Previous research on impulsivity in borderline personality disorder (BPD) has revealed inconsistent findings. Impulsive behaviour is often observed during states of emotional distress and might be ...exaggerated by current attention deficit hyperactivity disorder (ADHD) symptoms in individuals with BPD. We aimed to investigate different components of impulsivity dependent on stress induction controlling for self-reported ADHD symptoms in BPD. METHOD. A total of 31 unmedicated women with BPD and 30 healthy women (healthy controls; HCs), matched for age, education and intelligence, completed self-reports and behavioural tasks measuring response inhibition (go/stop task) and feedback-driven decision making (Iowa Gambling Task) under resting conditions and after experimental stress induction. ADHD symptoms were included as a covariate in the analyses of behavioural impulsivity. Additionally, self-reported emotion-regulation capacities were assessed.
BPD patients reported higher impulsive traits than HCs. During stress conditions - compared with resting conditions - self-reported impulsivity was elevated in both groups. Patients with BPD reported higher state impulsivity under both conditions and a significantly stronger stress-dependent increase in state impulsivity. On the behavioural level, BPD patients showed significantly impaired performance on the go/stop task under stress conditions, even when considering ADHD symptoms as a covariate, but not under resting conditions. No group differences on the Iowa Gambling Task were observed. Correlations between impulsivity measures and emotion-regulation capacities were observed in BPD patients.
Findings suggest a significant impact of stress on self-perceived state impulsivity and on response disinhibition (even when considering current ADHD symptoms) in females with BPD.
Signs of an inflammatory process, in particular increased pro-inflammatory cytokines and increased levels of prostaglandine E(2) (PGE(2)), have repeatedly been described in major depression (MD). As ...cyclooxygenase-2 (COX-2) inhibitors inhibit the PGE(2) production and the production of pro-inflammatory cytokines, we performed a therapeutic trial with the COX-2 inhibitor celecoxib. In a prospective, double-blind, add-on study, 40 patients suffering from an acute depressive episode were randomly assigned to either reboxetine and celecoxib or to reboxetine plus placebo. After a wash-out period, 20 patients received 4-10 mg reboxetine plus placebo and 20 received reboxetine plus 400 mg celecoxib for 6 weeks. The treatment effect was calculated by analysis of variance. There were no significant differences between groups in age, sex, duration or severity of disease or psychopathology, or reboxetine dose or plasma levels. Over 6 weeks, both groups of patients showed significant improvement in scores of the Hamilton Depression Scale. However, the celecoxib group showed significantly greater improvement compared to the reboxetine-alone group. Additional treatment with celecoxib has significant positive effects on the therapeutic action of reboxetine with regard to depressive symptomatology. Moreover, the fact that treatment with an anti-inflammatory drug showed beneficial effects on MD indicates that inflammation is related to the pathomechanism of the disorder, although the exact mechanisms remain to become elucidated.
Overgeneralization (i.e., the transfer of fear to stimuli not related to an aversive event) is part of alterations in associative fear learning in mental disorders. In the present experimental study, ...we investigated whether this holds true for post‐traumatic stress disorder (PTSD) related to childhood abuse. We expected that fear generalization under experimental conditions reflects generalization of aversive stimuli to different social domains in real life. Sixty‐four women with PTSD after childhood abuse and 30 healthy participants (HC) underwent a differential fear conditioning and generalization paradigm. Online risk ratings, reaction time, and fear‐potentiated startle served as dependent variables. Based on the subjectively assessed generalization of triggered intrusions across different domains of life, PTSD participants were split into two groups reporting low (low‐GEN) and high (high‐GEN) generalization. PTSD patients reported a higher expectation of an aversive event. During fear conditioning, they assessed the risk of danger related to a safety cue slower and showed a blunted fear‐potentiated startle toward the danger cue. During generalization testing, reaction time increased in the high‐GEN patients and decreased in the HC group with increasing similarity of a stimulus with the conditioned safety cue. Alterations of fear learning in PTSD suggest impaired defensive responses in case of a high threat probability. Moreover, our findings bridge the gap between the generalization of aversive cues during everyday life and laboratory‐based experimental parameters: impairments in the processing of cues signaling safety generalize particularly in those patients who report a spreading of PTSD symptoms across different domains of everyday life.
Up to 75% of individuals who experienced physical and sexual abuse during childhood develop a post‐traumatic stress disorder (PTSD). The present experimental study contributes to the understanding of this disorder by revealing a complex picture of impairments in cognitive and emotional fear learning. A blunted fear‐potentiated startle revealed impaired defensive responses linked to the intensity and frequency of avoidance symptoms. Moreover, this is the first study that links overgeneralization of fear under experimental conditions to overgeneralization of aversive stimuli to different social domains in PTSD patients' real life.
