Affective Disorders among Patients with Borderline Personality Disorder

Background

The high co-occurrence between borderline personality disorder and affective disorders has led many to believe that borderline personality disorder should be considered as part of an affective spectrum. The aim of the present study was to examine whether the prevalence of affective disorders are higher for patients with borderline personality disorder than for patients with other personality disorders.

Methods

In a national cross-sectional study of patients receiving mental health treatment in Norway (N = 36 773), we determined whether psychiatric outpatients with borderline personality disorder (N = 1 043) had a higher prevalence of affective disorder in general, and whether they had an increased prevalence of depression, bipolar disorder or dysthymia specifically. They were compared to patients with paranoid, schizoid, dissocial, histrionic, obsessive-compulsive, avoidant, dependent, or unspecified personality disorder, as well as an aggregated group of patients with personality disorders other than the borderline type (N = 2 636). Odds ratios were computed for the borderline personality disorder group comparing it to the mixed sample of other personality disorders. Diagnostic assessments were conducted in routine clinical practice.

Results

More subjects with borderline personality disorder suffered from unipolar than bipolar disorders. Nevertheless, borderline personality disorder had a lower rate of depression and dysthymia than several other personality disorder groups, whereas the rate of bipolar disorder tended to be higher. Odds ratios showed 34% lower risk for unipolar depression, 70% lower risk for dysthymia and 66% higher risk for bipolar disorder in patients with borderline personality disorder compared to the aggregated group of other personality disorders.

Conclusions

The results suggest that borderline personality disorder has a stronger association with affective disorders in the bipolar spectrum than disorders in the unipolar spectrum. This association may reflect an etiological relationship or diagnostic overlapping criteria.     

Early Affective Processing in Patients with Acute Posttraumatic Stress Disorder: Magnetoencephalographic Correlates

Background

In chronic PTSD, a preattentive neural alarm system responds rapidly to emotional information, leading to increased prefrontal cortex (PFC) activation at early processing stages (<100 ms). Enhanced PFC responses are followed by a reduction in occipito-temporal activity during later processing stages. However, it remains unknown if this neuronal pattern is a result of a long lasting mental disorder or if it represents changes in brain function as direct consequences of severe trauma.

Methodology

The present study investigates early fear network activity in acutely traumatized patients with PTSD. It focuses on the question whether dysfunctions previously observed in chronic PTSD patients are already present shortly after trauma exposure. We recorded neuromagnetic activity towards emotional pictures in seven acutely traumatized PTSD patients between one and seven weeks after trauma exposure and compared brain responses to a balanced healthy control sample. Inverse modelling served for mapping sources of differential activation in the brain.

Principal Findings

Compared to the control group, acutely traumatized PTSD patients showed an enhanced PFC response to high-arousing pictures between 60 to 80 ms. This rapid prefrontal hypervigilance towards arousing pictorial stimuli was sustained during 120–300 ms, where it was accompanied by a reduced affective modulation of occipito-temporal neural processing.

Conclusions

Our findings indicate that the hypervigilance-avoidance pattern seen in chronic PTSD is not necessarily a product of an endured mental disorder, but arises as an almost immediate result of severe traumatisation. Thus, traumatic experiences can influence emotion processing strongly, leading to long-lasting changes in trauma network activation and expediting a chronic manifestation of maladaptive cognitive and behavioral symptoms.     

Influence of Timed Nutrient Diet on Depression and Light Sensitivity in Seasonal Affective Disorder

