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Executive dysfunction in bipolar disorder and borderline personality disorder

Published online by Cambridge University Press:  21 October 2015

H.Z. Gvirts ,
Y. Braw ,
H. Harari ,
M. Lozin ,
Y. Bloch ,
K. Fefer  and
Y. Levkovitz
H.Z. Gvirts
Affiliation:
The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Y. Braw
Affiliation:
The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Department of Behavioural Sciences, Ariel University, Ariel, Israel
H. Harari
Affiliation:
The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
M. Lozin
Affiliation:
Department of Behavioural Sciences, Ariel University, Ariel, Israel
Y. Bloch
Affiliation:
The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
K. Fefer
Affiliation:
The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
Y. Levkovitz*
Affiliation:
The Emotion-Cognition Research Center, Shalvata Mental Health Care Center, Hod-Hasharon, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
*
⁎Corresponding author. Emotion-Cognition Research Center, Shalvata Mental Health Center, Hod-Hasharon, Israel. Tel.: +972-9-7478644; fax: +972-9-7478643. E-mail address:ylevk@clalit.org.il (Y. Levkovitz).
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Abstract

Objective

The boundary between bipolar disorder (BD) and borderline personality disorder is a controversial one. Despite the importance of the topic, few studies have directly compared these patient groups. The aim of the study was to compare the executive functioning profile of BD and BPD patients.

Method

Executive functioning (sustained attention, problem-solving, planning, strategy formation, cognitive flexibility and working memory) was assessed in BD (n = 30) and BPD outpatients (n = 32) using a computerized assessment battery (Cambridge Neuropsychological Test Automated Battery, CANTAB). The groups were compared to one another as well as to healthy controls.

Results

BD patients showed deficits in strategy formation and in planning (indicated by longer execution time in the ToL task) in comparison to BPD patients and healthy controls. BPD patients showed deficits in planning (short deliberation time in the ToL task) in comparison to BD patients and in comparison to healthy controls. In comparison to healthy controls, BPD patients displayed deficits in problem-solving.

Conclusions

Differences in executive dysfunction between BD and BPD patients suggest that this cognitive dimension may be relevant for the clarification of the boundary between the disorders.

Keywords

Bipolar disorderBorderline personality disorderCognitionExecutive dysfunction
Type
Original article
Information
European Psychiatry , Volume 30 , Issue 8 , November 2015 , pp. 959 - 964
Copyright
Copyright © European Psychiatric Association 2020

