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Research into BPD SPDN Jeremy Hall Borderline Personality Disorder • First defined by Gunderson • Core features – Affective instability – Interpersonal difficulties – Impulsivity • Heritability about 40% • Strongly associated with early life stress The Scale of the Problem • • • • • BPD affects 1-2% of the population BPD accounts for 10% OPD contacts BPD main diagnosis in 6% admissions Frequent cause of attendance at A&E Associated with a 10% risk of suicide Current Treatments • 1. Pharmacological Treatments – Antidepressants only if concurrent depression – Antipsychotics for perceptual disturbances – Some evidence for mood stabilisers – All trials very small – NICE unable to recommend any treatment Current Treatments • 2. Psychological Treatments – Best evidence is for DBT – Some evidence also for CBT – HOWEVER • Trials generally small • Limited availability • Not suitable for all How can Research help? • Psychological Research – Larger studies – “Real-life” settings • Biological Research – Develop measures of deficits in BPD – Relate these to changes in the brain – Develop new treatments Our Research • Developing measures of BPD symptoms – Affective responses – Interpersonal interactions – Impulsivity • Determining their specificity to BPD • Developing translational assessments Emotion and Impulse Study • 1. Background information • 2. Symptom severity • 3. Computer tests of: – A. Emotion processing – B. Social responses – C. Impulsivity Who did we study? • 20 people with symptoms • 20 people without symptoms • Age range 20-55 • 75% female What did we find out? Background and Symptoms Some things weren’t different… 40 120 100 30 IQ Age 80 20 60 40 10 20 0 0 CON SYMPT CON SYMPT Group Group AGE IQ … and some things were: 50 20 15 Hamilton Child Stress 40 30 20 10 5 10 0 0 CON SYMPT CON SYMPT Group Group CHILD STRESS DEPRESSION Computer tests 1 Emotion Processing Expression in faces Facial Emotion Recognition Anger Happiness Fear Sadness Surprise Disgust Results: Emotions 12 10 ** Score 8 CON SYMPT 6 4 2 0 ANG HAP SAD Task SUR FEAR DIS Emotion Recognition and Trauma Computer tests 2 Social Responses Social decisions Trustworthy? Social Judgement APPROACHABLE NOT APPROACHABLE Results: Social 32 *** 30 ** 28 Score 26 CON SYMPT 24 22 20 18 16 AGE ATT DIS INT Task TRU APP Social Judgement Bias BPD Social Judgement and Trauma Computer tests 3 Impulsivity Motor Impulsivity 400 350 SSRT (ms) 300 250 200 150 100 50 0 CON SYMPT Group Delayed Reward Which would you prefer?: £10 Straight away £20 In two weeks Delayed Reward 100 90 % waiting for later 80 70 60 CON SYMPT 50 40 30 20 10 0 2 7 30 Delay (days) 180 Conclusions Conclusions • We could measure difficulties in core areas: – Emotion processing – Social responses – Impulsivity • What does this mean in the brain? Basis in the brain? PFC AMY The future! Acknowledgements • • • • CSO / SFC Merrick Pope Katie Nicol All the participants Contacts • Jeremy Hall – Email: [email protected] – Tel: 0131 537 6313 • Merrick Pope – Email: [email protected] – Tel: 0131 537 6390