Seasonal Affective Disorder (SAD) patients crave and eat more carbohydrates (CHO) in fall‐winter when depressed, especially in the evenings, and feel energetic thereafter. Evening CHO‐rich meals can phase delay circadian rhythms, and glucose increases retinal response to light. We studied timed CHO‐ or protein‐rich (PROT) diet as a putative therapy for SAD. Unmedicated, DSM‐IV‐diagnosed depressed women with SAD (n=22, 19–63 yrs) in the follicular phase of the menstrual cycle (present in 19) were randomized to nine days of eating ～1600 kcal of either CHO before 12:00 h (n=9), CHO after 18:00 h (n=6), or PROT after 18:00 h (n=7); only water was allowed for the rest of the day. Measurements included the depression questionnaire SIGH‐SAD (with 21‐item Hamilton depression subscale), Eating Behavior Questionnaire (DEBQ), percentage fat (by bioimpedancemetry), clinical biochemistry (glucose, cholesterol, triglycerides, TSH, T4, cortisol), and electroretinogram (ERG). No differential effects of diet were found on any of the studied parameters (except DEBQ). Clinically, participants improved slightly; the 21‐HDRS score (mean±SD) decreased from 19.6±6.4 to 14.4±7.4 (p=.004). Percent change correlated significantly with menstrual day at diet onset (mood improved the first week after menstruation onset), change in available sunshine (more sunlight, better mood), and initial percentage fat (fatter patients improved more). Scotopic ERG amplitude was diminished after treatment (p=.025, three groups combined), probably due to greater exposure to sunshine in 14/22 subjects (partial correlation analysis significant). Keeping in mind the limitations of this ambulatory study (i.e., inability to control outdoor light exposure, small number of participants, and briefness of intervention), it is suggested that the 25% clinical improvement (of the order of magnitude of placebo) is not related to nutrient diet or its timing, but rather to natural changes during the menstrual cycle, available sunshine, and ease of dieting for fatter patients.     

Increased Cyclic AMP-Dependent Protein Kinase Activity in Postmortem Brain from Patients with Bipolar Affective Disorder

Previous observations of reduced [3H]cyclic AMP binding in postmortem brain regions from bipolar affective disorder subjects imply cyclic AMP-dependent protein kinase function may be altered in this illness. To test this hypothesis, basal and stimulated cyclic AMP-dependent protein kinase activity was determined in cytosolic and particulate fractions of postmortem brain from bipolar disorder patients and matched controls. Maximal enzyme activity was significantly higher (104%) in temporal cortex cytosolic fractions from bipolar disorder brain compared with matched controls. In temporal cortex particulate fractions and in the cytosolic and particulate fractions of other brain regions, smaller but statistically nonsignificant increments in maximal enzyme activity were detected. Basal cyclic AMP-dependent protein kinase activity was also significantly higher (40%) in temporal cortex cytosolic fractions of bipolar disorder brain compared with controls. Estimated EC50 values for cyclic AMP activation of this kinase were significantly lower (70 and 58%, respectively) in both cytosolic and particulate fractions of temporal cortex from bipolar disorder subjects compared with controls. These findings suggest that higher cyclic AMP-dependent protein kinase activity in bipolar disorder brain may be associated with a reduction of regulatory subunits of this enzyme, reflecting a possible adaptive response of this transducing enzyme to increased cyclic AMP signaling in this disorder.     

情感性障碍的遗传异质性研究啊

对10省市的548例情感性障碍患者进行了遗传异质性的分析。结果表明,抑郁症在发病年龄上存在异质性,提示抑郁症可能存在着早发和晚发二类亚型。又经亲属相关性的分析,表明抑郁症或单次躁狂发作均与双相情感性障碍之间存在着遗传异质性,支持了Lconhard（1959）（3）将该症区分为单相型和双相型观点。     

Phase Typing of Patients with Seasonal Affective Disorder: A Test for the Phase Shift Hypothesis

The study evaluates the phase-shift hypothesis for seasonal affective disorder (Lewy et al., 1987, 1988) in parallel-design comparison of effects of morning (800-1000) or afternoon (1600-1800) light treatment on mood and circadian phase. Subjective arousal, body temperature, melatonin and cortisol were measured at 800, 1200, 1600, 2000 and 2400 in 23 women with seasonal depression and 20 controls before and after a week of bright light (2 hours per day). The rates of clinical response to both treatments were similar. Comparison of circadian variations did not provide evidence for significant phase-delay in patients compared to controls. However, morning light produced significant phase advance in patients, but not in controls. Also we found that advance phase shifts in well-responded patients were more often than in patients with worse response and controls. Before light treatment phase concordance between different variables in patients was lower compared to either themselves after light treatment or controls before and after light treatment. Dependence of antidepressant response to light from pretreatment circadian phases was also observed. Those patients who responded worse to morning light tended to have advance circadian phases, while those who responded worse to afternoon light tended to have delay phases. Although some results are lending support for the phase-shift hypothesis, other explanations for mechanisms by which biological rhythms are implicated in winter depression and light treatment might be suggested.     

