ABSTRACT
Borderline personality disorder (BPD) is a severe psychiatric condition that affects up to 2.7% of the population and is highly linked to functional impairment and suicide. Despite its severity, there is a lack of knowledge about its pathophysiology. Studies show genetic influence and childhood violence as factors that may contribute to the development of BPD; however, the involvement of neuroinflammation in BPD remains poorly investigated. This article aimed to explore the pathophysiology of BPD according to the levels of brain-derived neurotrophic factor (BDNF), inflammatory cytokines, and oxidative stress substances that exacerbate neuronal damage. Few articles have been published on this theme. They show that patients with BPD have a lower level of BDNF and a higher level of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in peripheral blood, associated with increased plasma levels of oxidative stress markers, such as malondialdehyde and 8-hydroxy-2-deoxyguanosine. Therefore, more research on the topic is needed, mainly with a pre-clinical and clinical focus.
Subject(s)
Borderline Personality Disorder , Humans , Child , Borderline Personality Disorder/epidemiology , Borderline Personality Disorder/genetics , Borderline Personality Disorder/psychology , Brain-Derived Neurotrophic Factor/genetics , Interleukin-6 , Tumor Necrosis Factor-alphaABSTRACT
OBJECTIVE: Genetic factors underlying different personality traits are not entirely understood, particularly how genes interact to modulate their effect. We studied 76 patients diagnosed with borderline personality disorder (BPD), characterized by extreme levels of personality traits, especially neuroticism (N), in which we genotyped two polymorphisms, the 5HTTLPR of the Serotonin transporter (SERT) gene, and the Val66Met of the Brain-derived neurotrophic factor (BDNF) gene. RESULTS: We found an association with SERT, where S-allele carriers had significantly higher levels of N than L-homozygous. Furthermore, we found that the protective effect of L-homozygosity is only evident on A-allele carriers of the BDNF Val66Met polymorphism. Genetic constitution in SERT and BDNF seems to be important in neuroticism, the most relevant personality trait on BPD.
Subject(s)
Borderline Personality Disorder/genetics , Borderline Personality Disorder/physiopathology , Brain-Derived Neurotrophic Factor/genetics , Neuroticism , Serotonin Plasma Membrane Transport Proteins/genetics , Adult , Female , Humans , Male , Polymorphism, Single NucleotideABSTRACT
Borderline personality disorder (BPD) is highly prevalent and associated with significant dysfunctional behavior and suicide risk. The association with psychosocial factors is well established, however its neurobiology is not fully unraveled. According with the revised studies, subjects with BPD have structural and functional brain alterations, particularly in areas involved in affective and cognitive regulation and control of impulses. These alterations allow us to understand the psychopathology of this disorder and partly explain its pathogenesis.
Subject(s)
Borderline Personality Disorder , Borderline Personality Disorder/genetics , Borderline Personality Disorder/pathology , Borderline Personality Disorder/psychology , Brain/pathology , Brain/physiopathology , Cognitive Behavioral Therapy , Empathy , HumansABSTRACT
Borderline personality disorder (BPD) is highly prevalent and associated with significant dysfunctional behavior and suicide risk. The association with psychosocial factors is well established, however its neurobiology is not fully unraveled. According with the revised studies, subjects with BPD have structural and functional brain alterations, particularly in areas involved in affective and cognitive regulation and control of impulses. These alterations allow us to understand the psychopathology of this disorder and partly explain its pathogenesis.
Subject(s)
Humans , Borderline Personality Disorder , Borderline Personality Disorder/genetics , Borderline Personality Disorder/pathology , Borderline Personality Disorder/psychology , Brain/pathology , Brain/physiopathology , Cognitive Behavioral Therapy , EmpathyABSTRACT
The relationship between bipolar disorder and borderline personality disorder remains controversial since in both conditions there are overlapping and similar symptomatic dimensions. Symptomatic dimensions suitable to subserve differential diagnosis are: mood, mood variability mode, and personal and family history. Characteristics of psychotic symptoms may also be useful in the differentiation. On the other hand, anxiety symptoms, neuropsychological profiles, neuro-imaging procedures and biomarkers seem not to contribute to differentiate between both diseases. The presentation of nonsuicidal self mutilation behavior can offer some differences between bipolar and borderline personality disorders, but both can coexist in clinical comorbid forms and do not significantly contribute to the differential diagnosis. Differential diagnosis is complicated by the fact that a low percentage of patients can experience comorbidity of both conditions. In this work we review all these issues, and particularly emphasize the importance of sitematically take into account the patient background, the course that follows his or her disorder, together with the outcome in response to medical decisions.
