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BACKGROUND: The relationship between borderline personality disorder (BPD) and type-II bipolar disorder (BDII) is not clearly understood. Nevertheless, in clinical practice and research, most efforts focus on establishing a categorical distinction between the two. We propose using personality traits as a more informative strategy to describe them. METHODS: Five-Factor Model personality traits were measured in 73 individuals with either BPD or BDII. Latent class cluster analysis was applied to the sample. RESULTS: A three-cluster model resulted the best fit to the data, where all clusters had high neuroticism and low extraversion scores but differed widely on the other traits. The clusters' boundaries did not match the categorical diagnosis. CONCLUSIONS: Our sample showed significant heterogeneity on personality traits, which can have a relevant effect on the outcome of each disorder and that was not captured by the categorical diagnosis. Thus, we advocate for a multivariate approach as a better way to understand the relationship between BPD and BDII.
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OBJECTIVE: Genetic factors underlying different personality traits are not entirely understood, particularly how genes interact to modulate their effect. We studied 76 patients diagnosed with borderline personality disorder (BPD), characterized by extreme levels of personality traits, especially neuroticism (N), in which we genotyped two polymorphisms, the 5HTTLPR of the Serotonin transporter (SERT) gene, and the Val66Met of the Brain-derived neurotrophic factor (BDNF) gene. RESULTS: We found an association with SERT, where S-allele carriers had significantly higher levels of N than L-homozygous. Furthermore, we found that the protective effect of L-homozygosity is only evident on A-allele carriers of the BDNF Val66Met polymorphism. Genetic constitution in SERT and BDNF seems to be important in neuroticism, the most relevant personality trait on BPD.
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Transtorno da Personalidade Borderline/genética , Transtorno da Personalidade Borderline/fisiopatologia , Fator Neurotrófico Derivado do Encéfalo/genética , Neuroticismo , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Adulto , Feminino , Humanos , Masculino , Polimorfismo de Nucleotídeo ÚnicoRESUMO
BACKGROUND: Disturbances in central serotonin function have been implicated in impulsive and aggressive behavior. A deletion/insertion polymorphism within the 5-HT transporter promoter gene (5-HTTLPR) is thought to be associated with disturbed impulse control, anxiety, and depression. The serotonin transporter (5-HTT) is the primary action site for selective serotonin reuptake inhibitors (SSRIs). Several studies of major depression have shown that the l allele of 5-HTTLPR is associated with better SSRI antidepressant effects than the s allele. METHODS: This study investigates the association between response of impulsivity to treatment with fluoxetine and 5-HTTLPR polymorphism in 49 personality disordered patients. Additionally, we studied TPH1, 5HT1B and 5HT2C receptor polymorphisms as predictors of response in this population. RESULTS: Results reveal that patients with the l/l genotype of 5-HTTLPR had a significantly better response to fluoxetine when compared to s allele carriers, as evaluated on the basis of total (P<0.05) and Aggression subscale (P<0.01) Overt Aggression Scale Modified-score percentage change. There were no significant associations between fluoxetine response and TPH1 (A218C) (-6525 A>G) (-5806 G>T), HTR1B (G861C) and HTR2C (G68C) genotype groups. CONCLUSION: This is the first study assessing the association between these polymorphisms and anti-impulsive response to fluoxetine in personality disorder. As the s genotype is associated with a poorer selective serotonin reuptake inhibitors response in major depression, bulimia nervosa and borderline personality disorder, it could represent a common biological background for SSRI response.
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Agressão , Fluoxetina/uso terapêutico , Comportamento Impulsivo/genética , Transtornos da Personalidade/genética , Polimorfismo Genético/genética , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Adolescente , Adulto , Idoso , Agressão/efeitos dos fármacos , Agressão/fisiologia , Alelos , Feminino , Genótipo , Humanos , Comportamento Impulsivo/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/tratamento farmacológico , Escalas de Graduação Psiquiátrica , Adulto JovemRESUMO
OBJECTIVE: Borderline personality disorder is a severe mental disorder, whereas previous studies suggest executive functions may be impaired. The aim of this study was to evaluate executive planning in a sample of 85 individuals. METHODS: Planning was assessed by means of the Tower of London (Drexel University version) task. Latent class cluster analysis models were adjusted to the data. RESULTS: We identified two different subpopulations of borderline personality disorder patients, one of them with significantly reduced performance. CONCLUSION;. Neuropsychological mechanisms may be involved in borderline personality disorder, at least in a subgroup of patients.
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Transtorno da Personalidade Borderline/diagnóstico , Transtornos Cognitivos/diagnóstico , Função Executiva , Jogos Experimentais , Resolução de Problemas , Adulto , Agressão/psicologia , Transtorno da Personalidade Borderline/psicologia , Transtornos Cognitivos/psicologia , Feminino , Humanos , Entrevista Psicológica , Masculino , Modelos Psicológicos , Inventário de Personalidade/estatística & dados numéricos , Psicometria , Tempo de Reação , Valores de ReferênciaRESUMO
Existe una controversia respecto a la independencia nosológica del trastorno límite de personalidad. Algunos autores sostienen que es parte del trastorno bipolar, mientras otros afirman que es una entidad independiente. En este trabajo se analiza la evolución histórica de los conceptos de trastorno límite y trastorno bipolar. Se discuten los argumentos a favor y en contra de incluir el trastorno límite dentro del trastorno bipolar. Por último se proponen nuevas estrategias para abordar este problema.