Phase Typing of Patients with Seasonal Affective Disorder: A Test for the Phase Shift Hypothesis

The study evaluates the phase-shift hypothesis for seasonal affective disorder (Lewy et al., 1987, 1988) in parallel-design comparison of effects of morning (800-1000) or afternoon (1600-1800) light treatment on mood and circadian phase. Subjective arousal, body temperature, melatonin and cortisol were measured at 800, 1200, 1600, 2000 and 2400 in 23 women with seasonal depression and 20 controls before and after a week of bright light (2 hours per day). The rates of clinical response to both treatments were similar. Comparison of circadian variations did not provide evidence for significant phase-delay in patients compared to controls. However, morning light produced significant phase advance in patients, but not in controls. Also we found that advance phase shifts in well-responded patients were more often than in patients with worse response and controls. Before light treatment phase concordance between different variables in patients was lower compared to either themselves after light treatment or controls before and after light treatment. Dependence of antidepressant response to light from pretreatment circadian phases was also observed. Those patients who responded worse to morning light tended to have advance circadian phases, while those who responded worse to afternoon light tended to have delay phases. Although some results are lending support for the phase-shift hypothesis, other explanations for mechanisms by which biological rhythms are implicated in winter depression and light treatment might be suggested.     

Type and Timing of Childhood Maltreatment and Severity of Shutdown Dissociation in Patients with Schizophrenia Spectrum Disorder

Dissociation, particularly the shutting down of sensory, motor and speech systems, has been proposed to emerge in susceptible individuals as a defensive response to traumatic stress. In contrast, other individuals show signs of hyperarousal to acute threat. A key question is whether exposure to particular types of stressful events during specific stages of development can program an individual to have a strong dissociative response to subsequent stressors. Vulnerability to ongoing shutdown dissociation was assessed in 75 inpatients (46M/29F, M = 31±10 years old) with schizophrenia spectrum disorder and related to number of traumatic events experienced or witnessed during childhood or adulthood. The Maltreatment and Abuse Chronology of Exposure (MACE) scale was used to collect retrospective recall of exposure to ten types of maltreatment during each year of childhood. Severity of shutdown dissociation was related to number of childhood but not adult traumatic events. Random forest regression with conditional trees indicated that type and timing of childhood maltreatment could predictably account for 31% of the variance (p < 0.003) in shutdown dissociation, with peak vulnerability occurring at 13-14 years of age and with exposure to emotional neglect followed by various forms of emotional abuse. These findings suggest that there may be windows of vulnerability to the development of shutdown dissociation. Results support the hypothesis that experienced events are more important than witnessed events, but challenge the hypothesis that “life-threatening” events are a critical determinant.     

Monoamine Receptors in an Animal Model of Affective Disorder

After a relatively mild course of uncontrollable shocks, two distinct groups of rats can be defined in terms of their performance in learning to escape from a controllable stressor. Response-deficient (RD) rats do not learn to terminate the controllable stressor, whereas nondeficient (ND) rats learn this response as readily as do untreated control rats. The current studies were designed to determine the neurochemical correlates of the behavioral differences between these groups of rats. The major findings concerned postsynaptic beta-adrenergic effects in the hippocampus of RD rats. These included an up-regulation of beta-adrenergic receptors and, in parallel experiments, an increase in the sensitivity of adenylyl cyclase to stimulation by norepinephrine. There was no difference in brain levels of catecholamines between the three groups of rats. A statistically significant increase in levels of 5-hydroxytryptamine was noted in the hippocampus and hypothalamus of RD rats as compared to levels in ND rats, but no significant differences were measured between groups of rats in terms of S1 or S2 serotonergic receptor binding. These results implicate both beta-adrenergic and serotonergic mechanisms in the behavioral deficit caused by uncontrollable shock.     

