Download BPD and ANT - Edinburgh Research Participation

Morey and Zanarini (2000)
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Patients with BPD described as having unstable
emotions, difficulty maintaining relationships & a
higher probability of self inflicting damage.
DSM- IV (Diagnostic and statistical manual of mental
disorders, 4th edition) is used to classify borderline
personality disorder.
Recent research suggests using a normal
personality test to diagnose BPD - specifically the
FFM.
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Present study looked to compare the FFM
with the categorical model currently in use
Also examined what, if anything, the FFM
missed in diagnosing patients with BPD via
antecedent, concurrent and predictive validity
as criteria.
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Initial screening gathered 378 participants between 18 and 35 years
of age, who had normal or better intelligence, with no previous
symptoms of schizophrenia or bipolar l disorder and had been
assigned a definite or probable Axis 2 diagnosis.
All participants tested on:
Structured Clinical Interview for DSM-III-R Axis 1 disorders
The revised diagnostic interview for borderlines (DIB-R)
The diagnostic interview for DSM-III-R personality disorders (DIPD-R)
NEO-Five Factor Model
Revised childhood experiences questionnaire
Revised Family History Questionnaire
The Dissociative Experiences Scale
Dysphoric affect Scale
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290 met both DIB-R and DSM-III-R criteria for BPD
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72 met DSM-III-R criteria for non-borderline
personality disorder (Control group)
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Borderline and control participants similar in age,
marital status and racial background.
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However, BPD patients came from significantly
lower socioeconomic backgrounds.
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Also, there was a significantly larger number of
female participants with BPD than in the control
group.
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NEO Five-Factor Inventory Descriptive and
Regression Statistics for Patient Groups
Nonborderline
Borderline
Logistic regression
Variable
M
SD
M
SD
B
SE
P
Neuroticism
26.33
7.9
35.07
7.0
.1494
.0222
.0000
Extraversion
25.66
6.7
22.59
6.9
-.0071
.0258
.7821
Openness
30.51
6.6
29.80
6.6
-.0051
.0230
.8252
Agreeableness
32.68
6.5
30.35
6.7
-.0462
.0255
.0698
Conscientiousness
28.59
7.4
28.56
7.7
.0571
.0220
.0095
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Can see neuroticism provides largest difference between
borderline and nonborderline patients.
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However there was still some variance not accounted for in
the NEO-FFI.
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Of the four content areas from the DIB-R, impulse action
patterns was least well represented in the NEO-FFI
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Thus they correlated the NEO-FFI representation of BPD and
the full BPD diagnosis with a number of external markers, e.g.
historical data, and found the NEO-FFI explained a significant
amount of the variance in historical and outcome variables.
However, it did not explain the variance for concurrent
symptoms and history of sexual abuse.
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Three main findings:
The diagnosis of BPD is related to the fivefactor-model of personality (in particular
neuroticism).
Some definitional aspects of BPD are not
fully captured in a FFM as shown by the
NEO-FFI (particularly those under the
domain impulse actions).
Diagnostic elements independent of the
FFM are still valid elements of BPD.
Swanson et al 2000
*I did French at school so this is all goes over my head. If
you can read German/Dutch(?!) please feel free to let
everyone else in on the joke…..
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Plays an important role in attention.
Candidate gene approach-looked at
dopamine receptor D4 (DRD4) on
chromosome 11p15.5.
Initial studies suggested that the DRD4 7repeat allele is associated with ADHD, but
with a small relative risk.
DRD4 7-repeat isn’t necessary (1/2 ADHD
cases don’t have it) or sufficient (some nonADHD-ers have it!)
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Lots of stimulant drugs get to work in the
dopamine synapse
◦ Results in decreased activity, inattention and
impulsivity (i.e. ADHD symptoms)
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Their theory…DRD4 7-repeat allele might
code for subsensitive dopamine receptors in
the frontal lobes and produce underactivity in
the neural networks involved in executive
functions
◦ So, ADHD-ers with the 7-repeat should show more
attention deficits than ADHD-ers without it.
