A Cluster Analysis of Neuropsychological Impairment in Borderline Personality Disorder: Identifying a Neurocognitive Subtype Linked to Attention Deficit Hyperactivity Disorder.

INTRODUCTION: Cognitive impairment associated with borderline personality disorder (BPD) has been consistently demonstrated. However, a specific neuropsychological profile has not yet been established for this disorder, maybe due to the heterogeneity of BPD. The aim of this work is the search for distinct neuropsychological subtypes among patients with BPD and for the association of neuropsychological subgroups with specific clinical characteristics. METHODOLOGY: One hundred fifteen patients with BPD diagnosis received an extensive neuropsychological evaluation assessing attentional, memory and executive functions indexes. For subtyping strategies, a cluster analysis of neuropsychological BPD distribution was performed. Central clinical dimensions of BPD were measured and analysed in relation with the obtained neuropsychological clusters. RESULTS: Two clusters were found: Cluster 1 showed a significantly lower score on the working memory index, and Cluster 2 had significantly worse overall executive performance, response inhibition and planning abilities. Patients in the neurocognitive Cluster 2 showed significantly higher clinical deficits of attention as measured with subscales of the CAARS attention deficit hyperactivity disorder (ADHD) index (F = 2.549, p < 0.005, d = 11.49). CONCLUSIONS: Two neuropsychological clusters of patients were found in the BPD sample: Cluster 1 patients showed greater impairment in working memory, while Cluster 2 patients had greater deficits of executive functioning, particularly for response inhibition and planning. In addition, BPD patients with greater executive deficits presented greater levels of ADHD clinical features. These findings might also facilitate earlier diagnosis of severe BPD patient profiles and to establish more personalized treatment based on neurocognitive stimulation.

The mediating role of reflective functioning in the association between childhood trauma and suicide attempt.

BACKGROUND: Childhood trauma is intimately related with suicidal behaviour. Patients who have suffered childhood trauma develop impaired Reflective Functioning (RF), which refers to the capacity to understand ourselves and others in terms of intentional mental states. An improvement in RF has been associated with a reduction in suicidal attempts, but the mediating role of RF between childhood trauma and suicidal behaviour has not been addressed so far. OBJECTIVE: We aim to examine the potential mediating effect of RF among childhood trauma and suicide attempts. METHOD: We included 748 patients who had attempted suicide at least once. They were asked to complete the Reflective Functioning Questionnaire (RFQ-8), the Columbia-Suicide Severity Rating scale (CSSRS), and the Childhood Trauma Questionnaire-Short Form (CTQ-SF). We conducted linear regressions by simple mediating model to examine the role of RF in the indirect association between childhood trauma and the number of suicide attempts. RESULTS: Our results show significant indirect effects through hypo and hypermentalizing between Emotional Abuse (EA) and Sexual Abuse (SA) in childhood and the number of suicide attempts in lifetime. These results indicate that ineffective RF significantly mediates the association between childhood trauma and suicidality. CONCLUSION: This is the first study supporting the mediational role of RF in the relationship between EA and SA, and the number of suicide attempt in lifetime. These findings have important implications for reducing suicide rates and preventing future re-attempts. Further studies analysing this mediating role and focusing efforts on increasing RF-based interventions are required.

Transdiagnostic inflammatory and oxidative biomarkers with predictive capacity of self-injurious behavior in impulsive and unstable disorders.