Objectives: There is substantial uncertainty about the most efficacious serum lithium level for the long‐term treatment of bipolar disorder (BD). This review focuses on the available evidence taking ...into consideration the effects of previous lithium history, changes in lithium level and polarity of relapse or recurrence.
Methods: We conducted a MEDLINE search, using the MeSH Terms ‘bipolar disorder’ and ‘lithium’ together with ‘randomized controlled trial’ or ‘controlled clinical trial’ covering the time span from 1966 to March 2006. We only included studies reporting on the long‐term treatment of mood disorders where patients with BD were examined as a separate group and were assigned to precisely specified target ranges of lithium level.
Results: The minimum efficacious serum lithium level in the long‐term treatment of bipolar disorder was 0.4 mmol/L with optimal response achieved at serum levels between 0.6–0.75 mmol/L. Lithium levels >0.75 mmol/L may not confer additional protection against overall morbidity but may further improve control of inter‐episode manic symptoms. Abrupt reduction of serum levels of more than 0.2 mmol/L was associated with increased risk of relapse.
Conclusions: In the long‐term treatment of bipolar disorder clinicians should initially aim for serum lithium levels of 0.6–0.75 mmol/L, while higher levels may benefit patients with predominantly manic symptoms.
Objectives: The aim of this study was to systematically integrate the available evidence on response prediction to prophylactic lithium based on clinical factors.
Methods: Each clinical variable ...that was related to lithium response in at least one prior study was examined with respect to response prediction. If several studies were located for the same variable, results were integrated using the meta‐analytic approach as suggested by DerSimonian and Laird which was developed for substantial heterogeneity in primary studies.
Results: Of 42 potential clinical predictors investigated, five variables were identified as possible response predictors of prophylactic lithium: 1 An episodic pattern of mania‐depression‐interval, and 2 a high age of illness onset were identified as potentially protective against a recurrence under lithium. 3 A high number of previous hospitalizations, 4 an episodic pattern of depression‐mania‐interval, and 5 continuous cycling were identified as potential risk factors. Six further variables were found to be significantly related to lithium response, though calculation of fail‐safe numbers indicates that current evidence is not sufficient to hold these variables as reliable predictors of lithium response. All effect‐sizes relating clinical predictors to response were small to moderate.
Conclusions: Although a few variables are quite robustly supported as response‐predictors in this review, a more in‐depth analysis of each potential predictor is needed. As none of the potential predictors had a very strong impact on response, prediction of lithium response should be based on a multitude of variables.
Objective: According to DSM‐IV criteria, dissociative symptoms in borderline personality disorder (BPD) occur in response to stress. Empirical evidence is, however, lacking.
Method: Using ...ambulatory monitoring, we assessed dissociative symptoms and subjective ratings of stress every 60 min for 48 h on a palmtop computer in BPD‐patients (n = 51), clinical controls (CC; major depression n = 25; panic disorder n = 26), and healthy controls (HC; n = 40). Data analyses were primarily based on hierarchical linear models.
Results: In all groups, states of increased stress were paralleled by increased scores of dissociation, thus confirming the hypothesized association between stress and dissociation. The increase in dissociation was more pronounced in BPD‐patients when compared with CC and HC. Additionally, BPD‐patients reported heightened dissociative experience compared with CC and HC, even after controlling for stress.
Conclusion: Our data suggest that BPD‐patients might be prone to dissociation when experiencing stress and are characterized by a generally heightened level of dissociation.
Objective: Several studies have shown reduced pain perception in patients with borderline personality disorder (BPD) and current self‐injurious behavior (SIB). The aim of the present study was to ...test whether pain perception in patients with current SIB is different from that of patients who had stopped SIB, and whether pain perception of the latter group differs from healthy controls (HC).
Method: We investigated 24 borderline patients and 24 HC. Thirteen patients showed current SIB (BPD‐SIB) and 11 patients did not exhibit SIB anymore (BPD‐non‐SIB). Pain thresholds were assessed using thermal stimuli and laser radiant heat pulses.
Results: We found significant linear trends for all pain measures. The BPD‐SIB group was less sensitive than the BPD‐non‐SIB group and the latter were less sensitive than HC. The pain sensitivity negatively correlated with borderline symptom severity.
Conclusion: The results suggest an association between the termination of SIB, decline of psychopathology and normalization of pain perception in borderline patients.
Background: Early authors described hypomanic symptoms as mixed features in depressive episode, but this syndrome has not been sufficiently explored in previous studies.
Methods: 958 consecutive ...depressed patients were assessed by using a standardized method in terms of 43 psychiatric symptoms at hospitalization.
