Bone mineral density in premenopausal women with major depressive disorder

This cross-sectional study investigated whether a group of unmedicated patients with major depressive disorder, single episode, had decreased bone mineral density (BMD). The BMD at the lumbar spine and proximal femur in 25 premenopausal women with major depressive disorder and 15 normal women was measured by dual-energy X-ray absorptiometry. Bone turnover markers and serum cortisol levels were also evaluated for each subject. As compared with values in the normal women, the mean BMD in the depressed women was significantly lower at the lumbar spine and at all sites of the proximal femur. There was no statistically significant difference between serum cortisol levels and bone turnover markers except for significantly higher urinary excretion of deoxypyridinoline cross-links in the patients compared with the controls. In conclusion, depressed women may have decreased BMD even at the very early stages of the illness, and this possibility should be taken into consideration in treatment.     

Cortisol, the cortisol-dehydroepiandrosterone ratio, and pro-inflammatory cytokines in patients with current major depressive disorder comorbid with borderline personality disorder.

BACKGROUND: Major depression in young women is often comorbid with borderline personality disorder (BPD); however, adrenal steroids and pro-inflammatory cytokines in patients with comorbid current major depressive disorder and BPD (MDD/BPD) have not been systematically examined. Therefore, our study aimed at examining serum profiles of cortisol, cytokines, and the cortisol/dehydroepiandrosterone (cortisol/DHEA) ratio in MDD/BPD patients and a healthy comparison group. METHODS: Twelve medication-free female patients with MDD/BPD and 12 healthy women were included. Serum profiles of cortisol, DHEA, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and interleukin-1beta were sampled, and the molar cortisol/DHEA ratio was determined. RESULTS: Concentrations of serum cortisol, TNF-alpha, and IL-6, as well as the cortisol/DHEA ratios were significantly increased in MDD/BPD patients as compared with the healthy comparison group. CONCLUSIONS: Depressed patients with comorbid BPD display endocrine and immune alterations similar to those observed in cases of melancholic MDD without BPD. Elevated concentrations of serum cortisol, cortisol/DHEA ratios, and pro-inflammatory cytokines might indicate a state marker in these patients and might contribute to long-term metabolic alterations that have also been associated with MDD.     

Sustained unemployment in psychiatric outpatients with bipolar depression compared to major depressive disorder with comorbid borderline personality disorder

Zimmerman M, Martinez JH, Young D, Chelminski I, Dalrymple K. Sustained unemployment in psychiatric outpatients with bipolar depression compared to major depressive disorder with comorbid borderline personality disorder. Bipolar Disord 2012: 14: 856–862. © 2012 John Wiley & Sons A/S.Published by Blackwell Publishing Ltd. Objectives: The morbidity associated with bipolar disorder is, in part, responsible for repeated calls for improved detection and recognition. No such clinical commentary exists for improved detection of borderline personality disorder in depressed patients. Clinical experience suggests that borderline personality disorder is as disabling as bipolar disorder; however, no studies have directly compared the two disorders. For this reason we undertook the current analysis from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project comparing unemployment and disability rates in patients with bipolar disorder and borderline personality disorder. Methods: Patients were interviewed with semi‐structured interviews. We compared three non‐overlapping groups of depressed patients: (i) 181 patients with DSM–IV major depressive disorder and borderline personality disorder, (ii) 1068 patients with major depressive disorder without borderline personality disorder, and (iii) 84 patients with bipolar depression without borderline personality disorder. Results: Compared to depressed patients without borderline personality disorder, depressed patients with borderline personality disorder were significantly more likely to have been persistently unemployed. A similar difference was found between patients with bipolar depression and major depressive disorder without borderline personality disorder. No differences were found between patients with bipolar depression and depression with borderline personality disorder. Conclusions: Both bipolar disorder and borderline personality disorder were associated with impaired occupational functioning and thus carry a significant public health burden. Efforts to improve detection of borderline personality disorder in depressed patients might be as important as the recognition of bipolar disorder.     