Intrinsic Affective Network Is Impaired in Children with Attention-Deficit/Hyperactivity Disorder

Deficits in impulsivity and affect dysregulation are key features of attention-deficit/hyperactivity disorder (ADHD) besides impairing levels of hyperactivity and/or inattention. However, the neural substrates underlying these traits are relatively under-investigated. In this study, we use resting-state functional magnetic resonance imaging to test the hypothesis of diminished functional integration within the affective/limbic network (which includes the amygdala, hippocampus, subgenual cingulate cortex, orbitofrontal cortex and nucleus accumbens) of children with ADHD, which is associated with their behavioral measures of emotional control deficits. Resting state-fMRI data were obtained from 12 healthy control subjects and 15 children with ADHD, all who had a minimum one-month washout period for medications and supplements. Children with ADHD demonstrated less integrated affective network, evidenced by increased bilateral amygdalar and decreased left orbitofrontal connectivity within the affective network compared to healthy controls. The hyper-connectivity at the left amygdalar within the affective network was associated with increased aggressiveness and conduct problems, as well as decline in functioning in children with ADHD. Similar findings in affective network dysconnectivity were replicated in a subset of children with ADHD three months later. Our findings of divergent changes in amygdala and orbitofrontal intrinsic connectivity support the hypothesis of an impaired functional integration within the affective network in childhood ADHD. Larger prospective studies of the intrinsic affective network in ADHD are required, which may provide further insight on the biological mechanisms of emotional control deficits observed in ADHD.     

Brain-Derived Neurotrophic Factor Levels in Women with Postpartum Affective Disorder and Suicidality

Our aim was to investigate serum brain-derived neurotrophic factor (BDNF) levels in postpartum women, according to the presence of postpartum affective disorder (PPAD) and suicidality. A cross-sectional study was carried out with women between 45 and 90?days after delivery. PPAD (depression, manic and mixed episode) and suicide risk were assessed using the Mini International Neuropsychiatric Interview. BDNF was assessed using a commercial ELISA kit. Linear regression was used for multivariate analyses. A hundred ninety women participated in the study, 15.3?% had PPAD, 7.4?% showed PPAD with suicide risk. BDNF levels were lower in subjects with three or more Stressful Life Events (P?=?0.01). The serum BDNF levels of women with PPAD presenting suicide risk were significantly lower than those of women without suicide risk (1.50?±?1.38 and 2.33?±?1.28?ng/ml, P?=?0.02). Clinicians should enquire postpartum women about their history of stressful life events, PPAD, and suicidality. This study shows the potential role of BDNF in the neurobiology of the association of PPAD and suicidality.     

血清电解质紊乱对ICU慢性阻塞性肺疾病患者预后的影响

目的探讨血清电解质紊乱对慢性阻塞性肺疾病（COPD）预后的影响。方法将广西医科大学第一附属医院ICU2007年7月~2008年1月收治的213例慢性阻塞性肺疾病患者,按血清电解质水平分为非电解质紊乱组86例和电解质紊乱组127例,分析不同电解质水平与COPD预后之间的关系。结果两组患者年龄、性别无显著差异性,两组的住院时间、发生酸碱失衡、接受机械通气治疗时间及病死率比较差异有显著性（P〈0.05）。电解质紊乱组经治疗后,得以纠正者治疗有效率高于纠正无效者,两者差异有统计学意义。结论 COPD合并电解质紊乱较非电解质紊乱患者的住院时间及入住ICU接受机械通气治疗时间长,前者病死率较后者高。电解质紊乱可以作为判断慢性阻塞性肺疾病病情预后的指标之一。     

The Structure of Co-Occurring Bullying Experiences and Associations with Suicidal Behaviors in Korean Adolescents

Objective

This study had two main goals: to examine the structure of co-occurring peer bullying experiences among adolescents in South Korea from the perspective of victims and to determine the effects of bullying on suicidal behavior, including suicidal ideation and suicide attempts, among adolescents.

Method

This study used data gathered from 4,410 treatment-seeking adolescents at their initial visits to 31 local mental health centers in Gyeonggi Province, South Korea. The structure of peer bullying was examined using latent class analysis (LCA) to classify participants’ relevant experiences. Then, a binomial logistic regression adjusted by propensity scores was conducted to identify relationships between experiences of being bullied and suicidal behaviors.

Results

The LCA of experiences with bullying revealed two distinct classes of bullying: physical and non-physical. Adolescents who experienced physical bullying were 3.05 times more likely to attempt suicide than those who were not bullied. Victims of (non-physical) cyber bullying were 2.94 times more likely to attempt suicide than were those who were not bullied.