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Subjects-96 ADHD, 48 age and gender
matched controls
◦ ADHD-ers were not medicated at least a day preexp
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Inclusion criteria for ADHD subjects;
◦ “DSM-I V diagnosis of ADHD-Combined Type,
including the endorsement of at least six of nine
symptoms of inattention and six of nine symptoms
of hyperactivity/impulsivity.”
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ANT (Posner and Raichle, 1994)
◦ Tasks probe functions of three brain regions
implicated in the attentional deficits in ADHD
 (anterior cingulate, right dorsolateral prefrontal and
posterior parietal cortex).
•Ss checked frequently while doing tasks.
•Experimenter redirected if necessary.
•Ss given frequent rest periods.
Task
Assessing
Brain region
Colour-word task
Executive function
and conflict
resolution
Anterior cingulate
Cue-detection task
Orienting, shifting
and maintaining
attention
Posterior parietal
and Frontal
Go-change task
Alerting network
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Blood taken from 32 ADHD Ss.
DNA extracted.
40.6% had at least one 7-repeat allele.
◦ ‘7-present’
◦ This statistic is slightly lower than other reports
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59.4% did not have a 7-repeat allele.
◦ ‘7-absent’
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ADHD and controls compared on all three tasks.
◦ RT and SD (variability) of performance revealed large
group differences.
◦ ADHD slower and more variable than controls in all
tasks. (Moderate to large effect sizes.)
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7-repeat absent vs. present (ADHD)
◦ Didn’t differ statistically on ADHD symptom severity, IQ,
meds, ethnicity etc etc.
◦ ‘Present’s didn’t differ from controls in attention tasks.
◦ ‘absent’s performed worse than
‘present’s…..unexpected.
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So…7-present genotype is not necessary for
the manifestation of ADHD-typical cognitive
abnormalities.
7-present ADHD-ers are a subgroup.
◦ ✔ behavioural aspects of ADHD
◦ ✖ cognitive aspects
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7-repeat allele on DRD4 gene might be
associated with extreme placement on
personality/temperament dimension.
‘Absent’ group is heterogeneous, possibly
with other genetic abnormalities, e.g. other
alterations on DRD4 (or similar) genes.
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Small sample size-not a huge turnout for the
blood tests
Other studies have failed to replicate the
present vs. absent findings.
Strict ADHD criteria used means results might
not be representative ADHD inattentive type
or hyperactive/impulsive type .
It’s not all about DRD4.
Fertuck et al., 2002
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A change in research methods
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Posner et al.
◦ Attention Network Task (ANT)
 Alerting
 Orienting
 Conflict/executive control
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Heaton et al.
◦ Wisconsin card sorting task
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Correlation between WCST and conflict scores
of the ANT
Compare their performance with diagnostic
criteria for BPD and GAF
22 female BPD patients
◦ Met DSM-IV BPD criteria
◦ Aged between 18-50
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Computerised version of WCST and ANT
IPDE – generate 3 scores:
◦ 1: categorical
◦ 2: No. of criteria met
◦ 3: dimensional score
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They found that more impaired, higher ANT alertness
scores were correlated with more percent perseverative
errors and responses on the WCST.
More impaired, higher ANT conflict scores were
correlated with increased percent nonperseverative
errors and fewer conceptual level responses on the
WCST.
The found that poorer performances on both the
alertness and orienting scores, but not the conflict
score, were significantly correlated with higher levels of
BPD symptomology. In contrast, the WCST variables
were not related to the extent of BPD symptomology.
Regression analysis and correlations
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2 separate lab assays of executive and
attentional control were correlated with one
another.
Failure on the WCST may be caused by poor
sustained attention.
Construct validity of the ANT task.
Lab based tasks
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Does not differentiate between subtypes of
BPD features
All females
How do basic neurocognitive functions
interrelate with the attachment system and
other higher-order personality variables
such as identity and moral values?
