Executive functions in obsessive-compulsive disorder: state or trait deficits?

OBJECTIVE: Despite the neuropsychology literature providing reliable evidence of impaired executive functions in obsessive-compulsive disorder (OCD), to date it has not been determined whether these deficits are trait-related (independent of symptomatology) or state-dependent (dependent on symptomatology). The current research examines the executive functions in OCD in a comprehensive manner and, for the first time, assesses the stability of these deficits over the developmental course of the disorder. METHOD: Using a cross-sectional design, Study 1 examined the executive functions (set shifting, inhibition, planning, verbal fluency and working memory) in 60 subjects (20 actively Symptomatic OCD, 20 Remitted OCD and 20 Panic Disorder). Using a longitudinal design, Study 2 reassessed a subsample of OCD subjects (participants in Study 1) once they reached remitted status. RESULTS: Study 1 found that the OCD groups exhibited deficits in set shifting and inhibition relative to Panic Disorder controls; however, no deficits were observed in planning, verbal fluency or working memory. There were no differences found between the Symptomatic and Remitted OCD groups on any of the executive function measures. Study 2 found that the identified executive function deficits in individuals were stable over time and remained unchanged despite symptom remittance. CONCLUSION: Current results confirm the presence of specific executive function deficits in OCD, and indicate that these deficits are trait-like in nature.     

Do dreams reflect a biological state?

The purpose of this study was to prospectively evaluate the hypothesis that dreams reflect biological states. Inpatients on a nonacute cardiology service were studied. Dream material was gathered by an independent interviewer using the Staged Interview Technique, a newly developed interview technique that limited bias. The outcome measures used were obtained at the time of cardiac catheterization. Different levels of severity of cardiac disease with these measures were interpreted as representing different biological states. The patients' dreams were evaluated for the predicted correlations of the number of dream references to death (men) and separation (women) with different levels of severity of heart disease. The severity of heart disease was evaluated with anatomical (coronary angiography) and physiological (ejection fraction) measures obtained at cardiac catheterization, each represented by a 6-point scale of increasing severity. There was no correlation of the number of dream references with the severity of abnormalities on coronary angiography. However, the number of dream references to death and separation correlated with the severity of cardiac dysfunction, as measured by the ejection fraction, which is a more sensitive parameter of disease severity. The data provided prospective support for the hypothesis by showing that dreams reflected a biological state, the ejection fraction. This suggested a possible biological "meaning" of dreams.     

Dynamic psychotherapy or dialectical behavioral therapy-- which is better for borderline personality disorder?

Clinical dilemma: A 20-year-old female patient, diagnosed as suffering from borderline personality disorder, is referred to your clinic. Her disorder is characterized by unstable personal relationships, impulsivity, suicidal behavior, emotional instability and pan-anxiety. After initiation of pharmacological treatment which you have chosen, you meet with her parents who ask you which is better for their daughter dynamic-analytic psychotherapy or dialectical behavioral therapy.     

Chemokines in bipolar disorder: Trait or state?

Recent evidence has suggested that inflammatory and immune mechanisms may play a role in the pathophysiology of bipolar disorder (BD). Only a few studies have assessed the profile of chemokines, a family of chemotactic cytokines related to the recruitment of leukocytes, in BD. The objective of our study was to evaluate the plasma levels of chemokines in BD patients in different mood states in comparison with healthy controls. Seventy BD type I patients (35 in euthymia and 35 in mania), and 50 healthy controls matched by age, gender, and education level were enrolled in this study. All subjects were assessed by the Mini-International Neuropsychiatry Interview and the patients by the Young Mania Rating Scale and the Hamilton Depression Rating Scale. The plasma levels of CCL2, CCL3, CCL11, CCL24, CXCL8, and CXCL10 were measured by enzyme-linked immunosorbent assay. BD patients presented higher plasma levels of CCL11 (1.69-fold increase; p < 0.001), CCL24 (1.40-fold increase; p = 0.02), CXCL10 (1.45-fold increase; p < 0.001) and decreased plasma levels of CXCL8 (8.68-fold decrease p < 0.001). Logistic regression stressed the main effect of increased plasma levels of CXCL10 (OR = 1.009, 95 % CI = 1.000–1.018, p = 0.042) and CCL11 (OR = 1.002, 95 % CI = 1.001–1.003, p = 0.003) and decreased plasma levels of CXCL8 (OR = 0.995, 95 % CI = 0.990–0.999, p = 0.013) to BD. This study reinforces the view that BD is associated with an immune dysfunction.     

Do personality traits predict first onset in depressive and bipolar disorder?

The aim was to investigate whether personality traits predict onset of the first depressive or manic episode (the vulnerability hypothesis) and whether personality might be altered by the mood disorder (the scar hypothesis). A systematic review of population-based and high-risk studies concerning personality traits and affective disorder in adults was conducted. Nine cross-sectional high-risk studies, seven longitudinal high-risk studies and nine longitudinal population-based studies were found. Most studies support the vulnerability hypothesis and there is evidence that neuroticism is a premorbid risk factor for developing depressive disorder. The evidence for the scar hypothesis is sparse, but the studies with the strongest design showed evidence for both hypotheses. Only few studies of bipolar disorder were found and the association between personality traits and bipolar disorder is unclear. Neuroticism seem to be a risk factor by which vulnerable individuals can be identified, thus preventing the development of depressive disorder. A connection between personality traits and development of bipolar disorder, and evidence of a personality-changing effect of affective episodes need to be further investigated.     

Schizotypal personality disorder or prodromal symptoms of schizophrenia?