Subject(s)
Bipolar Disorder/diagnosis , Borderline Personality Disorder/diagnosis , Bipolar Disorder/epidemiology , Bipolar Disorder/genetics , Bipolar Disorder/therapy , Borderline Personality Disorder/epidemiology , Borderline Personality Disorder/genetics , Borderline Personality Disorder/therapy , Comorbidity , Diagnosis, Differential , Female , Humans , Longitudinal Studies , Male , Phenotype , Prevalence , Self Mutilation , Treatment OutcomeABSTRACT
Introduction: Impulsiveness and aggressiveness are characteristics of borderline personality disorders. Aggressive and impulsive behaviors are associated to a serotoninergic system dysfunction and are treated with selective serotonin reuptake inhibitors (SSRJs). The short (S) allele of the serotonin transporter promoter (5-HTTPR) gene is associated to a worse response to SSRI in major depression. The objective of this work is to study the anti-impulsive effect of fluoxetine and his relation with short and long alleles of 5-HTTPR gene in borderline personality disordered patients. Method: 59 patients with DSM-IV borderline personality disorder were treated with fluoxetine for 12 weeks. Impulsivity was evaluated with the Overt Aggression Scale Modified (OAS-M). Polymorphisms L and S of the 5-HTTPR gene were determined. Results: S carriers (LS and SS) had a significantly minor response on OAS-M and Aggression subscale than LL carriers. Conclusions: S allele of the 5-HTTPR gene predicts poor response to anti-impulsive effect of fluoxetine in borderline personality disorder. It is likely that multiple genes contribute to a SSRI response.
Introducción: Los trastornos límite de personalidad se caracterizan por una elevada impulsividad y agresividad. Las conductas agresivas e impulsivas se han asociado a disfunciones del sistema serotoninérgico y responden a los inhibidores de la recaptura de serotonina (ISRS). En depresión mayor el alelo corto (S) del promotor del gene del transportador de serotonina se asocia a pobre respuesta a los ISRS. El objetivo de este trabajo es estudiar el efecto anti-impulsivo de serotonina y su relación con los alelos LyS en pacientes con trastorno límite de personalidad. Método: 59 pacientes con trastorno límite de personalidad fueron tratados por 12 semanas confluoxetina. Se evaluó la impulsividad mediante la Overt Aggression Scale Modified (OAS-M)y se determinó los polimorfismos LyS. Resultados: Los portadores de S (LS y SS) presentaron una menor reducción en la OAS-M total y en la subescala de agresividad que los homocigotos LL. Conclusiones: En trastorno límite de personalidad el alelo S del promotor del gene del transportador de serotonina predice pobre respuesta anti-impulsiva de la fluoxetina. Probablemente múltiples genes participen en la respuesta a los ISRS.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Antidepressive Agents, Second-Generation/therapeutic use , Fluoxetine/therapeutic use , Polymorphism, Genetic , Borderline Personality Disorder/genetics , Borderline Personality Disorder/drug therapy , Aggression , Impulsive Behavior/psychology , Selective Serotonin Reuptake Inhibitors/therapeutic use , Pharmacogenetics , Promoter Regions, Genetic , Psychiatric Status Rating Scales , Serotonin Plasma Membrane Transport Proteins , Borderline Personality Disorder/psychologyABSTRACT
BACKGROUND: Suicide prediction is a huge challenge for mental health workers. Structured interviews based on epidemiological and clinical factors don't show effectiveness for suicide prevention. Biological markers, such as 5-HTTLPR, could help for identification of potential suicide attempters. METHODS: We evaluated 198 bipolar patients and 103 health controls, using a structured interview according to DSM-IV criteria. Genotyping, blind of clinical assessment for identification of S carriers and structured interviews were performed in order to describe clinical and epidemiological factors which could be associated with suicide behavior. Statistical analyses were calculated by the x(2) test and logistic regression model. RESULTS: We found that 26.77% and 16.67% had a lifetime history of non violent suicide attempt and violent suicide attempt, respectively. The clinical factors associated with violent and non violent suicide attempt had several differences. Violent suicide attempters had an earlier illness onset and had a higher number of psychiatric comorbidities (borderline personality disorder, panic disorder and alcoholism). The frequency of S allele carriers was higher only in those patients who had made a violent suicide attempt in their lifetime (x(2)=16.969; p=0.0001). In a logistic regression model including these factors, S allele carrier (5-HTTLPR) was the only factor associated with violent suicide attempt. LIMITATIONS: Sample size and retrospective assessment of suicide behavior history are the limitations of this study. CONCLUSIONS: Our study showed that serotonin polymorphism (5-HTTLPR) is strongly associated with violent suicidal behavior in BD patients. If confirmed, our results could be an important step to create a genetic tool for long-term suicide prediction.
