[Neuropsychological dysfunctions in personality borderline disorder: detection strategies]. / Alteraciones neuropsicológicas en el trastorno límite de la personalidad: estrategias de detección.

INTRODUCTION: Borderline personality disorder (BPD) is characterized by emotional instability and impulsivity. However, there is evidence that neurocognitive alterations have a relevant role in the clinical features of these patients. The present study investigates cognitive function in BPD in order to search for a specific profile of neuropsychological alterations. METHODS: Based on previous research and cognitive complaints reported by patients, a neuropsychological assessment protocol focused on prefrontal functioning was applied. The applied neuropsychological battery included tests assessing the following cognitive domains: memory (fixation, consolidation and recovery processes) categorical evocation, cognitive flexibility, sustained attention, processing rate, inhibitory control and working memory. The patient sample was recruited from an outpatient BPD unit and was composed by 26 patients (14 women, 12 men) diagnosed of BPD. RESULTS: In comparison to the normative values, BPD patients have a deficit in the execution of most of the neuropsychological tests. This deficit was especially present in the following: recovery processes of the immediate and differed memory, working memory, sustained attention and processing rate, verbal fluency, impulse control, cognitive flexibility, abstraction and planning. CONCLUSIONS: BPD patients could present a pattern of neurocognitive alterations that suggests a specific impairment of the prefrontal areas and requires a more detailed study. The neuropsychological dysfunctions could partially explain the behavioral alterations in BPD patients.

[Neuropsychological rehabilitation in patients with borderline personality disorder: a case series]. / Rehabilitación neuropsicológica en pacientes con trastorno límite de personalidad: una serie de casos.

Recent research studies have been confirming the evidence that patients with personality borderline disorder (BPD) suffer significant neuropsychological disorders. Neurocognitive dysfunction of BPD seems to mainly affect the functions characteristic of the prefrontal areas that participate in information processing and management and in the regulation of complex behavioral responses. Neuropsychological disorders not only are seen in the specific tests but are also reflected and could play an important role in the clinical manifestations of borderline disorder, such as emotional dysregulation and impulsive behaviors. Neurocognitive rehabilitation therapy has been used successfully in psychiatric disorders such as schizophrenia, also characterized by the presence of neuropsychological dysfunctions. Thus, it can be expected that rehabilitation of the neurocognitive functions affected in BPD contributes to the patient's functional improvement. The present work describes a series of five patients with BPD who presented important neuropsychological dysfunctions and who were treated successfully with a specific program of neurocognitive rehabilitation. The results observed justify the performance of controlled clinical studies on the efficacy of this technique in the treatment of BPD.

Alteraciones neuropsicológicas en el trastorno límite de la personalidad: estrategias de detección / Neuropsychological dysfunctions in personality borderline disorder: detection strategies

Introducción. Los síntomas más característicos del trastorno límite o «borderline» de la personalidad (TLP) son la inestabilidad afectiva y la impulsividad. No obstante, existen indicios de que las alteraciones neurocognitivas podrían tener un papel relevante en la clínica de estos trastornos. El objetivo del presente estudio es investigar la función cognitiva en el TLP y buscar un patrón específico de alteraciones neuropsicólogicas. Metodología. Sobre la base de investigaciones anteriores y de las quejas cognitivas referidas por los pacientes, se ha aplicado un protocolo de evaluación neuropsicológica centrado en las funciones prefrontales. La batería neuropsicológica aplicada estaba compuesta por diferentes pruebas que evalúan los siguientes dominios cognitivos: memoria (procesos de fijación, consolidación y de recuperación), evocación categorial, flexibilidad cognitiva, atención sostenida, velocidad de procesamiento, control de inhibición y memoria de trabajo. Se han evaluado 26 pacientes diagnosticados de TLP, de los cuales 14 eran mujeres y 12 hombres, todos ellos pertenecientes al Servicio de Psiquiatría del Hospital Clínico San Carlos. Resultados. En comparación con los valores normativos, los pacientes con TLP presentan un déficit en la ejecución de la mayoría de las pruebas neuropsicológicas utilizadas, especialmente en los procesos de recuperación de memoria inmediata y diferida, memoria de trabajo, atención sostenida y velocidad de procesamiento, fluidez verbal, control de impulsos, flexibilidad cognitiva, abstracción y planificación. Conclusiones. El TLP podría presentar un patrón de alteraciones neurocognitivas que sugiere una afectación específica de áreas prefrontales y que precisa ser estudiado con mayor detalle. Las disfunciones neuropsicológicas podrían explicar parcialmente las alteraciones conductuales de estos pacientes (AU)