A developmental perspective might point to
the precursors and risk factors of BPD.
Posner et al, 2002
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Kandel (1998/9) argued that new concepts
in neuroscience make it possible to relate
higher level cognition to brain systems
Due to its complexity and lack of organic
markers, BPD poses one of the greatest
challenges to this goal
Present study examines whether patients
with BPD show a systematic deficit in a
circuit known from neuroimaging studies to
be involved in regulation of cognition and
emotion
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That BPD patients will be high in negative
affect and low in effortful control
That BPD patients might exhibit a specific
disorder of mechanisms related to effortful
control
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39 individuals diagnosed with BPD by trained
psychiatrists
22 individuals that showed similar levels of
negative affect and effortful control as
measured by the Adult Temperament
Questionnaire (ATQ)
70 individuals that showed mean levels of
these two temperamental variables
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All completed the attention network test
(ANT) – reaction time test that provides
evaluation of efficiency on alerting,
orientation and conflict resolution
For all participants correlated ANT scores
with effortful control measures of the ATQ.
Previous studies shown that effortful
control as measured by a child version of
the ATQ correlates with the ability to
resolve conflicts
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ANOVAs showed no difference between
groups on overall RT, error rate, alerting or
orientating scores
However patients were found to differ
significantly from average controls but not
temperamental controls on conflict
resolution, controlling for age and
medication.
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Seems to be a specific abnormality in BPD
patients in an attentional network involved in
conflict resolution only
However were unable to indentify
abnormalities in candidate genes.
Suggested that difficulties in socialization
might produce inappropriate development of
attentional mechanisms
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Neuroimaging studies show the conflict
resolution network involves the anterior
cingulate gyrus, which develops between
ages 2-7.
In children and adults, lesions in this area,
produce a tendency towards poor
interpersonal relationships, a common
symptom of BDP.
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BPD patients did not differ significantly from
temperamental controls
No indication that children who fail to
develop conflict resolution mechanisms end
up with BPD
Unable to indentify abnormalities in
candidate genes related to conflict resolution
in BPD patients.
Clarkin & Posner (2005)
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Personality disorders allow for examining the mental
structures of people experiencing difficulty in
interacting with their social environment
Borderline Personality Disorder (BPD) is characterized
by turbulent, angry, and depressive emotional states,
unstable interpersonal relationships, an incoherent
and often contradictory self-concept, and impulsive
and often dangerous behaviours such as self-injury.
It is complex and lacks clear organic markers,
making it difficult to understand it psychobiological
development
Unique paper as a collaboration of researchers with
different areas of expertise
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5 or more of the 9 criteria for BPD in DSM-IV
Grinker (1968) suggests impulsivity and
negative affectivity are the core personality
traits
Must go beyond the symptom level though as
this does not explain the mechanisms of
action
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Temperament and its relationship to
biological systems provide an organising
scheme for the investigation of the
development of BPD
This research has been guided by a model of
temperament with it relating to:
-negative effect
-evolving self control
-internal sense of self and others
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Negative Affect and Defective Self Regulation:
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Identity Diffusion:
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Attachment:
Negative affect invades information processing and
organisation of personal experiences. There is poor
regulation of negative affect and this inability is
seen in impulsive behaviours
In DSM-IV criteria and is the lack of integration of
the concept of self and others. These poor
integrations derive from excessive dissociations
between positive and negative affect
Insecure attachments developed in childhood
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BPD is an interaction of:
-temperament
-low effortful control
-lack of sense of self and others
-insecure, anxious attachment style
Treatments should focus on the information
processing system that results from this
symptom interaction
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Temperament:
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Attentional Network Task:
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Conceptualization of Interpersonal Relations:
Used the Adult Temperament Questionnaire and BPD