INTRODUCTION: Alterations in inflammatory processes have previously been reported in impulsive and unstable disorders, as well as in other psychiatric conditions. In order to investigate transdiagnostic biomarkers associated with various phenotypic features of these disorders, this study is designed to identify biomarkers of inflammatory and oxidative endophenotypes related to autolytic behavior. METHODS: Peripheral blood mononuclear cells were collected from 35 patients with borderline personality disorder (BPD), 29 patients with restrictive eating disorder (rED), 21 patients with purging eating disorder (pED) and 23 control subjects. Plasma levels of different inflammatory and oxidative factors were measured by ELISA and the expression of selected proteins was by Western Blot. Principal component analysis (PCA) was performed to categorize the different inflammatory factors. Additionally, Ancova was performed to observe the differences in the principal components among the different groups and logistic regression analysis was conducted to assess the predictive capacity of these components for autolytic behaviors. RESULTS: We found two inflammatory/oxidative components were associated with BPD, characterized by high levels of JNK and ERK and low levels of GPx, SOD and Keap1; and two other inflammatory/oxidative components were linked to pED, associated with more JNK, TBARS and TNF-α and less GPx and SOD. Two components, with more JNK and ERK and less GPx, SOD and Keap1, predicted non-suicidal self-injury and three components, with higher JNK, TBARS and TNF-α levels and lower GPx, SOD and iNOS levels, predicted suicide attempts. CONCLUSIONS: These results strongly support the endophenotypic characterization of impulsivity and the identification of transdiagnostic inflammatory/oxidative biomarkers relevant to autolytic behavior in impulsive and unstable disorders. These dates lay the groundwork for developing of screening tests for these biomarker components to rapidly detect biological risk factors for specific impulse control disorders and future self-injurious behaviors.

Decreased oxytocin plasma levels and oxytocin receptor expression associated with aggressive behavior in aggressive-impulsive disorders.

INTRODUCTION: This study aims to enhance the understanding of the association between the phenotypic and endophenotypic characteristics of impulsive-aggressive disorders, through the study of plasma oxytocin (OXT) and oxytocin receptor (OXTR) levels in patients with borderline personality disorder (BPD) and patients with eating disorders (ED), as well as to examine the relationship of OXT system with aggressive behavior in these disorders. METHODS: 68 patients with BPD, 67 patients with ED and 57 healthy control subjects were examined for plasma oxytocin levels and protein expression of OXTR in blood mononuclear cells. Aggressive behavior was assessed using the State-Trait Anger Expression Inventory (STAXI-2). Other self and hetero-aggressive behaviors were also evaluated through interviews. RESULTS: BPD and ED patients exhibited significantly lower plasma oxytocin levels than control subjects. Furthermore, BPD patients demonstrated significantly reduced expression of OXTR compared to controls. Plasma oxytocin levels negatively correlated with verbal aggression, while OXTR expression was inversely associated with the STAXI trait subscale. CONCLUSIONS: The findings validate the existence of oxytocin system dysfunction in impulsive-aggressive disorders. They also support the link between low OXT levels in plasma and OXTR expression and the impulsive-aggressive behavior that characterizes these patients in both state and trait situations.

Inflammatory and oxidative endophenotypes in borderline personality disorder: A biomarker cluster analysis.

OBJECTIVES: This study is designed to search for aggrupation of inflammatory/oxidative biomarker alterations in borderline personality disorder (BPD) and their association with phenotypic features. METHODOLOGY: Inflammatory/nitrosative proteins were measures in plasma and peripheral blood mononuclear cells obtained from BPD patients. Patients were assessed on different clinical dimensions of BPD. Oxidative damage was tested by measuring TBARS, nitrites, catalase, GPx and SOD. Protein expression of IκBα, NFκB, iNOS, COX-2, PPARγ, Keap1, NQO1, Nrf2 and α7nAChR was also determined. Western blot and ELISA were used for measurements and a cluster analysis of inflammatory/oxidative biomarkers alterations was performed to investigate subgroups of patients with similar alterations and its relationship with clinical features of BPD. RESULTS: 69 patients were included in the study. Two inflammatory/nitrosative clusters of patients were found: Cluster 1 patients showed significantly higher levels of GPx, IκBα, keap1, NQO1, PPARγ, α7nAChR and Nrf2 than cluster 2 patients. These patients had significantly longer duration of illness, milder anxiety symptoms and lower prescription of antipsychotic drugs than cluster 2. CONCLUSIONS: Two clusters of BPD patients according to the inflammatory/nitrosative profiles were identified. Cluster 1 had increased antioxidant and anti-inflammatory biomarkers and was characterised by greater chronicity of illness but less acute symptomatic severity.