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References

Akiskal, H.S.. Demystifying borderline personality: critique of the concept and unorthodox reflections on its natural kinship with the bipolar spectrum. Acta Psychiatr Scand 2004;110(6):401–407.Google ScholarPubMed
American Psychiatric Association, Diagnostic and statistical manual of mental disorders. DSM-IV-TR ed. Washington, DC: American Psychiatric Association; 2000.Google Scholar
Ancín, I.Santos, J.Teijeira, C.Sánchez-Morla, E.Bescós, M.Argudo, I., et al.Sustained attention as a potential endophenotype for bipolar disorder. Acta Psychiatr Scand 2010;122(3):235–245.CrossRefGoogle ScholarPubMed
Bazanis, E.Rogers, R.Dowson, J.Taylor, P.Meux, C.Staley, C., et al.Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder. Psychol Med 2002;32(08):1395–1405.CrossRefGoogle ScholarPubMed
Bourne, C.Aydemir, Ö.Balanzá-Martínez, V.Bora, E.Brissos, S.Cavanagh, J., et al.Neuropsychological testing of cognitive impairment in euthymic bipolar disorder: an individual patient data meta-analysis. Acta Psychiatr Scand 2013;128:149–162.CrossRefGoogle ScholarPubMed
Braw, Y.Erez, G.Sela, T.Gvirts, H.Z.Hare, E.V.Bloch, Y., et al.A longitudinal study of cognition in asymptomatic and mildly symptomatic bipolar disorder patients. Psychiatry Res 2013;210(3):842–849.CrossRefGoogle ScholarPubMed
Coulston, C.M.Tanious, M.Mulder, R.T.Porter, R.J.Malhi, G.S.. Bordering on bipolar: the overlap between borderline personality and bipolarity. Austr NZ J Psychiatry 2012;46(6):506–521.CrossRefGoogle ScholarPubMed
De Luca, C.R.Wood, S.J.Anderson, V.Buchanan, J.A.Proffitt, T.M.Mahony, K., et al.Normative data from the CANTAB I: development of executive function over the lifespan. J Clin Exp Neuropsychol 2003;25(2):242–254.CrossRefGoogle ScholarPubMed
Dell’Osso, B.Berlin, H.Serati, M.Altamura, A.C.. Neuropsychobiological aspects, comorbidity patterns and dimensional models in borderline personality disorder. Neuropsychobiology 2010;61(4):169–179.CrossRefGoogle ScholarPubMed
Eling, P.Derckx, K.Maes, R.. On the historical and conceptual background of the Wisconsin Card Sorting Test. Brain Cogn 2008;67(3):247–253.CrossRefGoogle ScholarPubMed
Elisei, S.Anastasi, S.Verdolini, N.. The continuum between bipolar disorder and Borderline Personality Disorder. Psychiatr Danubina 2012;24(Suppl. 1):46–49.Google ScholarPubMed
Fertuck, E.A.Lenzenweger, M.F.Clarkin, J.F.Hoermann, S.Stanley, B.. Executive neurocognition, memory systems, and borderline personality disorder. Clin Psychol Rev 2006;26(3):346–375.CrossRefGoogle ScholarPubMed
First, M.B.Spitzer, R.L.Gibbon, M.Williams, J.B.. The structured clinical interview for DSM-III-R personality disorders (SCID-II). Part I: description. J Pers Disord 1995;9(2):83–91.CrossRefGoogle Scholar
First, M.B.Spitzer, R.L.Gibbon, M.Williams, J.B.SCID-I/P; 2007.Google Scholar
Guy, W.Clinical Global Impressions (CGI). In: Guy, W.ECDEU assessment manual for psychopharmacology – revised. Rockville, MD: National Institute of Mental Health; 1976, p. 218–222.Google Scholar
Gvirts, H.Z.Harari, H.Braw, Y.Shefet, D.Shamay-Tsoory, S.G.Levkovitz, Y.Executive functioning among patients with borderline personality disorder (BPD) and their relatives. J Affect Dis 2012;143:261–264.CrossRefGoogle ScholarPubMed
Haaland Vo, Esperaas, L.Landro, N.Selective deficit in executive functioning among patients with borderline personality disorder. Psychol Med 2009;39(10):1733.CrossRefGoogle ScholarPubMed
Hagenhoff, M.Franzen, N.Koppe, G.Baer, N.Scheibel, N.Sammer, G., et al.Executive functions in borderline personality disorder. Psychiatry Res 2013;210:223–224.CrossRefGoogle ScholarPubMed
Hamilton, M.A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23(1):56.CrossRefGoogle ScholarPubMed