Introduction. Borderline personality disorder (BPD) is characterized by emotional instability and impulsivity. However, there is evidence that neurocognitive alterations have a relevant role in the clinical features of these patients. The present study investigates cognitive function in BPD in order to search for a specific profile of neuropsychological alterations. Methods. Based on previous research and cognitive complaints reported by patients, a neuropsychological assessment protocol focused on prefrontal functioning was applied. The applied neuropsychological battery included tests assessing the following cognitive domains: memory (fixation, consolidation and recovery processes) categorical evocation, cognitive flexibility, sustained attention, processing rate, inhibitory control and working memory. The patient sample was recruited from an outpatient BPD unit and was composed by 26 patients (14 women, 12 men) diagnosed of BPD. Results. In comparison to the normative values, BPD patients have a deficit in the execution of most of the neuropsychological tests. This deficit was especially present in the following: recovery processes of the immediate and differed memory, working memory, sustained attention and processing rate, verbal fluency, impulse control, cognitive flexibility, abstraction and planning. Conclusions. BPD patients could present a pattern of neurocognitive alterations that suggests a specific impairment of the prefrontal areas and requires a more detailed study. The neuropsychological dysfunctions could partially explain the behavioral alterations in BPD patients (AU)

Rehabilitación neuropsicológica en pacientes con trastorno límite de personalidad: una serie de casos / Neuropsychological rehabilitation in patients with borderline personality disorder: a case series

La evidencia de que los pacientes con trastorno límite de la personalidad (TLP) padecen alteraciones neurospicológicas significativas se ha ido confirmando en recientes estudios de investigación. La disfunción neurocognitiva del TLP parece afectar principalmente a funciones propias de las áreas prefrontales que participan en el procesamiento y manejo de la información y en la regulación de las respuestas conductuales complejas. Las alteraciones neuropsicológicas no sólo se evidencian en los tests específicos sino que se reflejan y podrían tener un papel importante en las manifestaciones clínicas del trastorno límite, como la disregulación emocional y las conductas impulsivas. La terapia de rehabilitación neurocogntiva ha sido utilizada con éxito en trastornos psiquiátricos como la esquizofrenia, caracterizada también por la presencia de disfunciones neuropsicológicas. Por ello es esperable que la rehabilitación de las funciones neurocognitivas afectadas en el TLP contribuya a la mejoría funcional de los pacientes. En el presente trabajo se describe una serie de cinco pacientes con TLP que presentaban disfunciones neuropsicológicas notables y que fueron tratados con éxito mediante un programa específico de rehabilitación neurocognitiva. Los resultados observados justifican la realización de estudios clínicos controlados de la eficacia de esta técnica en el tratamiento del TLP (AU)

Recent research studies have been confirming the evidence that patients with personality borderline disorder (BPD) suffer significant neuropsychological disorders. Neurocognitive dysfunction of BPD seems to mainly affect the functions characteristic of the prefrontal areas that participate in information processing and management and in the regulation of complex behavioral responses. Neuropsychological disorders not only are seen in the specific tests but are also reflected and could play an important role in the clinical manifestations of borderline disorder, such as emotional dyregulation and impulsive behaviors. Neurocognitive rehabilitation therapy has been used successfully in psychiatric disorders such as schizophrenia, also characterized by the presence of neuropsychological dysfunctions. Thus, it can be expected that rehabilitation of the neurocognitive functions affected in BPD contributes to the patient’s functional improvement. The present work describes a series of five patients with BPD who presented important neuropsychological dysfunctions and who were treated successfully with a specific program of neurocognitive rehabilitation. The results observed justify the performance of controlled clinical studies on the efficacy of this technique in the treatment of BPD (AU)

[Long-acting injectable risperidone in treatment resistant borderline personality disorder. A small series report]. / Risperidona intramuscular de acción prolongada en el trastorno límite de la personalidad resistente al tratamiento.Un estudio piloto.