Conclusions

Both physical and non-physical bullying were associated with suicide attempts, with similar effect sizes. Schools and mental health professionals should be more attentive than they currently are to non-physical bullying.     

Influence of Post-Traumatic Stress Disorder on Neuroinflammation and Cell Proliferation in a Rat Model of Traumatic Brain Injury

Long-term consequences of traumatic brain injury (TBI) are closely associated with the development of severe psychiatric disorders, such as post-traumatic stress disorder (PTSD), yet preclinical studies on pathological changes after combined TBI with PTSD are lacking. In the present in vivo study, we assessed chronic neuroinflammation, neuronal cell loss, cell proliferation and neuronal differentiation in specific brain regions of adult Sprague-Dawley male rats following controlled cortical impact model of moderate TBI with or without exposure to PTSD. Eight weeks post-TBI, stereology-based histological analyses revealed no significant differences between sham and PTSD alone treatment across all brain regions examined, whereas significant exacerbation of OX6-positive activated microglial cells in the striatum, thalamus, and cerebral peduncle, but not cerebellum, in animals that received TBI alone and combined TBI-PTSD compared with PTSD alone and sham treatment. Additional immunohistochemical results revealed a significant loss of CA3 pyramidal neurons in the hippocampus of TBI alone and TBI-PTSD compared to PTSD alone and sham treatment. Further examination of neurogenic niches revealed a significant downregulation of Ki67-positive proliferating cells, but not DCX-positive neuronally migrating cells in the neurogenic subgranular zone and subventricular zone for both TBI alone and TBI-PTSD compared to PTSD alone and sham treatment. Comparisons of levels of neuroinflammation and neurogenesis between TBI alone and TBI+PTSD revealed that PTSD did not exacerbate the neuropathological hallmarks of TBI. These results indicate a progressive deterioration of the TBI brain, which, under the conditions of the present approach, was not intensified by PTSD, at least within our time window and within the examined areas of the brain. Although the PTSD manipulation employed here did not exacerbate the pathological effects of TBI, the observed long-term inflammation and suppressed cell proliferation may evolve into more severe neurodegenerative diseases and psychiatric disorders currently being recognized in traumatized TBI patients.     

Mapping Pathological Phenotypes in a Mouse Model of CDKL5 Disorder

Mutations in cyclin-dependent kinase-like 5 (CDKL5) cause early-onset epileptic encephalopathy, a neurodevelopmental disorder with similarities to Rett Syndrome. Here we describe the physiological, molecular, and behavioral phenotyping of a Cdkl5 conditional knockout mouse model of CDKL5 disorder. Behavioral analysis of constitutive Cdkl5 knockout mice revealed key features of the human disorder, including limb clasping, hypoactivity, and abnormal eye tracking. Anatomical, physiological, and molecular analysis of the knockout uncovered potential pathological substrates of the disorder, including reduced dendritic arborization of cortical neurons, abnormal electroencephalograph (EEG) responses to convulsant treatment, decreased visual evoked responses (VEPs), and alterations in the Akt/rpS6 signaling pathway. Selective knockout of Cdkl5 in excitatory and inhibitory forebrain neurons allowed us to map the behavioral features of the disorder to separable cell-types. These findings identify physiological and molecular deficits in specific forebrain neuron populations as possible pathological substrates in CDKL5 disorder.     

Effects of the Seasons and of Bright Light Administered at Different Times of Day on Sleep EEG and Mood in Patients with Seasonal Affective Disorder

A brief account of the need for removing masking factors, either by protocol or calculation, is given. The strengths and weaknesses of both constant routine protocols and purification methods is outlined. It is concluded that each can contribute to the development of our knowledge of the endogenous component of circadian rhythms.     