Hanwella, R.de Silva, V.A.Signs and symptoms of acute mania: a factor analysis. BMC Psychiatry 2011;11(1):137.CrossRefGoogle ScholarPubMed
Harvey, P.D.Wingo, A.P.Burdick, K.E.Baldessarini, R.J.Cognition and disability in bipolar disorder: lessons from schizophrenia research. Bipolar Disord 2010;12(4):364–375.CrossRefGoogle ScholarPubMed
Hellvin, T.Sundet, K.Simonsen, C.Aminoff, S.R.Lagerberg, T.V.Andreassen, O.A., et al.Neurocognitive functioning in patients recently diagnosed with bipolar disorder. Bipolar Disord 2012;14(3):227–238.CrossRefGoogle ScholarPubMed
Henry, C.Mitropoulou, V.New, A.S.Koenigsberg, H.W.Silverman, J.Siever, L.J.Affective instability and impulsivity in borderline personality and bipolar II disorders: similarities and differences. J Psychiatric Res 2001;35(6):307–312.CrossRefGoogle ScholarPubMed
Judd, L.L.Akiskal, H.S.Schettler, P.J.Endicott, J.Maser, J.Solomon, D.A., et al.The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002;59(6):530–537.CrossRefGoogle ScholarPubMed
Kunert, H.J.Druecke, H.W.Sass, H.Herpertz, S.C.Frontal lobe dysfunctions in borderline personality disorder?. Neuropsychological findings. J Pers Disord 2003;17(6):497–509.CrossRefGoogle ScholarPubMed
Luciana, M.Practitioner review: computerized assessment of neuropsychological function in children: clinical and research applications of the Cambridge Neuropsychological Testing Automated Battery (CANTAB). J Child Psychol Psychiatry 2003;44(5):649–663.CrossRefGoogle Scholar
Malhi, G.Tanious, M.Fritz, K.Coulston, C.Bargh, D.Phan, K., et al.Differential engagement of the fronto-limbic network during emotion processing distinguishes bipolar and borderline personality disorder. Mol Psychiatry 2013;18:1247–1248.CrossRefGoogle ScholarPubMed
Mann-Wrobel, M.C.Carreno, C.J.Dickinson, J.T.D.Meta-analysis of neuropsychological functioning in euthymic bipolar disorder: an update and investigation of moderator variables. Bipolar Disord 2011;13(4):334–342.CrossRefGoogle ScholarPubMed
Martino, D.J.Marengo, E.Igoa, A.Scapola, M.Ais, E.D.Perinot, L., et al.Neurocognitive and symptomatic predictors of functional outcome in bipolar disorders: a prospective 1 year follow-up study. J Affect Disord 2009;116(1–2):37–42.CrossRefGoogle ScholarPubMed
Miyake, A.Friedman, N.P.Emerson, M.J.Witzki, A.H.Howerter, A.Wager, T.D.The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: a latent variable analysis. Cogn Psychol 2000;41(1):49–100.CrossRefGoogle ScholarPubMed
Niendam, T.A.Bearden, C.E.Johnson, J.K.McKinley, M.Loewy, R.O’Brien, M., et al.Neurocognitive performance and functional disability in the psychosis prodrome. Schizophr Res 2006;84(1):100–111.CrossRefGoogle ScholarPubMed
Paris, J.Borderline or bipolar? Distinguishing borderline personality disorder from bipolar spectrum disorders. Harvard Rev Psychiatry 2004;12(3):140–145.CrossRefGoogle ScholarPubMed
Quraishi, S.Frangou, S.Neuropsychology of bipolar disorder: a review. J Affect Disord 2002;72(3):209–226.CrossRefGoogle ScholarPubMed
Rossi, R.Pievani, M.Lorenzi, M.Boccardi, M.Beneduce, R.Bignotti, S., et al.Structural brain features of borderline personality and bipolar disorders. Psychiatry Research: Neuroimaging 2013;213(2):83–91.CrossRefGoogle ScholarPubMed
Ruocco, A.C.The neuropsychology of borderline personality disorder: a meta-analysis and review. Psychiatry Res 2005;137(3):191–202.CrossRefGoogle ScholarPubMed
Ruocco, A.C.Laporte, L.Russell, J.Guttman, H.Paris, J.Response inhibition deficits in unaffected first-degree relatives of patients with borderline personality disorder. Neuropsychology 2012;26(4):473.CrossRefGoogle ScholarPubMed
Sahakian, B.J.Owen, A.M.Computerized assessment in neuropsychiatry using CANTAB: discussion paper. J R Soc Med 1992;85(7):399–402.Google ScholarPubMed