Results: A principal component analysis, followed by varimax rotation, extracted six interpretable factors: typical vegetative symptoms, depressive retardation/loss of feeling, hypomanic syndrome, anxiety, psychosis, and depressive mood/hopelessness. The extracted factor structure was relatively stable among several patient groups. There was no evidence that the hypomanic factor was exaggerated by antidepressant pretreatments before hospitalization. Bipolar diagnoses were associated with higher scores on depressive retardation and hypomanic symptoms, and a lower score on anxiety.
Limitations: Psychiatric syndromes and their interrelationships, found in the present study, may be strongly influenced by the rating instrument used. The sample of this study was depressed inpatients. The results should not be generalized for depressed outpatients or epidemiological depressed populations.
Conclusions: Hypomanic symptoms, as characterized by the flight of ideas, racing thought, increased drive, excessive social contact, irritability, and aggression are a salient syndrome in acutely ill depressed patients, lending support to the factor validity of mixed depression. The symptoms may not be related to pretreatments with antidepressants, or comorbidity of substance abuse, suggesting that they reflect various natural phenomenological manifestations of depressive episodes. Anxiety is unlikely to play a major role in the core phenomenological features of mixed depression. Hypomanic symptoms during a depressive episode were more represented in bipolar disorders, which may serve for further clarifications of latent bipolarity in unipolar depression, and prediction of switch into maniform states under biological depression treatments.
Objectives: Elevated homocysteine (Hcy) levels have been demonstrated to have a negative impact on cognitive functioning in healthy elderly people. Further studies suggest that they are an ...independent risk factor for dementia, in particular for Alzheimer's disease. Bipolar disorder is also associated with cognitive impairment. However, the pathophysiological mechanisms of these deficits have not been elucidated yet. This study examines the role of Hcy on cognition and its impact on psychosocial functioning in euthymic bipolar patients.
Methods: A total of 55 euthymic bipolar patients and 17 healthy controls were enrolled in the study. Neuropsychological assessments consisted of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), the Trail Making Test (TMT), the Weschler Adult Intelligence Scale, 3rd edition (WAIS‐III) subtest Letter–Number Sequencing Test (LNST) and the HAWIE‐R (German version of the WAIS‐R) subtest Information. Psychosocial functioning was assessed using the Social Adjustment Scale (SAS). To obtain plasma levels of Hcy, blood samples were collected in EDTA tubes, immediately put on ice, centrifuged within 15 min and stored at −80°C. Total Hcy concentration was measured using high‐performance liquid chromatography.
Results: In the neuropsychological tests, patients differed significantly from healthy controls on the TMT B and the RBANS composite indices Language, Attention and Total Score. No differences were found on the HAWIE‐R subtest Information, the TMT A, LNST or the RBANS composite indices Immediate Memory, Visuospatial/Constructional Abilities and Delayed Memory. Mean Hcy levels were 9.8 ± 3.2 μm/L in the patient group and 7.8 ± 2.1 μm/L in the control group, respectively (p = 0.012). In the patient group Hcy levels significantly correlated with gender, diagnosis and RBANS index scores for Immediate Memory, Language, Attention and Total Score. Linear regression analyses revealed a significant and independent association of Hcy levels with Immediate Memory and TMT B scores in the patient group. Homocysteine levels did not correlate with any measure in the control group. Spearman's correlations indicated that psychosocial functioning in bipolar patients is not associated with clinical variables apart from time in remission. However, it correlated significantly with working memory measures (LNST). No relationship could be determined between psychosocial functioning and Hcy plasma levels.
Conclusions: Elevated Hcy levels seem to be associated with cognitive impairment in euthymic bipolar patients, but not with psychosocial functioning. More studies are needed to clarify the role of Hcy in cognition in bipolar disorder.
The aim was to systematically integrate the available evidence on psychosocial and demographic factors associated with response prediction to prophylactic lithium.
Each psychosocial or demographic ...variable that was related to lithium response in at least one study was examined with respect to response prediction. If several studies were located for the same variable results were integrated using a meta-analytical approach. To account for heterogeneity of primary studies aggregation of results was based on a random-effects model.
Out of 27 psychosocial and demographic variables investigated in this review, nine variables were identified as significantly related to outcome under to prophylactic lithium: (1) high social status, (2) social support, (3) good compliance, and (4) dominance may be protective against a recurrence under lithium. In contrast, (5) stress, (6) high expressed emotions, (7) neurotic personality traits, (8) unemployment, and (9) a high number of life events were identified as possible risk factors for poor response.
This systematic review shows a surprisingly high number of psychosocial variables to be related to lithium response. Effect sizes were, however, small to moderate. Many variables should, therefore, be considered simultaneously to predict response.
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