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Atypical antipsychotics are a new treatment option for patients with impaired impulse regulation as seen in Cluster B personality disorders. Preliminary data are available on the use of atypical antipsychotics especially in the treatment of impulsivity in borderline personality disorder. The aim of the present study is to investigate efficacy regarding impaired impulse regulation, different psychopathological symptoms and tolerability of quetiapine in a group of patients with Cluster B personality disorder.
Fifteen consecutive patients with a DSM-IV diagnosis of borderline, histrionic, or narcissistic personality disorder were treated for 8 weeks with open-label quetiapine at the dose of 400 mg/day. Patients were assessed at baseline, week 1, 2, 3, 4, 6, and week 8. The clinical efficacy and side effects were assessed using the following scales: Hamilton Scales for Depression (HAM-D) and Anxiety (HAMD-A), Beck-Depression Inventory (BDI), Barratt Impulsivity Scale version 10 (BIS-10), Brief Psychiatric Rating Scale (BPRS), and the Dosage Record and Treatment Emergent Symptom Scale (DOTES).
Twelve patients completed the study. Three patients (20%) dropped out due to noncompliance. A significant improvement was found for the scores of the following scales: BPRS (anxiety/depression subscale), HAM-D, and BDI. No significant result was found for impaired impulse regulation. Common adverse effects, possibly due to study medication, were mild-to-moderate somnolence, mouth dryness, agitation, nausea, and dizziness.
An 8 week open label treatment with 400mg quetiapine daily seems to improve depressive and anxiety, but not impulsivity symptoms in cluster-B personality disorders.
Intrusive memories of traumatic events are a core feature of post-traumatic stress disorder but little is known about the neurobiological formation of intrusions. The aim of this study was to determine whether the activity of the noradrenergic system during an intrusion-inducing stressor would influence subsequent intrusive memories.
We conducted an experimental, double-blind, placebo-controlled study in 118 healthy women. Participants received a single dose of either 10 mg yohimbine, stimulating noradrenergic activity, or 0.15 mg clonidine, inhibiting noradrenergic activity, or placebo. Subsequently, they watched an established trauma film which induced intrusions. The number of consecutive intrusions resulting from the trauma film, the vividness of the intrusions, and the degree of distress evoked by the intrusions were assessed during the following 4 days. Salivary cortisol and α-amylase were collected before and after the trauma film.
A significant time × treatment interaction for the number of intrusions and the vividness of intrusions indicated a different time course of intrusions depending on treatment. Post-hoc tests revealed a delayed decrease of intrusions and a delayed decrease of intrusion vividness after the trauma film in the yohimbine group compared with the clonidine and placebo groups. Furthermore, after yohimbine administration, a significant increase in salivary cortisol levels was observed during the trauma film.
Our findings indicate that pharmacological activation of the noradrenergic system during an emotionally negative event makes an impact on consecutive intrusive memories and their vividness in healthy women. The noradrenergic system seems to be involved in the formation of intrusive memories.
Patients with borderline personality disorder (BPD) show negative and unstable self- and other-evaluations compared to healthy individuals. It is unclear, however, how they process self- and other-relevant social feedback. We have previously demonstrated a positive updating bias in healthy individuals: When receiving social feedback on character traits, healthy individuals integrate desirable more than undesirable feedback. Here, our aim was to test whether BPD patients exhibit a more negative pattern of social feedback processing.
We employed a character trait task in which BPD patients interacted with four healthy participants in a real-life social interaction. Afterwards, all participants rated themselves and one other participant on 80 character traits before and after receiving feedback from their interaction partners. We compared how participants updated their ratings after receiving desirable and undesirable feedback. Our analyses included 22 BPD patients and 81 healthy controls.
Healthy controls showed a positivity bias for self- and other-relevant feedback as previously demonstrated. Importantly, this pattern was altered in BPD patients: They integrated undesirable feedback for themselves to a greater degree than healthy controls did. Other-relevant feedback processing was unaltered in BPD patients.
Our study demonstrates an alteration in self-relevant feedback processing in BPD patients that might contribute to unstable and negative self-evaluations.
Disturbances in social interaction are a defining feature of patients with borderline personality disorder (BPD). In this study, facial emotional expressions, which are crucial for adaptive interactions in social contexts, were assessed in patients with BPD in response to social exclusion.
We examined facial emotional reactions of 35 patients with BPD and 33 healthy controls when playing Cyberball, a virtual ball-tossing game that reliably induces social exclusion. Besides self-reported emotional responses, facial emotional expressions were analyzed by applying the Emotional Facial Action Coding System (EMFACS).
Patients with BPD showed a biased perception of participation. They more readily reported feeling excluded compared to controls even when they were included. In BPD, social exclusion led to an increase in self-reported other-focused negative emotions. Overall, EMFACS analyses revealed that BPD patients reacted with fewer positive expressions and with significantly more mixed emotional expressions (two emotional facial expressions at the same time) compared to the healthy control group when excluded.
Besides a negative bias for perceived social participation, ambiguous facial emotional expressions may play an important role in the disturbed relatedness in patients with BPD.
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