Sanchez-Moreno, J.Martinez-Aran, A.Tabarés-Seisdedos, R.Torrent, C.Vieta, E.Ayuso-Mateos, J.Functioning and disability in bipolar disorder: an extensive review. Psychother Psychosom 2009;78(5):285–297.CrossRefGoogle Scholar
Savitz, J.Solms, M.Ramesar, R.Neuropsychological dysfunction in bipolar affective disorder: a critical opinion. Bipolar Disord 2005;7(3):216–235.CrossRefGoogle ScholarPubMed
Sepede, G.De Berardis, D.Campanella, D.Perrucci, M.G.Ferretti, A.Serroni, N., et al.Impaired sustained attention in euthymic bipolar disorder patients and non-affected relatives: an fMRI study. Bipolar Disord 2012;14(7):764–779.CrossRefGoogle ScholarPubMed
Shallice, T.Specific impairments of planning. Philos Trans R Soc Lond B Biol Sci 1982;298(1089):199–209.Google ScholarPubMed
Simonsen, C.Sundet, K.Vaskinn, A.Birkenaes, A.B.Engh, J.A.Hansen, C.F., et al.Neurocognitive profiles in bipolar I and bipolar II disorder: differences in pattern and magnitude of dysfunction. Bipolar Disord 2008;10(2):245–255.CrossRefGoogle ScholarPubMed
Skodol, A.E.Gunderson, J.G.Shea, M.T.McGlashan, T.H.Morey, L.C.Sanislow, C.A., et al.The collaborative longitudinal personality disorders study (CLPS): overview and implications. J Person Disord 2005;19(5):487.CrossRefGoogle ScholarPubMed
Sole, B.Martinez-Aran, A.Torrent, C.Bonnin, C.Reinares, M.Popovic, D., et al.Are bipolar II patients cognitively impaired? A systematic review. Psychol Med 2011;41(9):1791–1803.CrossRefGoogle ScholarPubMed
Solé, B.Bonnin, C.Torrent, C.Balanzá-Martínez, V.Tabarés-Seisdedos, R.Popovic, D., et al.Neurocognitive impairment and psychosocial functioning in bipolar II disorder. Acta Psychiatr Scand 2012;125(4):309–317.CrossRefGoogle ScholarPubMed
Sprock, J.Rader, T.J.Kendall, J.P.Yoder, C.Y.Neuropsychological functioning in patients with borderline personality disorder. J Clin Psychol 2000;56(12):1587–1600.3.0.CO;2-G>CrossRefGoogle ScholarPubMed
Stuss, D.T.Functions of the frontal lobes: relation to executive functions. J Int Neuropsychol Soc 2011;17(05):759–765.CrossRefGoogle ScholarPubMed
Sung, G.Kim, B.-N.Lee, E.-H.Yu, B.-H.Hong, K.S.Kim, J.-H.Underestimating the severity of bipolar depression: a comparison of the Hamilton depression rating scale items. J Affect Disord 2012;136(3):425–429.CrossRefGoogle ScholarPubMed
Taylor Tavares, J.V.Clark, L.Cannon, D.M.Erickson, K.Drevets, W.C.Sahakian, B.J.Distinct profiles of neurocognitive function in unmedicated unipolar depression and bipolar II depression. Biol Psychiatry 2007;62(8):917–924.CrossRefGoogle ScholarPubMed
Tohen, M.Frank, E.Bowden, C.L.Colom, F.Ghaemi, S.N.Yatham, L.N., et al.The International Society for Bipolar Disorders (ISBD) Task Force report on the nomenclature of course and outcome in bipolar disorders. Bipolar Disord 2009;11(5):453–473.CrossRefGoogle ScholarPubMed
Wilson, S.T.Stanley, B.Oquendo, M.A.Goldberg, P.Zalsman, G.Mann, J.J.Comparing impulsiveness, hostility, and depression in borderline personality disorder and bipolar II disorder. J Clin Psychiatry 2007;68(10):1533.CrossRefGoogle ScholarPubMed
Wingo, A.P.Harvey, P.D.Baldessarini, R.J.Neurocognitive impairment in bipolar disorder patients: functional implications. Bipolar Disord 2009;11(2):113–125.CrossRefGoogle ScholarPubMed
Young, R.C.Biggs, J.T.Ziegler, V.E.Meyer, D.A.A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978;133:429–435.CrossRefGoogle ScholarPubMed
Zanarini, M.C.Stanley, B.Black, D.W.Markowitz, J.C.Goodman, M.Pilkonis, P., et al.Methodological considerations for treatment trials for persons with borderline personality disorder. Ann Clin Psychiatry 2010;22(2):75.Google Scholar
Zimmerman, M.Morgan, T.A.The relationship between borderline personality disorder and bipolar disorder. Dial Clin Neurosci 2013;15(2):155.Google ScholarPubMed
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