Neurochemical alterations in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder

Background. Borderline personality disorder (BPD) is associated with structural and functional brain changes. Recent models and findings refer to alterations of glutamate and total N-acetylaspartate (tNAA) in this condition. Methods. Absolute quantities of tNAA, creatine, glutamate, glutamine, myoinositol and total choline were measured using 3 Tesla magnetic resonance spectroscopy of the left anterior cingulate cortex and the left cerebellum in 14 unmedicated women with BPD and comorbid attention-deficit hyperactivity disorder (ADHD) and 18 healthy women. Both groups were matched with respect to age, education and premorbid intelligence. Results. In the anterior cingulate, we found significantly higher tNAA and glutamate concentrations and a trend for lower glutamine levels in women with BPD and comorbid ADHD as compared to healthy women. There were no significant group differences in cerebellar metabolite concentrations. Conclusions. Glutamatergic changes in the anterior cingulate may be associated with BPD and comorbid ADHD. Increased anterior cingulate tNAA may indicate disturbed energy metabolism or impaired frontal maturation.     

Corpus callosum abnormalities in women with borderline personality disorder and comorbid attention-deficit hyperactivity disorder

OBJECTIVE: Decreased brain volumes in prefrontal, limbic and parietal areas have been found in women with borderline personality disorder (BPD). Recent models suggest impaired structural and functional connectivity in this condition. To investigate this, we studied the thickness of the corpus callosum, the largest connecting fibre bundle in the human brain. METHODS: We acquired magnetic resonance imaging scans from 20 healthy women and 20 women with BPD and comorbid attention-deficit hyperactivity disorder. A novel computational mesh-based method was applied to measure callosal thickness at high spatial resolution. RESULTS: Women with BPD had a thinner isthmus of the corpus callosum, compared with healthy women. In the patient group, a history of childhood sexual abuse was associated with a thinner posterior body of the corpus callosum. CONCLUSION: Interhemispheric structural connectivity involving parietal and temporal areas may be impaired in women with BPD and comorbid attention-deficit hyperactivity disorder.     

Overnight urinary cortisol release in women with borderline personality disorder depends on comorbid PTSD and depressive psychopathology.

Free cortisol was investigated in BPD patients and healthy controls. A positive association was found between cortisol and depression scores, while the number of PTSD symptoms was negatively correlated with cortisol release. These findings suggest that alterations in cortisol release in BPD are strongly associated with the severity of psychopathology.     

Clinical outcome of ECT in patients with major depression and comorbid borderline personality disorder

OBJECTIVE: Previous research suggests that the comorbidity of major depression with a personality disorder, especially borderline personality disorder, is associated with a poorer response to ECT. The authors compared the acute outcome of ECT in depressed patients with borderline personality disorder, with personality disorders other than borderline personality disorder, and with no personality disorder. METHOD: The study subjects were 139 patients with a primary diagnosis of unipolar major depression and scores of at least 20 on the 24-item Hamilton Depression Rating Scale. Patients were treated with suprathreshold right unilateral or bilateral ECT in a standardized manner and were assessed with the Hamilton depression scale within 3 days and 4-8 days after completing ECT. RESULTS: Compared to patients with personality disorders other than borderline personality disorder (N=42) and those with no personality disorder (N=77), patients with borderline personality disorder (N=20) had less symptomatic improvement assessed up to 8 days after ECT. Patients with personality disorders other than borderline personality disorder responded as well to ECT as those with no personality disorder. Borderline personality disorder patients were more likely to be female and to have medication-resistant depression than the patients in the two comparison groups; they were also younger. However, none of these differences accounted for the borderline personality disorder patients' poorer response to ECT. CONCLUSIONS: Patients with borderline personality disorder have a poorer acute response to ECT, but explanations for this finding remain elusive.     

