Mentalizing deficits in borderline personality disorder related to axis I comorbidity: Clinical relevance.

AIM: Deficits in mentalization have been described in several mental disorders, but information is still scarce and ambiguous about the types of mentalization errors in each disorder and their specificity and severity in borderline personality disorder (BPD). Due to the high comorbidity between this disorder and axis I disorders, the aim of this work is to study differences in mentalization responses in BPD considering the different comorbidity profiles with other disorders. METHODS: A total of 141 BPD patients were evaluated using The Mini-International Neuropsychiatric Interview (MINI), to identify comorbid axis I disorders. Mentalizing ability was assessed by the Movie for the Assessment of Social Cognition (MASC). Statistical associations were analysed into the different variables. RESULTS: Patients with comorbid BPD and anorexia nervosa (AN), suicidal behaviour disorder or post-traumatic stress disorder (PTSD) respectively presented higher overmentalization, undermentalization and absence of mentalization errors, compared with patients with BPD without comorbidity. CONCLUSIONS: Results show that BPD comorbidity with AN, suicidal behaviour disorder and PTSD affect to the types and severity of mentalizing deficits observed in these patients. This study highlights the importance of the assessment and treatment of axis I comorbid disorders in borderline personality disorder, with the objective of shaping personalized treatment for every patient.

Inflammatory profiles in women with eating disorder: Linking inflammatory biomarkers to clinical phenotypes.

INTRODUCTION: Eating disorders (ED) represent a group of very complex and serious diagnoses characterized by emotional dysregulation and impulsivity. New approaches are necessary to achieve effective diagnosis and treatments. Shifting biomarker research away from the constraints of diagnostic categories may effectively contribute to a dimensional differentiation across disorders according to neurobiology (e.g., inflammatory biomarkers). Thus, the aim of our study was to identify inflammatory profiles in patients with ED. METHODS: A sample of 100 women with an ED (23.4 ± 8.55 years) and 59 healthy controls (HC) (20.22 ± 4.18 years) was used. K-means cluster analysis was followed to identify inflammatory clusters considering seven blood biomarkers (iNOS, TNFα, COX2, p38, ERK, TBARS and PPARγ). Moreover, a wide assessment of clinical features was conducted. RESULTS: Two distinct clusters were identified. Cluster 1 patients were characterized by higher inflammatory levels of TNF-α, COX2, p38, and ERK, and had more restrictive anorexia diagnosis than cluster 2. Cluster 2 participants showed higher inflammatory levels of iNOS and were older than cluster 1 and controls and had lower BMI than HC. In addition, they had higher levels of bulimic symptoms than those from the cluster 1 and HC, and higher impulsivity than HC. All ED patients (regardless of cluster) showed higher ED symptoms and more trauma than HC. CONCLUSIONS: Our study revealed that inflammatory dysfunction may be linked with clinical endophenotypes in ED, one more restrictive (cluster 1) with an inflammation/oxidative endophenotype more cytokine and MAPK/ERK mediated, and the other more impulsive, with more bulimic symptoms (cluster 2) with NO free radical high output source iNOS. Trauma seems to be a vulnerability factor for both endophenotypes.

Social cognition deficits in borderline personality disorder: Clinical relevance.

Interpersonal difficulties in borderline personality disorder (BDP) have been suggested to be related to impairments in Social Cognition (SC), mainly due to deficits in Theory of Mind (ToM). However, literature is scarce and ambiguous. This work aims to study the SC impairments in BPD patients, by the specific assessment of ToM deficits, and to investigate the relationship between these SC impairments and clinical variables. 82 BPD patients with BPD and 47 control subjects were assessed with the Movie for the Assessment of Social Cognition (MASC). Clinical variables of severity, chronicity, functionality and anxious-depressive symptomatology were recorded. BPD patients had fewer correct mentalization responses and more overmentalization, undermentalization, and absence of mentalization errors than controls. Chronicity was negatively correlated with overmentalization and positively correlated with undermentalization and absence of mentalization errors. Functionality was indirectly correlated with absence of mentalization. These results confirm previous reports of alterations in SC in BPD patients. Furthermore, this study shows that SC impairments in patients with BPD are dependent on characteristics such as chronicity or degree of functionality. The different ToM profiles in patients with BPD indicate the necessity of developing variants of mentalization therapy depending on the deficits of each patient.

Neurocognitive profile associated with borderline personality disorder: building specific indices of executive function.

The objective of this work is the creation of specific indices of the different executive functions (EF).

Predictive value of the feeling of emptiness in suicidal behaviour of emotionally unstable disorders.