The independent nosological status of borderline personality disorder is a controversial issue. Some authors consider borderline as part of bipolar spectrum, but other sustain that is a independent entity. The historical evolution of borderline personality disorder and bipolar disorder is analyzed in this work. The arguments for include, or not include, borderline personality disorder in bipolar disorder is discussed. Finally, new strategies for study this problem are proposed.
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Transtorno Bipolar/história , Transtorno da Personalidade Borderline/história , PsiquiatriaRESUMO
Antecedentes: Las conductas agresivas e impulsivas han sido asociadas con disfunciones del sistema serotoninérgico central. Polimorfismos del transportador de serotonina, de la triptófano hidroxilasa (TPH1) y de los receptores serotoninérgicos 5HT1B y 5HT2C han sido vinculados a agresión e impulsividad. Varios estudios en depresión mayor han demostrado que el alelo corto (S) del promotor del gen transportador de serotonina se asocia a una peor respuesta a los inhibidores selectivos de la recapacitación de serotonina (ISNS). Material y métodos: En este estudio se investigó la asociación entre la respuesta de la impulsividad al tratamiento con fluoxetina y polimorfismos del transportador de serotonina, TPH1 y de los receptores 5HT1B y 5HT2C, en 49 pacientes con trastorno límite de personalidad. Resultados: Los pacientes con el genotipo L/L del promotor del gen transportador de serotonina, evaluados mediante la Overt Aggression Scale-Modified (OAS-M), tuvieron una respuesta a fluoxetina significativamente mejor que los portadores del alelo S. No se encontró asociación entre la respuesta a fluoxetina y los genotipos de TPH1 y de los receptores 5HT1B y 5HT2C. Conclusiones: Este es el primer estudio en el que se evalúa la asociación entre estos polimorfismos y la respuesta anti-impulsiva a la fluoxetina en pacientes con trastorno límite de personalidad. El alelo S puede representar un factor común de peor respuesta a los ISRS en enfermedades asociadas a una disfunción serotoninérgica.
Background: Disturbances in central serotonin function have been implicated in impulsive and aggressive behavior. Serotonin transporter tryptophan hydroxylase (TPH1) and serotoninergic receptor (5HT1B, 5HT2C) polymorphisms have been linked to aggression and impulsivity. Several studies of major depression have shown that the short allele (S) of the serotonin transporter promoter gene is associated with a worse response to selective serotonin reuptake inhibitors (SSRIs). Material and methods: This study investigates the association between the response of impulsivity to fluoxetine treatment and serotonin transporter, TPH1 and 5HT1B and 5HT2C receptor polymorphisms in 49 patients with borderline personality disorder. Results: Patients with the Long/Long (L/L) genotype of the serotonin transporter promoter had a significantly better response to fluoxetine when compared to the S allele carriers, as evaluated by the Overt Aggression Scale-Modified (OAS-M). There were no significant associations between these polymorphisms and anti-impulsive response to fluoxetine in patients with borderline personality disorder. The S allele may represent a common factor of worse response to SSRIs in diseases associated to serotonin dysfunction.
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Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Farmacogenética , Fluoxetina , Genes , Serotonina , Transtornos da PersonalidadeRESUMO
Objetivo. Estudiar los efectos de la fluoxetina sobre la impulsividad y otros síntomas del trastorno límite de personalidad. Método. 33 pacientes que cumplían los criterios diagnósticos del International Personality Disorders Examination (IPDE) para trastorno límite de personalidad y que no se encontraban recibiendo fármacos, fueron tratados duante 12 semanas con fluoxetina. Previamente se descartó trastorno del Eje 1 del DSM-IV y patología somática. Los sujetos fueron evaluados al inicio del estudio y a las 4 y 12 semanas mediante brief Psychiatric Rating Scale (BPRS), escala de Hamilton para la depresión (HAM-D) y ansiedad (HAM-A), Global Assesment Scale(GAS) y Overt Aggresion Scale Modified (OAS-M). Resultados. Hubo una reducción significativa de los puntajes de BPRS, HAM-D, HAM-A Y OAS-M y mejoría del funcionamiento global en el GAS. Hubo una marcada reducción de la impulsividad en especial de la subescala de agresividad de la OAS-M. Conclusiones. La fluoxetina demostró ser eficaz en el tratamiento de la sintomatología del trastorno límite de personalidad, especialmente de la impulsividad. Estos resultados apoyan la existencia de una disfunción serotoninégica en estos trastornos, la que podría ser corregida por la fluoxetina.