Decreased oxytocin plasma levels and oxytocin receptor expression in borderline personality disorder.

INTRODUCTION: Borderline personality disorder (BPD) is characterized by intense affective reactions with underlying social and interpersonal cognitive deficits. Oxytocin has largely been associated with both stress regulation and social cognition in psychiatric patients and in non-clinical populations in previous studies. Finally, abnormal oxytocin levels have been preliminary reported in BPD patients. METHODS: 53 patients with moderate-severe BPD and 31 healthy control subjects were investigated for plasma levels of oxytocin and protein expression of oxytocin receptor in blood mononuclear cells. Clinical assessments were made for severity, functionality, and comorbidity with axis I and II conditions. RESULTS: Oxytocin plasma levels were significantly lower in BPD patients compared with controls. In addition, protein expression of oxytocin receptor was significantly reduced in the BPD group. A positive correlation was found between plasma oxytocin levels and the activity index score of the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ). Oxytocin receptor protein expression, on the contrary, had a negative correlation with the ZKPQ sociability index score. CONCLUSIONS: Results support the evidence of a dysfunction of the oxytocin system in borderline personality disorder, which could be involved in emotional dysregulation and interpersonal disturbances in these patients.

Depressive-type emotional response pattern in impulsive-aggressive patients with borderline personality disorder.

INTRODUCTION: Borderline personality disorder (BPD) is typically characterized by severe affective dysregulation leading to impulsive behaviors. Accordingly, preliminary data suggest the hypothesis that BPD patients could have a specific and altered pattern of subjective emotional response to stimuli. The nature of the emotional response in BPD can be compared with other affective disorders and provide further insight on the nosological proximity with other psychiatric disorders. METHODS: Subjective emotional response was investigated in 19 patients with DSM-IV BPD with no current depressive episode and in 19 healthy control subjects by using the International Affective Picture System (IAPS). The intensity of arousal, valence and dominance was rated in response to 60 images categorized as pleasant, unpleasant and neutral by using a self-assessment instrument. ANOVA of multiple factors was used for between-groups comparisons. RESULTS: The obtained pattern showed that BPD patients considered the unpleasant and neutral images as less aversive than controls, but the activation that these images induced was higher. Patients showed significantly greater arousal than controls for unpleasant and neutral images (p<0.05) but presented greater valence (more positive emotion) for these images (p<0.05). In addition, BPD patients showed lower dominance (greater insecurity and dyscomfort) for positive images (p<0.05). CONCLUSIONS: The subjective emotional response pattern of BPD patients suggests a trait of vulnerability to pleasant stimuli and is similar to the pattern found in depressive patients in previous studies. This supports the evidence that BPD could in part be related with the spectrum of the affective temperament and affective disorders.

Orbitofrontal dysfunction related to depressive symptomatology in subjects with borderline personality disorder.

OBJECTIVE: In order to explore the relationships of fronto-limbic dysfunction with the clinical features of borderline personality disorder (BPD), the authors investigated brain electrophysiological activity in BPD patients following stimulation with emotionally arousing images. METHODS: Seventeen non-medicated patients with borderline personality disorder were studied with magneto-encephalography. Regional cortical activities were obtained by minimum norm estimate (MNE) of steady-state visual evoked fields (ssVEFs). Linear regression models were conducted to explore clinical correlates of brain activity. RESULTS: Although no interaction group × picture category × brain region was found, a significant interaction group × brain region appeared for orbito-frontal cortex (OFC). BPD patients showed significantly reduced magnetocortical activity in left OFC across all picture categories (F = 26.4; p<.05; F = 31.4). Left OFC activity was inversely correlated with depression score in the BDI (r: -0.48, p < 0.05), with score in the Cornell Dysthymia rating scale (r: -0.52, p < 0.05) and with the number of criteria met for depressive personality disorder (r: -0.44, p < 0.05). Left orbitofrontal activity was also inversely correlated with the global score in the GAF (r-0.63, p < 0.01). No correlations were found between OFC activity and impulsivity or global severity of BPD symptoms. CONCLUSIONS: Abnormal functioning at orbitofrontal areas in BPD could be related to the presence of affective symptomatology and is associated with greater functional deterioration of patients.