Subject(s)
Alleles , Bipolar Disorder/genetics , Genetic Markers/genetics , Polymorphism, Genetic/genetics , Serotonin Plasma Membrane Transport Proteins/genetics , Suicide, Attempted/psychology , Adult , Age of Onset , Alcoholism/diagnosis , Alcoholism/genetics , Alcoholism/psychology , Bipolar Disorder/diagnosis , Bipolar Disorder/psychology , Borderline Personality Disorder/diagnosis , Borderline Personality Disorder/genetics , Borderline Personality Disorder/psychology , Comorbidity , Female , Genetic Carrier Screening , Genetic Predisposition to Disease/psychology , Genotype , Humans , Logistic Models , Male , Middle Aged , Panic Disorder/diagnosis , Panic Disorder/genetics , Panic Disorder/psychology , Risk Factors , Violence/psychologyABSTRACT
En la última década la literatura sobre la relación entre género y trastorno límite de la personalidad (TLP) generó mucha controversia y poca claridad. Recientemente, el TLP fue caracterizado como la "chica mala" de las etiquetas psiquiátricas (5); una acusación que implica una mayor utilización de este diagnóstico en las mujeres y un sesgo de género en la identificación de esta patología. El DSM IV establece que el trastorno límite de la personalidad se diagnostica predominantemente (75) en mujeres (10). La cuestión esencial a plantear entonces es si la mayor prevalencia en mujeres se debe a un sesgo en la muestra o en el diagnóstico o si reflejaría una diferencia biológica o sociocultural entre hombres y mujeres. El objetivo de este trabajo es mostrar y delinear algunas cuestiones sobre la aparente diferencia 3:1 entre mujeres y hombres con esta patología.
In the last decade, literature concerning gender and borderline personality disorder has aroused much controversy and little lightness. Recently, borderline personality disorder has been characterized as the "bad girl" of the psychiatric terms; this implies a bigger use of this diagnose in women and a biased gender in the identification of this disorder. The Diagnostic and Statistical Manual of Mental Disorders states that borderline persona lit y disorder is mostly diagnosed in women (75). The essential question to discuss is whether the larger prevalence in women is due to a biased sample or a biased diagnoses or it reflects a sociocultural and biological difference between men and women. The aim of this paper is to analyze some issues about the difference 3:1 women and men in this disorder.
Subject(s)
Humans , Female , Gender Identity , Borderline Personality Disorder/diagnosis , Prejudice , Borderline Personality Disorder/genetics , Sex OffensesABSTRACT
A partir del año 2000 la Universidad de Chile desarrolla el Programa de Doctorado en Ciencias Médicas y Especialidad, cuyo objetivo es formar un médico especialista y doctor en Ciencias Médicas competente para realizar investigación clínica del más alto nivel, integrando conocimientos y metodologías del área de las ciencias básicas con aquellas de las ciencias clínicas. El año 2002 se abrió por primera vez la posibilidad de desarrollar simultáneamente la formación como especialista en Psiquiatría de Adultos y como Doctor en Ciencias Médicas. Dados los espectaculares avances de la Neurociencia a nivel mundial, los cuales se habían traducido en importantes progresos en el diagnóstico y tratamiento de los enfermos mentales, parecía lógico invertir recursos orientados hacia el fortalecimiento del diálogo entre los médicos clínicos y los científicos básicos en el país. En el marco de este programa se desarrolló la tesis de doctorado cuyo resumen se presenta a continuación, la cual representa la unión de esfuerzos de profesionales y estudiantes de la Unidad de Trastornos de la Personalidad de la Clínica Psiquiátrica Universitaria y de los Programas de Genética Humana y de Biología Celular y Molecular del Instituto de Ciencias Biomédicas de la Facultad de Medicina de la Universidad de Chile.
Since 2000, University of Chile develops the Doctorate in Medical Sciences Program which is associated to a medical specialty. Its objective is to prepare a specialist MD and PhD capable of developing high quality clinical research, by integrating knowledge and methodologies of basic and clinical sciences. On 2002 the Program considered for the first time Psychiatry as the associated specialty. Given the spectacular progress of Neurosciences around the world, which have determined significant changes in the diagnosis and treatment of mental disorders, it seemed rational to invest resources destined to strengthen the dialog between clinical and basic scientists in Chile. The doctoral thesis that is hereby presented as a summary was developed in the context of this program. It was made possible by the joint efforts of professionals and students of the Personality Disorders Unit of the University Psychiatric Clinic and of the Programs of Human Genetics and of Cell and Molecular Biology of the Biomedical Sciences Institute of the Faculty of Medicine of University of Chile.
Subject(s)
Humans , Male , Female , Polymorphism, Genetic , Borderline Personality Disorder/geneticsABSTRACT
El presente trabajo describe un trabajo clínico realizado en el contexto de la Unidad Docente de Psicoterapia Breve del Hospital Salvador de Santiago, discute la pertinencia de una interpretación genética en psicoterapia breve en una paciente limítrofe y analiza la importancia del diagnóstico al hacer este tipo de indicación por sobre los criterios de selección propuestos por diferentes autores