Relationships between major depressive disorder and comorbid anxiety and personality disorders

OBJECTIVE: The aim of the study was to examine whether comorbid anxiety disorders influence depressed patients' likelihood of meeting criteria for a personality disorder (PD) and whether comorbid anxiety disorders influence the stability of the PDs in patients with remitted depression. METHODS: The initial sample consisted of 373 outpatients who met criteria for major depressive disorder (MDD) (by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition-Patient Edition) and who were enrolled in the 8-week acute treatment phase of a study of fluoxetine for MDD. Sixty-four subjects who responded to fluoxetine treatment in the acute phase met criteria for remission throughout a 26-week continuation phase during which they remained on fluoxetine with or without cognitive behavioral therapy. Stability of PDs was defined as meeting criteria for a PD at both beginning and end point of the continuation treatment phase. RESULTS: Before fluoxetine treatment, anxious depressed patients (defined as meeting criteria for MDD as well as at least one comorbid anxiety disorder) were significantly more likely to meet criteria for any comorbid PD diagnosis compared with depressed patients without comorbid anxiety disorders. In particular, there was a significant relationship between the presence of Cluster A and C PDs and the presence of anxious depression at baseline before antidepressant treatment. After successful treatment of MDD, we found a significant relationship between anxious depression diagnosed at baseline and the stability of a Cluster C PD diagnosis. CONCLUSION: Anxious depression may place patients at greater risk of having a PD diagnosis, especially one from Cluster A or C. Once the depression remits, patients who initially met criteria for anxious depression may be more likely to maintain a Cluster C PD diagnosis compared with patients initially diagnosed with MDD alone.     

Hippocampal volume in borderline personality disorder with and without comorbid posttraumatic stress disorder: A meta-analysis

Background

Several studies have found a reduction in hippocampal volume in borderline personality disorder (BPD) patients.

Methods

In order to investigate the degree to which comorbid posttraumatic stress disorder (PTSD) could account for reduction in hippocampal volume in these patients, we conducted a systematic review and meta-analysis of studies that compared hippocampal volume in BPD patients with and without PTSD relative to healthy controls.

Results

Seven articles, involving 124 patients and 147 controls, were included. We found a statistically significant reduction for the left and right hippocampus. Data from the four studies that discriminated BPD patients with and without PTSD indicate that hippocampal volumes were reduced bilaterally in BPD patients with PTSD, relative to healthy controls, but that results were mixed for BPD patients without PTSD, relative to healthy controls.

Conclusions

Results from this meta-analysis suggest that hippocampal volumes are reduced in patients with BPD, relative to healthy controls, but particularly in cases in which patients are diagnosed with comorbid PTSD.     

An fMRI study of cognitive reappraisal in major depressive disorder and borderline personality disorder

BackgroundOne common denominator to the clinical phenotypes of borderline personality disorder (BPD) and major depressive disorder (MDD) is emotion regulation impairment. Although these two conditions have been extensively studied separately, it remains unclear whether their emotion regulation impairments are underpinned by shared or distinct neurobiological alterations.MethodsWe contrasted the neural correlates of negative emotion regulation across an adult sample of BPD patients (n = 19), MDD patients (n = 20), and healthy controls (HCs; n = 19). Emotion regulation was assessed using an established functional magnetic resonance imaging cognitive reappraisal paradigm. We assessed both task-related activations and modulations of interregional connectivity.ResultsWhen compared to HCs, patients with BPD and MDD displayed homologous decreased activation in the right ventrolateral prefrontal cortex (vlPFC) during cognitive reappraisal. In addition, the MDD group presented decreased activations in other prefrontal areas (i.e., left dorsolateral and bilateral orbitofrontal cortices), while the BPD group was characterized by a more extended pattern of alteration in the connectivity between the vlPFC and cortices of the visual ventral stream during reappraisal.ConclusionsThis study identified, for the first time, a shared neurobiological contributor to emotion regulation deficits in MDD and BPD characterized by decreased vlPFC activity, although we also observed disorder-specific alterations. In MDD, results suggest a primary deficit in the strength of prefrontal activations, while BPD is better defined by connectivity disruptions between the vlPFC and temporal emotion processing regions. These findings substantiate, in neurobiological terms, the different profiles of emotion regulation alterations observed in these disorders.     