Diagnostic features of the cycloid psychoses in a first psychotic episode sample.

INTRODUCTION: The cycloid psychoses have not been included in the modern classifications-what makes scientific research difficult. The aim of the present study is to investigate the presence and specific characteristics of the cycloid psychoses in a broad sample of first psychotic episodes. METHODS: Seventy patients diagnosed with one-year first schizophrenia episode, schizophreniform disorder, or schizoaffective disorder were studied (mean age, 27.9 years old; SD±6.34). The detection of the possible cases of cycloid psychosis was done according to the Perris and Brockington operational criteria. Two groups of "cycloid" (n=11) and "non cycloid" (n=59) patients were compared according to demographic and clinical variables, and possible diagnostic variables were evaluated by the ROC curves. RESULTS: Significant differences were found between cycloid and non cycloid groups for a number of clinical variables: prodromic symptoms (p<0.001), PANSS total score (p=0.003), PANSS-P (p=0.009), PANSS-GP (p=0.001), total score for mania by EVMAC (p=0.001), and CDSS for depression (p=0.004). ROC curves were significant for PANSS-GP (AUC=0.791, p=0.002), EVMAC (AUC=0.938, p=0.001), and CDSS (AUC=0.770, p=0.005). A sensitivity/specificity study demonstrated a negative predictive value for PANSS-GP (93.88%), EVMAC (96.30%), and CDSS (93.88%). CONCLUSIONS: According to these results, cycloid psychoses might represent differentiated and well-defined clinical entity.

Estudios de resonancia magnética funcional en los trastornos de la conducta alimentaria / Functional magnetic resonance studies in eating behavior disorders

Los trastornos de la conducta alimentaria (TCA) constituyen una condición somática y psiquiátrica grave, que sucede principalmente en mujeres adolescentes y jóvenes adultas y que se caracteriza por deseo persistente de extrema delgadez, miedo patológico a engordar y distorsión de la percepción corporal. Desde un punto de vista neurobiológico, se ha sugerido la existencia de alteraciones en algunos de los sistemas neurales de estas pacientes, bien como causa o consecuencia de su patología. En los últimos años, se están realizando múltiples estudios de investigación en este ámbito, con el objetivo de determinar las alteraciones cerebrales subyacentes en los TCA. El propósito de este artículo es realizar una revisión de los principales hallazgos obtenidos en los estudios de neuroimagen realizados, incluyendo PET, SPECT, resonancia magnética con imagen espectroscópica (MRS) y centrándonos, principalmente, en la imagen de resonancia magnética funcional (fMRI). Se revisarán también algunas de las alteraciones y cambios metabólicos y de perfusión sanguínea que acompañan a los hallazgos de neuroimagen, así como los estudios encaminados a concretar si estas alteraciones persisten tras la recuperación de la enfermedad (AU)

Eating behavior disorders (EBD) constitute a serious somatic and psychiatric condition that occurs mainly in adolescent and young adult women and is characterized by a persistent desire to be extremely thin, pathologic fear of gaining weight and distortion of body perception. From a neurobiological vantage point, it has been suggested that alterations in some neural systems of these patients may exist, either as a cause or effect of their condition. In recent years various research studies have been conducted with the aim of identifying underlying brain disorders in EBD. The purpose of this article was to review the main findings obtained in neuroimaging studies, including PET, SPECT, magnetic resonance spectroscopy (MRS), focusing mainly on functional magnetic resonance imaging (fMRI). Some alterations and changes in metabolism and blood perfusion that accompany the neuroimaging findings will be reviewed, as well as studies designed to determine whether these alterations persist after recovery from the disease (AU)

Functional magnetic resonance studies in eating behavior disorders.