INTRODUCTION: Borderline personality disorder (BPD) is usually treated with a combination of antipsychotic and anticonvulsant drugs although only limited efficacy is obtained in many patients. A major problem in the treatment of BPD is the lack of compliance derived form the pathological impulsivity of BPD patients. METHODS: Twelve severe BPD patients refractory to previous treatment with drug combinations for three months were treated with intramuscular long-acting risperidone for a six-month period. Clinical changes were rated with the Clinical Global Impression (CGI), the Brief Psychiatric Rating Scale, anxiety and aggression scales. Functional improvement was evaluated with the Global Assessment of Functioning (GAF). RESULTS: Six-month treatment with IM risperidone was associated with significant improvement of CGI (t: 5.7 - 4.0; p<0.01) and of GAF (t: -4.5; gl: 10; p<0.01). Clinical improvement was robust after the first month of treatment. No relevant extrapiramidal side effects were reported with the exception of mild psychomotor slowing which requires dose adjustments in four patients. CONCLUSIONS: Treatment with i.m. long acting risperidone during six months was associated with significant clinical and functional improvement and excellent tolerability in a group of BPD patients refractory to previous treatment. The results indicate that the effect of IM risperidone in BPD should be further investigated in large placebo-controlled trials.

Risperidona intramuscular de acción prolongada en el trastorno límite de la personalidad resistente al tratamiento. Un estudio piloto / Long-acting injectable risperidone in treatment resistant borderlinepersonality disorder. A small series report

Introducción. El uso de fármacos antipsicóticos de segunda generación en combinación con fármacos anticomiciales en el trastorno límite de la personalidad (TLP) es común, pero muchos pacientes obtienen con ellos una mejoría muy limitada. Uno de los inconvenientes principales del tratamiento es el deficiente cumplimiento debido a la propia psicopatología impulsiva de los pacientes con TLP. Métodos. Doce pacientes con TLP grave y refractarios a tratamientos de combinación previos durante 3 meses fueron tratados con risperidona intramuscular de acción prolongada por un período de 6 meses. Se evaluaron los cambios clínicos mediante la Impresión Clínica Global (CGI), la Brief Psychiatric Rating Scale, las escalas de ansiedad y de depresión de Hamilton y la escalas de agresión. Se evaluó la mejoría funcional mediante la evolución de la Escala de Funcionamiento Global (GAF) del DSM-IV. Resultados. El tratamiento durante 6 meses se asoció a una mejoría significativa reflejada en la CGI (t: 5,7; gl: 10;p<0,01) y en la GAF (t: –4,5; gl: 10; p<0,01) que comenzó a consolidarse a partir del primer mes de tratamiento. No se registraron efectos extra piramidales relevantes, con excepción de un moderado enlentecimiento psicomotor que requirió ajustes de dosis en cuatro pacientes. Conclusiones. El uso de risperidona intramuscular de larga duración durante 6 meses se asoció a una significativa mejoría clínica y funcional y a una excelente tolerancia en un grupo de pacientes con TLP resistentes a tratamientos previos, lo que sugiere la conveniencia de investigar este efecto en ensayos clínicos controlados (AU)

Introduction. Borderline personality disorder (BPD) is usually treated with a combination of antipsychotic and anticonvulsant drugs although only limited efficacy is obtained in many patients. A major problem in the treatment of BPD is the lack of compliance derived form the pathological impulsivity of BPD patients. Methods. Twelve severe BPD patients refractory to previous treatment with drug combinations for three months were treated with intramuscular long-acting risperidone for a six-month period. Clinical changes were rated with the Clinical Global Impression (CGI), the Brief Psychiatric Rating Scale, anxiety and aggression scales. Functional improvement was evaluated with the Global Assessment of Functionng (GAF).Results. Six-month treatment with IM risperidone was associated with significant improvement of CGI (t: 5.7; gl: 10; p<0.01) and of GAF (t: –4.5; gl: 10; p < 0.01).Clinical improvement was robust after the first month of treatment. No relevant extrapiramidal side effects were reported with the exception of mild psychomotor slowing which requires dose adjustments in four patients. Conclusions. Treatment with i. m. long acting risperidone during six months was associated with significant clinical and functional improvement and excellent tolerability yin a group of BPD patients refractory to previous treatment. The results indicate that the effect of IM risperidone in BPD should be further investigated in large placebo-controlled trials (AU)