共病边缘型人格障碍的双相情感障碍患者认知功能状况

背景 双相情感障碍与边缘型人格障碍（BPD）共病率高,共病患者认知功能受损更严重。目的 探讨是否共病BPD的双相情感障碍患者认知功能的差异,为临床诊疗提供参考。方法 采用简单随机抽样,选取2021年4月-2022年4月在河北医科大学第一医院治疗的共病BPD的双相情感障碍患者60例（共病组）,其中双相抑郁患者33例,双相躁狂患者27例。同时选取双相情感障碍患者60例（未共病组）,其中双相抑郁35例,双相躁狂25例。采用中文版神经心理状态测验（RBANS）和Stroop色词测验评估患者的认知功能。结果 共病组RBANS中的即刻记忆、视觉广度、言语功能和总评分均低于未共病组,差异均有统计学意义（t=-2.356、-2.138、-3.306、-2.729,P<0.05或0.01）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组,差异均有统计学意义（t=4.808、3.341、5.249、5.167,P均<0.01）。共病BPD的双相抑郁患者RBANS中的即刻记忆、视觉广度、言语功能和总评分均低于未共病BPD的双相抑郁患者（t=-2.446、-2.407、-2.231、-2.078,P均<0.05）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组（t=3.652、3.035、4.406、5.016,P均<0.01）。共病组双相躁狂患者RBANS中的言语功能和总评分均高于未共病组（t=-2.777、-2.347,P<0.05或0.01）,Stroop色词测验中的单字时间、单色时间、双字时间和双色时间均长于未共病组（t=3.600、2.658、2.943、4.337,P<0.05或0.01）。结论 相较于未共病BPD的双相情感障碍患者,共病BPD的双相情感障碍患者认知功能受损更严重。     

Platelet alpha 2-adrenergic receptor binding sites in major depressive disorder and borderline personality disorder

Platelet alpha 2-adrenergic receptor binding sites were measured in a group of patients with major depressive disorder (MDD) (n = 23) and in normal controls (n = 25). When all depressed subjects were compared to controls, there were no differences in either Kd (affinity of the ligand) or total binding site (number/platelet), although a significant change in the ratio of high to low affinity states was observed in the depressed group. When the depressed patients were subdivided into those with and without a co-occurring borderline personality disorder (BPD), the BPD group had significantly fewer alpha 2 high affinity binding sites, while the group with depression alone had significantly more binding sites (both low and high affinity) than the control group. The results support the concept that assessment of comorbid diagnoses may be essential to biological studies of depression.     

骨转换指标和骨密度预测骨折危险性的可行性

背景：骨密度虽然可以诊断骨质疏松,但不能及时反映受试者正在发生的骨代谢情况;骨转换指标虽然不能诊断骨质疏松,但它可以及时反映受试个体正在发生的骨转换速率。 目的：概述骨转换指标和骨密度预测骨质疏松症的骨折危险性,从理论上分析,骨折术后愈合与否的预测方法的可行性。 方法：以bone tunrnover,biochemical marker,osteoporosis为检索词,检索Pubmed数据库(1999-01/2009-01);以骨转换,骨代谢,生化标志物,骨密度,骨质疏松,骨折为检索词,检索CNKI数据库(1999-01/2009-01)。文献检索语种限制为英文和中文。纳入与骨转换指标和骨密度预测骨折危险性的研究紧密相关的文章;排除重复文献。 结果与结论：计算机初检得到631篇文献,根据纳入排除标准,对其中31篇文献进行分析。骨质疏松症是老年人发病及死亡的主要原因之一,早期预测骨质疏松症的骨折危险性意义重大。文章介绍了长期制动后的骨代谢机制、骨生化标志物种类、骨密度测量、多细胞基本单位和 OPG-RANKL-RANK 系统在骨重建中的作用;重点介绍了国内外学者运用骨转换指标和骨密度预测骨质疏松症和长期制动后的骨折危险性,从理论上分析骨折术后愈合与否的预测方法的可行性。     

Smaller stress-sensitive hippocampal subfields in women with borderline personality disorder without posttraumatic stress disorder

Background

Animal and human studies have suggested that hippocampal subfields are differentially vulnerable to stress, but subfield volume has not been investigated in patients with borderline personality disorder (BPD). Based on the putative role of stressful life events as vulnerability factors for BPD, we hypothesized that patients with BPD would exhibit reduced volumes for the stress-sensitive dentate gyrus (DG) and the cornu ammonis (CA) 3 subfields volumes, and that these volumes would be associated with traumatic childhood experiences.