Eating behavior disorders (EBD) constitute a serious somatic and psychiatric condition that occurs mainly in adolescent and young adult women and is characterized by a persistent desire to be extremely thin, pathologic fear of gaining weight and distortion of body perception. From a neurobiological vantage point, it has been suggested that alterations in some neural systems of these patients may exist, either as a cause or effect of their condition. In recent years various research studies have been conducted with the aim of identifying underlying brain disorders in EBD. The purpose of this article was to review the main findings obtained in neuroimaging studies, including PET, SPECT, magnetic resonance spectroscopy (MRS), focusing mainly on functional magnetic resonance imaging (fMRI). Some alterations and changes in metabolism and blood perfusion that accompany the neuroimaging findings will be reviewed, as well as studies designed to determine whether these alterations persist after recovery from the disease.

Tratamiento para la esquizofrenia. Revisión crítica sobre la farmacología y mecanismos de acción de los antipsicóticos / Schizophrenia treatment. Critical review on the drugs and mechanisms of action of antipsychotics

El tratamiento de la esquizofrenia ha evolucionado a lo largo de la segunda mitad del siglo pasado, principalmente gracias al desarrollo de los fármacos antipsicóticos. A pesar del gran avance realizado, que ha permitido la disponibilidad y uso de nuevos y diferentes fármacos, éstos continuan constituyendo tres grupos básicos (atipsicóticos típicos, atípicos y agonistas parciales dopaminérgicos), y todos ellos tienen como principal mecanismo de acción, la actuación sobre los sistemas dopaminérgicos. Se cree que una gran parte de los antipsicóticos de segunda generación (antipsicóticos atípicos y agonistas parciales dopaminérgicos) ofrecen ventajas añadidas a los de primera generación en el tratamiento de la esquizofrenia. No obstante, las propiedades farmacológicas y terapéuticas que confieren respecto a los de primera generación no están claras, y ciertos efectos colaterales pueden todavía, afectar a la salud y calidad de vida del paciente. Además, la eficacia de los antipsicóticos es limitada, lo que ha llevado a la utilización de medicaciones adyuvantes para potenciar los efectos del tratamiento. Por otro lado, se ha trabajado en el desarrollo de nuevas líneas de investigación para el desarrollo de nuevos fármacos antipsicóticos no dopaminérgicos, siendo los resultados poco exitosos. Este artículo realiza una breve revisión crítica sobre el actual arsenal terapéutico para la esquizofrenia, estrategias de desarrollo de fármacos, y teorías sobre los mecanismos de acción de los antipsicóticos, centrándose en las nuevas dianas terapéuticas para el desarrollo de futuros tratamientos (AU)

Schizophrenic treatment was developed during the second half of the last century, mainly within the context of the development of antipsychotic drugs. Even though there has been significant progress due to the availability and use of multiple drugs, these can still be classified into three basic groups of antipsychotic drugs (atypical antipsychotics, typical antipsychotics and dopamine partial agonist antipsychotics). Their primary antipsychotic mechanism is still the action on the dopamine systems. Many of the second-generation antipsychotics are believed to offer advantages over first-generation agents in the treatment for schizophrenia. However, the drug properties that provide the different therapeutic effects from those of the first generation are not clear and some adverse effects may still affect the patient’s health and quality of life. Furthermore, the efficacy of the antipsychotics is limited. This has led to the use of adjuvant medications to strengthen the treatment effects. On the other hand, work is being done on the development of new research lines to develop new nondopaminergic antipsychotic drugs, with not very successful results. The aim of this paper is to make a brief review on the current therapeutic armamentarium for schizophrenia, the strategies to develop drugs, and theories of mechanisms of action of antipsychotics. Emphasis is placed on the new therapeutic targets for the development of future treatments (AU)

[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)

[Neuroimaging studies in borderline personality disorder]. / Estudios de neuroimagen en el trastorno límite de la personalidad.