PURPOSE: This study investigates the feeling of emptiness in patients with borderline personality disorder (BPD) and patients with eating disorder (ED) and its relationship with suicidal behaviour and childhood traumatic events. METHODOLOGY: One hundred three BPD patients and 107 ED patients were assessed with the Feeling of Emptiness Scale (FES) and the Traumatic Experiences Questionnaire (TQ). Suicidal behaviour was assessed with a specific interview for frequency and intensity of suicidal behaviour. RESULTS: Significant differences were found between the different factors of the FES between BPD patients and ED patients. A significant relationship was observed between Factors 1 and 4 of the FES and suicidal behaviour scores in both groups. Traumatic experiences were more strongly related to Factors 1, 2 and 4 in BPD patients. CONCLUSIONS: BPD patients and ED patients show similar scores in the global construct of feeling of emptiness. However, results suggest some qualitatively difference between the nature of feeling of emptiness in BPD and in ED. As expected, suicidal behaviour is most frequently in BPD patients, and is significantly associated with Factors 1 and 4 of the FES in both groups. Therefore, feeling of emptiness could be a predictor of suicidal behaviours in patients with emotional and behavioural instability.

Reduced glucocorticoid receptor expression in blood mononuclear cells of patients with borderline personality disorder.

Introduction: Abnormal cortisol suppression in borderline personality disorder has been consistently reported in previous studies, suggesting that a hypersensitivity response of the hypothalamic-pituitary-adrenal (HPA) axis might occur in these patients. In this study, the abnormalities of the cortisol response in borderline personality disorder (BPD) are investigated through the cellular expression of the glucocorticoid receptors (GR) in BPD patients and its relationship with traumatic experiences. Methodology: Sixty-nine male and female patients diagnosed with BPD and 62 healthy controls were studied. Peripheral blood mononuclear cells were obtained to investigate the expression of glucocorticoid receptors. Western blot was used to measure protein expression. Statistical correlations of GR expression with BPD clinical features and intensity of previous traumatic events were investigated. Results: A significant decrease in the nuclear expression of glucocorticoid receptors was found in BPD patients compared to healthy controls in a regression analysis controlling for the effect of medication. GR expression decrease correlated significantly with clinical levels of anxiety and depression, but not with previous traumatic experiences in patients. Conclusions: BPD patients had a lower nuclear expression of glucocorticoid receptors than healthy controls, when it was controlled for the effect of medication. The reduced GR expression in BPD patients was not associated with previous traumatic events and might be associated with other aspects of BPD, such as emotional instability; more studies with larger samples of patients are still needed to understand the relevance and the implications of these findings.

Persistent psychotic symptoms and neurocognitive deficits in borderline personality disorder.

BACKGROUND: Persistent psychotic symptomatology might be present in a group of patients with borderline personality disorder (BPD) according to recent research findings. AIMS: Investigate whether psychotic symptoms could be associated to greater cognitive and functional impairment in BPD patients. METHOD: In this observational, cross-sectional study (PI14/01449 and PI17/01023), we investigated the incidence of persistent psychotic symptoms in BPD patients and its association with specific neurocognitive impairments. A sample of 120 patients with diagnosis of BPD according to DSM IV TR was studied. RESULTS: A substantial number of BPD patients (52, 43,3%) presented psychotic symptoms for a period longer than 6 months. Among BPD patients with psychotic symptoms, 25 (48%) presented hallucinations, 35 (67,3%) presented delusional thoughts and 8 patients (15%) presented both. BPD psychotic patients had greater global severity at the CGI than non-psychotic patients (p 0.02). Psychotic BPD patients had greater impairment in attention (Hedges g = -0.36, 95% CI = -0.72 to 0.00) and in the executive functions domain (Hedges g = -0.48, 95% CI = -0.84 to -0.12) including working memory and cognitive flexibility. There were no differences of neurocognitive performance between patients with hallucinations and patients with delusional thoughts. CONCLUSIONS: Persistent psychotic symptoms are present in one third of BPD patients and are probably associated with neurocognitive and social impairment. Thus, it is a priority to extensively investigate the nature of interactions between psychosis, BPD psychopathology and neurocognitive impairment, in order to better understand BPD phenotypes and to design adjusted treatment interventions.

Hypothalamic-pituitary axis response to a 0.25-MG dexamethasone test in women with fibromyalgia.

Fibromyalgia has been reported as having some clinical overlap with both depression and emotionally-unstable disorders, although both types of disorders present different cortisol suppression response to dexamethasone. In this study we investigated the hypothalamic-pituitary-adrenal system (HPA) in the fibromyalgic syndrome (FMS) using a dexamethasone suppression test (DST) of 0.25 mg designed to specifically detect cortisol hypersuppression. We studied 59 women (20 patients and 39 healthy controls) to whom the DST was administered together with a battery of psychometric tests. In our results, patients with FMS had significant lower levels of basal cortisol pre- and post-DST compared with control subjects. However, cortisol suppression rate in patients after DST was not significantly different than in controls. As other syndromes like post-traumatic stress disorder or emotionally unstable personality disorders, also related with high incidence of severe trauma, FMS patients presented significant low basal cortisol. However, they did not have cortisol hypersuppression as is commonly found in the mentioned disorders. The relation of FMS with lifetime traumas and with emotional instability should be further investigated in order to improve psychological treatment approaches for these patients.LAY SUMMARYPatients with fibromyalgic syndrome have basal hypocortisoism but no cortisol hypersuppression after dexamethasone infusion compared to control subjects, as other trauma-related syndromes.