(high neg. Affect, low effortful control) were
compared to 2 control groups1. Temperamentally matched controls
2. Average controls
Patients differed from both control groups in the
conflict network only suggesting abnormality in the
attentional network. Temperament may play a role in
the disorder
Effortful control is developed via childhood
attachment
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Psychotherapy is the primary technique
Alternatives include:
-Psychodynamic treatment
-Dialectical-Behavioural therapy
-Transference-Focused Psychotherapy
The variables investigated in this research
paper should be incorporated into treatment
plans
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Interaction between patient and therapist:
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Neurocognitive Impediments to Treatment
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Emotion Processing:
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Sense of Self and Others
The interaction can be seen as a primary vehicle
for change. Treatments are aware but have a
differing degree of emphasis
Enhancement of emotional regulation
Examine interactions and if infused with hostility
then give corrective perception
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Model developed to better understand the
development of the neural networks that
underlie the abnormalities found in BPD
Hopefully this will bring research a step
closer to working out the interaction between
temperament, genes and experience that
produce the disorder
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Review of research on BPD
They agree identifying underlying mechanisms is
important in the research of BPD. Its
characterised by turbulent fluctuations and
hopefully this work can help de-mystify and destigmatize this disorder
Future studies may want to look at task
performance in relation to actual social behaviour
e.g. suicidality rather than just its associations
with diagnosis
McNally (2006)
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Anxiety disorder- usually in response to a terrifying
event.
Hallmark characteristic- sufferers relive their trauma
in the form of involuntary recollection.
This mediated research on examining the cognitive
mechanisms of PTSD.
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Phenomenological research has provided clues as to how memory
for a trauma is represented in memory- e.g. repetitive, unwanted
thoughts, vivid flashbacks.
Vivid flashbacks of stimuli that preceded the most frightening
part of the trauma as opposed to the most terrifying part of the
trauma per se.
Visual flashbacks= most common.
Halligan et al. (2003)- memories of trauma are more disorganised
in PTSD patients than those without PTSD and the severity of
the disorganisation predicts subsequent PTSD pathology.
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Meta-cognitive appraisals of post-traumatic symptoms predicts
the maintenance of PTSD (Ehlers et al., 2002).
Brewin (2003)- Dual-representation system.
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Emotional Stroop studies have consolidated finding that there is
involuntary recollection about the trauma in PTSD patients.
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Patients with PTSD take longer to name the colours of words associated
to their trauma than the trauma- exposed group without PTSD.
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Pathophysiological model of PTSD
- either hyper-responsive amygdala and/or hypo-responsive prefrontal
cortical regions.
- medial PFC (prefrontal cortex) for extinguishing conditioned fear.
Supported by Shin et al. (2004)- fearful vs happy facial expressions.
- also, smaller anterior cingulate cortex volumes in PTSD patients
compared with trauma-exposed individuals without PTSD. Yamasue et
al. (2003) and Woodward et al. (2006) also found the smaller the ACC
(anterior cingulate cortex) volume, the greater the severity of PTSD
symptoms.
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Many PTSD patients- learning and memory deficits.
Neurocognitive abnormalities might constitute potential risk
factors for PTSD e.g. attention deficits problems in early
childhood.
Role of IQ
-several studies shown that higher intelligence = resilience
factor.
- supported by Breslau et al. (in press) and also by twin studies
conducted by Gilbertson et al. (in press).
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PTSD patients find it difficult to recall specific
memories from the past.
Suggested that this might serve an emotionregulation function
- enabling distressed individuals to avoid dwelling on
terrifying events from their past.
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Hippocampus integral to autobiographical memory.
Many studies- individuals with PTSD have smaller
hippocampi volume than those without PTSD.
- supported by Gilbertson et al. (2002)- twin
study.
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Intrusive recollection of trauma appears to be mediated by
functional abnormalities in either the amygdala or PFC or
both.
- supported by the Emotional Stroop effect and neuroimaging.
Phenomenological research suggest a dual-representation
system of traumatic events.
Identified vulnerability factors for PTSD: lower IQ,
overgeneral memory and small hippocampi.