DSM-IV defines Borderline personality disorder (BPD) as a personality disorder that can be primarily characterized by emotional instability, extremely polarized thought and chaotic interpersonal relations. It is the most common personality disorder. Its prevalence is estimated to be from 0.2% to 1.8% of the general population, and the 76% of them are women. However, despite these data and the different biologic findings, there are few publications on neuroimage about this nosologic entity. Recent studies suggest that a dual cerebral disorder, including frontal and limbic circuits, could be present in characterize BPD. These cerebral areas would also be involved in the serotonergic dysfunction that seems to be related to the impulse dyscontrol and self-aggressive behaviour, characteristic of these patients. Most authors point out the importance of traumatic precedents in the BPD genesis, with a direct relation between stress and the neurobiological findings observed, including the neuroimage changes. The aim of this article is to make a revision of the main neuroimage data found in BPD, including the new techniques such as functional MRI, diffusion tensor MRI and spectroscopy.

Estudios de neuroimagen en el trastorno límite de la personalidad / Neuroimaging studies in the borderline personality disorder

El trastorno límite de la personalidad (TLP) o borderline, es actualmente definido por el DSM-IV como un trastorno de la personalidad que se caracteriza primariamente por disregulación emocional, pensamiento extremadamente polarizado y relaciones interpersonales caóticas. Es, con mucho, el más común de los trastornos de la personalidad. Se estima que su prevalencia oscila entre un 0,2% y un 1,8% de la población general. De ello el 76 % son mujeres. Sin embargo, a pesar de estas cifras nada desdeñables y de los diferentes hallazgos biológicos, existen pocas publicaciones sobre neuroimagen en esta entidad nosológica. La gran mayoría de los estudios recientes sostienen la hipótesis de que en el TLP existiría una patología cerebral dual que incluiría circuitos frontales y límbicos. Estas áreas cerebrales también estarían implicadas en la disfunción serotoninérgica que parece relacionarse con el descontrol de impulsos y la autoagresividad propios de este tipo de pacientes. Muchos autores apuntan a la importancia de los antecedentes traumáticos en la génesis del TLP, existiendo una relación directa entre el estrés y los hallazgos biológicos observados, incluyendo las alteraciones en la neuroimagen. El propósito de este artículo es realizar una revisión de los principales hallazgos obtenidos en los estudios de neuroimagen realizados en TLP, incluyendo las nuevas técnicas como la resonancia magnética (RM) con tensor de difusión, las pruebas funcionales como la RM funcional y la RM con espectroscopia (AU)

DSM-IV defines Borderline personality disorder (BPD) as a personality disorder that can be primarily characterized by emotional instability, extremely polarized thought and chaotic interpersonal relations. It is the most common personality disorder. Its prevalence is estimated to be from 0,2% to 1,8% of the general population, and the 76% of them are women. However, despite these data and the different biologic findings, there are few publications on neuroimage about this nosologic entity. Recent studies suggest that a dual cerebral disorder, including frontal and limbic circuits, could be present in characterize BPD. These cerebral areas would also be involved in the serotonergic dysfunction that seems to be related to the impulse dyscontrol and self-aggressive behaviour, characteristic of these patients. Most authors point out the importance of traumatic precedents in the BPD genesis, with a direct relation between stress and the neurobiological findings observed, including the neuroimage changes. The aim of this article is to make a revision of the main neuroimage data found in BPD, including the new techniques such as functional MRI, diffusion tensor MRI and spectroscopy (AU)

Schizophrenia treatment. Critical review on the drugs and mechanisms of action of antipsychotics.