Effects of the Seasons and of Bright Light Administered at Different Times of Day on Sleep EEG and Mood in Patients with Seasonal Affective Disorder

The study examines objective characteristics of sleep in women (n=31) with and without seasonal affective disorder, winter type, before and after a week of light treatment (at either 0800-1000 h, 1600-1800 h or 1800-2000 h). Subsamples of 13 patients and 7 controls were studied additionally in summer, and, among these patients, 9 were also recorded in spring and fall. Ranking the results from the lowest to the largest degree of deviation of sleep structure in patients from the norm yields the sequence: spring -> summer -> winter after light treatment -> fall -> winter before light treatment. In winter before light treatment the total amounts and percentage of slow wave sleep were significantly lower in responders to light (n=13) compared to both nonresponders (n=8) and controls (n=10), while following light treatment the difference disappeared. The reduced amounts of slow wave sleep in the depressive state predicted higher reduction and low posttreatment scores on psychiatric scales. Light treatment and summer season showed similar effects on patients' sleep: they caused an increase of slow wave sleep and a decline of sleep stage 2. Our data do not suggest that time of light treatment is important to achieve an antidepressant effect. Moreover, phase shifting effects of light treatment and of changing season on sleep EEG were not considerable. At the same time, subjective ratings of arousal demonstrated an advance shift of the arousal rhythm after morning and a delay shift after afternoon LT. We did not find significant changes in total amounts and percentage of REM sleep over time. The data suggest that abnormally increased need for REM sleep results in the hypersomnia and may be considered as a trait marker of winter depression. An abnormal architecture of nonREM sleep appears to be a state marker of those patients who benefit from bright light administered during waking hours.     

Childhood Experiences with Family Pets and Internalizing Symptoms in Early Adulthood

ABSTRACT

The purpose of this study was to investigate whether childhood experiences with family pets are associated with symptoms of depression and anxiety in early adulthood. Undergraduate students (n=318) responded to an online survey that included questions about bonding with childhood pets, exposure to family violence and human aggression directed toward family pets in childhood, and current symptoms of depression and anxiety. Two-way ANCOVAs were conducted with a measure of childhood emotional abuse included as a covariate, and significant interactions were observed between pet bonding and exposure to aggression toward pets (pet aggression). Among participants with medium-level bonds, those who were exposed to pet aggression had significantly higher depression and anxiety scores than those who were not exposed to pet aggression. Among participants who were not exposed to pet aggression, those with medium-level bonds had lower depression and anxiety scores than those with low-level bonds. Bearing in mind the limitations of the research design, the results are consistent with the assertion that bonding with pets may support mental health and that exposure to animal cruelty may lead to the development of internalizing symptoms. The results also support the contention that both bonding with pets and exposure to pet aggression should be considered when investigating the association between experiences with pets and mental health. Interventions for the protection of children may be indicated in cases of animal cruelty. Social workers who investigate child maltreatment may be advised to refer children who are exposed to animal cruelty for counseling. Clinicians should consider addressing issues that arise from exposure to pet aggression during the therapeutic process.     

Cerebral White Matter Lesions and Affective Episodes Correlate in Male Individuals with Bipolar Disorder

Background

Cerebral white matter lesions (WML) have been found in normal aging, vascular disease and several neuropsychiatric conditions. Correlations of WML with clinical parameters in BD have been described, but not with the number of affective episodes, illness duration, age of onset and Body Mass Index in a well characterized group of euthymic bipolar adults. Herein, we aimed to evaluate the associations between bipolar course of illness parameters and WML measured with volumetric analysis.

Methods

In a cross-sectional study 100 euthymic individuals with BD as well as 54 healthy controls (HC) were enrolled to undergo brain magnetic resonance imaging using 3T including a FLAIR sequence for volumetric assessment of WML-load using FSL-software. Additionally, clinical characteristics and psychometric measures including Structured Clinical Interview according to DSM-IV, Hamilton-Depression, Young Mania Rating Scale and Beck’s Depression Inventory were evaluated.

Results

Individuals with BD had significantly more (F = 3.968, p < .05) WML (Mdn = 3710mm3; IQR = 2961mm3) than HC (Mdn = 2185mm3; IQR = 1665mm3). BD men (Mdn = 4095mm3; IQR = 3295mm3) and BD women (Mdn = 3032mm3; IQR = 2816mm3) did not significantly differ as to the WML-load or the number and type of risk factors for WML. However, in men only, the number of manic/hypomanic episodes (r = 0.72; p < .001) as well as depressive episodes (r = 0.51; p < .001) correlated positively with WML-load.

Conclusions

WML-load strongly correlated with the number of manic episodes in male BD patients, suggesting that men might be more vulnerable to mania in the context of cerebral white matter changes.