Schizotypal personality disorder shares some attenuated phenotypic features with schizophrenia, but represents an independent syndrome. In contrast, prodromal symptoms of schizophrenia represent early warning signs of the impending onset of schizophrenia. Although these constructs are intended to reflect independent syndromes, self-report instruments measuring these constructs assess similar symptoms. It does not appear that existing research has examined the relative discriminant validity of screening instruments for these syndromes. A sample of 998 young adults (68% female; 73% Caucasian), within the age of risk for schizophrenia (ages 18–34; mean 20.4 ± 2.2), met validity criteria after completing online versions of the Abbreviated Schizotypal Personality Questionnaire (SPQ-B) and the 24-item Abbreviated Youth Psychosis at Risk Questionnaire (Y-PARQ-B). Based on clinical cut-off scores used in previous research, 5.2% were [only] considered at heightened risk for psychosis (potentially prodromal), 3.4% had [only] schizotypal personality features, and 2.9% met criteria for both constructs (75% of individuals meeting cutoff for one measure did not meet criteria for the other). Males and younger participants scored significantly higher on both measures. The total scores from the SPQ-B and Y-PARQ-B showed a significant positive correlation (r_s = .66, p < .001, R² = .43); however, 57% of the variance was not shared between the measures. Of the three SPQ-B subscales, Cognitive–Perceptual showed the strongest correlation with Y-PARQ-B. Results suggest that the SPQ-B and Y-PARQ-B have moderate discriminate validity between the overlapping, yet distinct, constructs of schizotypal personality and heightened risk of developing psychosis (potentially prodromal).     

Is the borderline personality disorder a complex post-traumatic stress disorder? - The state of research

Regarding the high prevalence of traumatic experiences in patients with borderline personality disorders (BPD), we review the available literature focussing on the hypothesis that BPD is a subtype of trauma associated disorders. The criteria of BPD, of complex post-traumatic stress disorders (PTSD), and of disorders of extreme stress not otherwise specified (DESNOS) substantially overlap. Research of the long-term course of BPD and PTSD, trauma research, and research of vulnerability in both disorders yielded converging results. Neuropsychological deficits in BPD and PTSD as well as psychoendocrinological and neuroimaging studies in BPD und PTSD also revealed common features. A pathogenetic specificity of individual etiologic factors does not appear to exist, however the assumption of a diathesis-stress model with traumatisation as a necessary but etiologically insufficient condition seems justified. Further research will have to prove BPD as a complex and early-onset post-traumatic stress disorder after multiple and/or chronic (type II) traumatic experiences during childhood and/or youth. Definitive conclusions require further research efforts.     

Semantic hyperpriming in thought-disordered patients with schizophrenia: state or trait?--a longitudinal investigation

Enhanced semantic priming (SP) has been reported in individuals with schizophrenia who exhibit positive formal thought disorder (TD) and it has been linked to heightened automatic spreading activation in semantic networks of these patients. However, the state or trait nature of semantic hyperpriming in schizophrenia and its relation to clinical features (e.g., length of illness, symptom shifts) is not clear. To explore these issues, we administered a lexical decision task with semantically related, indirectly related or unrelated prime-target pairs to acutely ill inpatients with schizophrenia shortly after admission and again after 12-16 weeks, while most patients were already in (partial) remission (n=33). In addition, we examined 20 healthy control subjects twice (2 weeks apart). Relative to control subjects, TD patients with schizophrenia exhibited hyperpriming only in the acute psychotic state, but not during the follow-up examination, when TD and other positive symptoms had resolved. There were no associations between priming effects and length of illness or number of previous psychotic episodes. In conclusion, semantic hyperpriming in TD patients with schizophrenia appears to be clearly state-dependent and might be viewed as an episode marker of psychosis with TD.     

Dispute over the multiple personality disorder: theoretical or practical dilemma?

Dissociative identity disorder (DID) could also be referred to as multiple personality disorder (MPD). Due to rare occurrence and difficulty in its' identification it is infrequently diagnosed in Poland. The indicated disorder has been portrayed by the authors throughout the historical context, referring to initial 18th century's references concerning dissociation. A typical dissociatively disordered person has been characterized along with his individual personality categories such as: original personality, altered personality, host and personality fragment. Moreover various diagnosis criterions of DID have been introduced. DID has also been differentiated with other disorders: PTSD (post-traumatic stress disorder) and BPD (borderline personality disorder). A hypothesis has been set up, stating that DID is directly correlated with the trauma experienced during childhood, while PTSD is linked with traumatic lived-through events in the later period of ones' life. The most contemporary and frequently used research tools for DID have been indicated: dissociative experience scale (DES) and somatoform dissociation questionnaire (SDQ-20). Based upon the known literature, the authors have presented treatment methods such as hypnotherapy and recorded therapy sessions. It is the view of the authors that the switching in dissociative identity disorder is of adaptive character (it occurrs depending upon adaptive needs).     

Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders

This article addresses the question whether borderline personality disorder (BPD) can be understood as a variant of bipolar disorder. In the past, borderline pathology has been seen as a variant of psychosis, depression, or posttraumatic stress disorder, but there are important differences between all of these conditions and BPD. The proposal that BPD falls within the bipolar spectrum depends on the assumption that affective instability develops through the same mechanism in both diagnostic categories. There are major differences in phenomenology, family history, longitudinal course, and treatment response between BPD and bipolar disorder, and the findings of comorbidity studies are equivocal. Thus, existing evidence is insufficient to support the concept that BPD falls in the bipolar spectrum.