Schizophrenic treatment was developed during the second half of the last century, mainly within the context of the development of antipsychotic drugs. Even though there has been significant progress due to the availability and use of multiple drugs, these can still be classified into three basic groups of antipsychotic drugs (atypical antipsychotics, typical antipsychotics and dopamine partial agonist antipsychotics). Their primary antipsychotic mechanism is still the action on the dopamine systems. Many of the second-generation antipsychotics are believed to offer advantages over first-generation agents in the treatment for schizophrenia. However, the drug properties that provide the different therapeutic effects from those of the first generation are not clear and some adverse effects may still affect the patient's health and quality of life. Furthermore, the efficacy of the antipsychotics is limited. This has led to the use of adjuvant medications to strengthen the treatment effects. On the other hand, work is being done on the development of new research lines to develop new non-dopaminergic antipsychotic drugs, with not very successful results. The aim of this paper is to make a brief review on the current therapeutic armamentarium for schizophrenia, the strategies to develop drugs, and theories of mechanisms of action of antipsychotics. Emphasis is placed on the new therapeutic targets for the development of future treatments.

Aplicaciones del International Affective Picture System en el estudio de la regulación emocional en los trastornos mentales / The use of the International Affective Picture System for the study of affective dysregulation in mental disorders

Introducción. El International Affective Picture System (IAPS)1 cuenta con una serie de estímulos pictóricos emocionales, normativos e internacionalmente accesibles, y está considerado el sistema más fiable y válido para el estudio experimental de las emociones. El IAPS se ha utilizado en la investigación sobre trastornos mentales como esquizofrenia, depresión mayor, ansiedad o rasgos psicopáticos de la personalidad. Asimismo es frecuente su uso como variable independiente en estudios de neuroimagen. Algunas de las aproximaciones al trastorno límite de la personalidad consideran que el elemento psicopatológico fundamental en estos sujetos es la disregulación afectiva, de la que se derivarían síntomas principales, tales como la intolerancia a la frustración, la reactividad o la disforia. El objetivo de este trabajo de revisiónes reunir y analizar la información sobre el estudio de la regulación emocional y del uso del IAPS en los distintos trastornos mentales. Métodos. Se realiza una revisión en las distintas bases de datos de los estudios publicados en población general y en poblaciones clínicas, así como de las características internas del test. Resultados. De acuerdo a los resultados descritos en los estudios revisados, el IAPS parece capaz de delimitar patrones específicos de respuesta emocional a estímulos en distintos trastornos mentales, incluyendo los trastornos del estado de ánimo y la esquizofrenia. Conclusiones. El uso del IAPS en el estudio del trastorno límite de la personalidad podría ser de interés para la comprensión y el tratamiento de los trastornos límite de la personalidad en los que la disregulación emocional es un factor principal (AU)

Introduction. The International Affective Picture System (IAPS) uses a series of emotional, normative and internationally accessible pictorial stimuli and is considered to be the most reliable and valid system in the experimental study of emotions. The IAPS has been used in research on mental disorders such as schizophrenia, major depression, anxiety or psychopathic personality traits. Furthermore, it is frequently used as independent variable in neuroimaging studies. Some of the approaches to borderline personality disorder consider that the fundamental psychopathological element in these subjects is affective dysregulation, from which the principal symptoms such as intolerance to frustration, reactivity or dysphoria are derived. This review paper has aimed to gather and analyze the information on the study of emotional regulation and the use of the IAPS in the different mental disorders. Methods. A review is made of the different data bases of the studies published in the general population and in the clinical populations as well as of the internal characteristics of the test. Results. In agreement with the results described in the studies reviewed, the IAPS seems capable of defining specific responses to stimuli in different mental disorders, including mood disorders and schizophrenia. Conclusions. In conclusion, the use of the IAPS in the study of borderline personality disorder could be of interest for the understanding and treatment of borderline personality disorder in which emotional dysregulation is a principal factor (AU)