Methods

All participants underwent 3 T magnetic resonance imaging. Hippocampal subfield volumes were estimated using an automated and validated segmentation algorithm implemented in FreeSurfer. Age and total subcortical grey matter volume were covariates. We assessed traumatic childhood experiences using the Childhood Trauma Questionnaire (CTQ).

Results

A total of 18 women with BPD and 21 healthy control women were included in the study. Only 1 patient had comorbid posttraumatic stress disorder (PTSD). The volumes of the left (p = 0.005) and right (p = 0.011) DG-CA4 and left (p = 0.007) and right (p = 0.005) CA2–3 subfields were significantly reduced in patients compared with controls. We also found significant group differences for the left (p = 0.032) and right (p = 0.028) CA1, but not for other hippocampal subfields. No associations were found between CTQ scores and subfield volumes.

Limitations

The self-reported CTQ might be inferior to more comprehensive assessments of traumatic experiences. The sample size was moderate.

Conclusion

The volumes of stress-sensitive hippocampal subfields are reduced in women with BPD without PTSD. However, the degree to which childhood trauma is responsible for these changes is unclear.     

Factors associated with borderline personality disorder in major depressive patients and their relationship to bipolarity

ObjectiveTo analyze the interface between borderline personality disorder (BPD) and bipolarity in depressed patients comorbid with BPD.MethodsAs part of National Multi-site Study of 493 consecutive DSM-IV major depressive patients evaluated in at least two semi-structured interviews 1 month apart, 19 (3.9%) had comorbid BPD (BPD+), whereas 474 (96.1%) did not manifest this comorbidity (BPD?).ResultsCompared to BPD (?), BPD (+) patients displayed higher rates of bipolar (BP) disorders and temperaments, an earlier age at onset with a family history of affective illness, more comorbidity, more stressors before the first episode which was more often depressive or mixed, as well as a greater number and severity of affective episodes.ConclusionsThe hypothesis which fitted at best our findings was to consider BPD as a contributory factor in the development of BP disorder, which could have favoured the progression from unipolar major depression to BP disorder. We could not however exclude that some features of BP disorder may have contributed to the development of BPD.     

Bone mineral density and turnover in children with attention-deficit hyperactivity disorder receiving methylphenidate

Attention-deficit hyperactivity disorder (ADHD) is the most common behavior disorder among children; methylphenidate is a drug frequently prescribed for the control of its symptoms. One of the potential side effects of methylphenidate that concerns parents is its impact on the growth of children, since the mechanism by which methylphenidate might influence growth is not known. As linear growth is associated with an increase in bone mineral density and turnover, this study was undertaken to evaluate bone mineral density by dual photon absorptiometry and bone turnover by measuring serum bone-specific alkaline phosphatase and the urinary deoxypyridinoline excretion rate in children treated with methylphenidate for 1 to 2 years as compared to a control group. There were no significant differences in bone mineral density at either the lumbar spine or femoral neck in the study group (0.662 +/- 0.04 and 0.735 +/- 0.07 g/cm2, respectively) as compared to the controls (0.675 +/- 0.05 g/cm2 and 0.734 +/- 0.07 g/cm2, respectively). Furthermore, there were no significant differences in serum bone-specific alkaline phosphatase in the study group (58 +/- 22 U/L) as compared to the control children (71 +/- 34 U/L) or in urinary deoxypyridinoline in the study group (34 +/- 38 nM/mM), as compared to the control group (27 +/- 12 nM/mM). In conclusion, our data do not support a significant effect of methylphenidate on bone mineral density turnover in children when used for 1 to 2 years.