, with an emphasis on developmental aspects. Focussing on measures, indexing autonomic nervous system (ANS) activity at rest, and its reactivity to experimental challenge, the narrative synthesis of the literature highlights current challenges in the field. Findings on the psychophysiological concomitants of personality pathology are mixed. Inconsistencies among studies arise from differences between disorders and heterogeneity within distinct diagnostic categories. The majority of studies addressed borderline personality disorder, illustrating robust alterations in ANS function linked to severe experiences of early maltreatment and trauma, and associated symptoms of dissociation. However, important life-style and secondary health-related factors (i.e. physical activity, smoking) influencing ANS function are frequently neglected. Adapting a dimensional approach to personality pathology and longitudinal research designs seem promising to advance the filed in the years to come.
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Affiliation(s)
- Julian Koenig
- Section for Experimental Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Julian F Thayer
- Department of Psychological Science, The University of California Irvine, Irvine, CA, USA
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Section for Translational Psychobiology in Child and Adolescent Psychiatry, Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
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10
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Eddie D, Bentley KH, Bernard R, Yeung A, Nyer M, Pedrelli P, Mischoulon D, Winkelman JW. Major depressive disorder and insomnia: Exploring a hypothesis of a common neurological basis using waking and sleep-derived heart rate variability. J Psychiatr Res 2020; 123:89-94. [PMID: 32044591 PMCID: PMC7047553 DOI: 10.1016/j.jpsychires.2020.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 01/03/2020] [Accepted: 01/25/2020] [Indexed: 01/16/2023]
Abstract
It remains unclear whether neurobiological dysfunction observed in major depressive disorder (MDD) and insomnia is an expression of common or independent bases. The present investigation sought to explore differences in heart rate variability (HRV)-a widely utilized biomarker of neurobiological functioning-among individuals with MDD, insomnia, and healthy controls, while awake and during distinct sleep stages (REM, N2), with the goal of improving our understanding of shared neurobiological factors in depression and insomnia. Participants were 73 adults who underwent home polysomnography. All N2 and REM sleep epochs with a duration greater than or equal to 5 min were identified for HRV analysis. Additionally, a single waking epoch was defined for each participant. From waking to N2 sleep, and waking to REM sleep, changes in HRV indices indicated participants experienced reductions in sympathetic arousal and increases in parasympathetic arousal. Contrary to hypotheses, however, no between group differences were observed in HRV. Though the present findings do not support the hypotheses of a shard neurobiological pathway between MDD and insomnia, more work is warranted to advance our understanding of the neurobiological bases of these common, debilitating, and frequently co-occurring psychiatric conditions, to improve early detection and identify novel intervention targets for these disorders.
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Affiliation(s)
- David Eddie
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
| | - Kate H Bentley
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Richard Bernard
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Albert Yeung
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Maren Nyer
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - Paola Pedrelli
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - David Mischoulon
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
| | - John W Winkelman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA
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11
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Mehren A, Reichert M, Coghill D, Müller HHO, Braun N, Philipsen A. Physical exercise in attention deficit hyperactivity disorder - evidence and implications for the treatment of borderline personality disorder. Borderline Personal Disord Emot Dysregul 2020; 7:1. [PMID: 31921425 PMCID: PMC6945516 DOI: 10.1186/s40479-019-0115-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022] Open
Abstract
A growing body of literature indicates a potential role for physical exercise in the treatment of attention deficit hyperactivity disorder (ADHD). Suggested effects include the reduction of ADHD core symptoms as well as improvements in executive functions. In the current review, we provide a short overview on the neurophysiological mechanisms assumed to underlie the beneficial effects of exercise. Further, we review the current evidence from experimental studies regarding both acute exercise and long-term interventions in ADHD. While the positive effects observed after acute aerobic exercise are promising, very few well-designed long-term intervention studies have been conducted yet. Moreover, although exercise effects have not yet been studied in borderline personality disorder (BPD), in the end of this paper we derive hypotheses why exercise could also be beneficial for this patient population.
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Affiliation(s)
- Aylin Mehren
- 1Department of Psychology, Biological Psychology Lab, European Medical School, University of Oldenburg, Oldenburg, Germany
| | - Markus Reichert
- 2Department of Applied Psychology, Mental mHealth Lab, Institute of Sports and Sports Science, Karlsruhe Institute of Technology (KIT), Karlsruhe, Germany.,3Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - David Coghill
- 4Royal Children's Hospital, Melbourne, Victoria Australia
| | - Helge H O Müller
- 5Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Niclas Braun
- 5Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - Alexandra Philipsen
- 5Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
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12
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Bachmann K, Schulze M, Sörös P, Schmahl C, Philipsen A. Development and validation of an emotional picture set of self-injury (EPSI) for borderline personality disorder: protocol for a validation study. BMJ Open 2019; 9:e027063. [PMID: 31122985 PMCID: PMC6538202 DOI: 10.1136/bmjopen-2018-027063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severe psychiatric disorder that is characterised by major problems in emotion regulation. Affected persons frequently engage in non-suicidal self-injury (NSSI) to regulate emotions. NSSI is associated with high emotionality in patients with BPD and it can be expected that stimuli depicting scenes of NSSI elicit an emotional response indicative of BPD. The present study protocol describes the development and validation of an emotional picture set of self-injury (EPSI) to advance future research on emotion regulation in BPD. METHODS AND ANALYSIS The present validation study aims to develop and validate an emotional picture set relevant for BPD. Emotional responses to EPSI as well as to a neutral picture set will be investigated in a sample of 30 patients with BPD compared with 30 matched, healthy controls and to 30 matched depressive controls. Emotional responses will be assessed by heart rate variability, facial expression and Self-Assessment Manikin. ETHICS AND DISSEMINATION Ethics approval was obtained by the medical ethics committee of the Carl-von-Ossietzky University of Oldenburg, Germany (registration: 2017-044). The results of the trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03149926; Pre-results.
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Affiliation(s)
- Katharina Bachmann
- Medical Campus University of Oldenburg, School of Medicine and Health Sciences, Psychiatry and Psychotherapy, Carl von Ossietzky Universitat Oldenburg, Bad Zwischenahn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
| | - Peter Sörös
- Department of Neurology, University of Oldenburg, Oldenburg, Germany
| | - Christian Schmahl
- Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Rheinische Friedrich-Wilhelms-Universitat Bonn, Bonn, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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