Zsolt Unoka

TRUST GAME REVEALS RESTRICTED INTERPERSONAL TRANSACTIONS IN PATIENTS WITH BORDERLINE PERSONALITY DISORDER

Patients with borderline personality disorder (BPD) display severe difficulties in interpersonal relationships and impulse control. We explored the possibility that patients with BPD show less trust and more risk-taking behavior in experimental games as compared with controls and with depressed patients with other personality disorders. In the trust game, the participant played the role of an investor who interacted with a trustee via the Internet. The investor could choose a costly action by giving money units (MU) to the trustee. The trustee then could honor the investors trust by sharing the monetary increase. In the risk game, the investor could transfer money to a lottery, and therefore the payoff depended on luck and not on the decision of another person. Results revealed that the patients with BPD (n = 25) transferred a smaller amount of MUs across 5 consecutive transactions in the trust game as compared with the controls (n = 25) and with the depressed patients (n = 25). In the risk game, the performance of the BPD patients was similar to that of the controls and depressed patients. Trust game performance was predicted by the interpersonal and cognitive sector scores of the Zanarini Rating Scale for Borderline Personality Disorder. Self reports indicated that the patients with BPD were less optimistic regarding the outcome (payoff) of the trust game, but not of the risk game. These results suggest that patients with BPD exhibit less trust during interpersonal interactions, which may be related to stress-related paranoia, dissociation, identity disturbance, and problems in interpersonal relationships.

Bifactor structural model of symptom checklists: SCL-90-R and Brief Symptom Inventory (BSI) in a non-clinical community sample

The Derogatis symptom checklist (SCL-90-R) and its short version, the Brief Symptom Inventory (BSI), are widely used instruments, despite the fact that their factor structures were not clearly confirmed. The goals of this research were to compare four measurement models of these instruments including one-factor, nine-factor, a second-ordered factor model and a bifactor model, in addition to testing the gender difference in symptom factors in a community sample. SCL-90-R was assessed in a large community survey which included 2710 adults who represent the population of Hungary. Statistical analyses included a series of confirmatory factor analyses and multiple indicator multiple cause (MIMIC modeling). The responses to items were treated as ordinal scales. The analysis revealed that the bifactor model yielded the closest fit in both the full SCL-90-R and BSI; however the nine-factor model also had an acceptable level of fit. As for the gender differences, women scored higher on global severity, somatization, obsession-compulsion, interpersonal sensitivity, depression and anxiety factors. Men scored higher on hostility and psychoticism. The bifactor model of symptom checklist supports the concept of global symptom severity and specific symptom factors. Global symptom severity explains the large correlations between symptom factors.

Regional Grey Matter Structure Differences between Transsexuals and Healthy Controls—A Voxel Based Morphometry Study

Gender identity disorder (GID) refers to transsexual individuals who feel that their assigned biological gender is incongruent with their gender identity and this cannot be explained by any physical intersex condition. There is growing scientific interest in the last decades in studying the neuroanatomy and brain functions of transsexual individuals to better understand both the neuroanatomical features of transsexualism and the background of gender identity. So far, results are inconclusive but in general, transsexualism has been associated with a distinct neuroanatomical pattern. Studies mainly focused on male to female (MTF) transsexuals and there is scarcity of data acquired on female to male (FTM) transsexuals. Thus, our aim was to analyze structural MRI data with voxel based morphometry (VBM) obtained from both FTM and MTF transsexuals (n = 17) and compare them to the data of 18 age matched healthy control subjects (both males and females). We found differences in the regional grey matter (GM) structure of transsexual compared with control subjects, independent from their biological gender, in the cerebellum, the left angular gyrus and in the left inferior parietal lobule. Additionally, our findings showed that in several brain areas, regarding their GM volume, transsexual subjects did not differ significantly from controls sharing their gender identity but were different from those sharing their biological gender (areas in the left and right precentral gyri, the left postcentral gyrus, the left posterior cingulate, precuneus and calcarinus, the right cuneus, the right fusiform, lingual, middle and inferior occipital, and inferior temporal gyri). These results support the notion that structural brain differences exist between transsexual and healthy control subjects and that majority of these structural differences are dependent on the biological gender.

The broken trust and cooperation in borderline personality disorder.

Trust and cooperation are essential features of human interpersonal transactions. Recent evidence suggests that these processes are related to brain areas implicated in social decision-making. These novel data provide a unique opportunity to characterize psychopathological conditions in which trust and cooperation are potentially impaired. Using economic games, independent investigations revealed that trust and cooperation are disrupted in patients with borderline personality disorder who have severe difficulties in their personal relationships and exhibit abnormal emotion regulation. Data from functional neuroimaging indicated that the abnormal activation of the anterior insula might be a key factor during these processes, together with the cingulate cortex and the amygdala.

What is the relationship between the recognition of emotions and core beliefs: Associations between the recognition of emotions in facial expressions and the maladaptive schemas in depressed patients

BACKGROUND Depressed patients are both characterized by social reality distorting maladaptive schemas and facial expression recognition impairments. The aim of the present study was to identify specific associations among symptom severity of depression, early maladaptive schemas and recognition patterns of facially expressed emotions. METHODS The subjects were inpatients, diagnosed with depression. We used 2 virtual humans for presenting the basic emotions to assess emotion recognition. The Symptom Check List 90 (SCL-90) was used as a self-report measure of psychiatric symptoms and the Beck Depression Inventory (BDI) was applied to assess symptoms of depression. The Young Schema Questionnaire Long Form (YSQ-L) was used to assess the presence of early maladaptive schemas. RESULTS The recognition rate for happiness showed significant associations with both the BDI and the depression subscale of the SCL-90. After performing the second order factor analysis of the YSQ-L, we found statistically significant associations between the recognition indices of specific emotions and the main factors of the YSQ-L. CONCLUSIONS In this study we found correlations between maladaptive schemas and emotion recognition impairments. While both domains likely contribute to the symptoms of depression, we believe that the results will help us to better understand the social cognitive deficits of depressed patients at the schema level and at the emotion recognition level.

Emotion appraisal is modulated by the genetic polymorphism of the serotonin transporter

We investigated the relationship between the genetic polymorphism of the promoter of the serotonin transporter gene (SLC64A) and emotion appraisal profiles for fear, sadness, and joy in 114 healthy volunteers. Results revealed that carriers of the s-allele achieved higher scores than non-carriers for unpleasantness and goal-hindrance but scored lower for coping ability in the case of fear and sadness. There were no such differences in the case of joy. These results indicate that the s-allele of the serotonin transporter gene is associated with a vulnerable cognitive style related to the appraisal of negative emotions.

Eating Disorder Behavior and Early Maladaptive Schemas in subgroups of eating disorders.

To examine relationship between Eating Disorder Behaviors (EDB) and Early Maladaptive Schemas (EMS) across eating disorder (ED) subgroups. EMS and ED behaviors were measured by Young Schema Questionnaire and Eating Behavior Severity Scale, respectively, among patients diagnosed with Restrictive or Binge/purging Anorexia, or bulimia nervosa. Canonical component analysis showed significant association between ED behaviors and EMSs. Canonical factor-pairs (EDB and EMS) revealed specific associations between certain patterns of EDBs, including binge-purging and physical exercise, and certain patterns of maladaptive cognitive schema, including Emotional deprivation, Abandonment, Enmeshments, Subjugation, and Emotional inhibition. ED subgroups significantly differred between the EMS and EDB canonical factors, respectively. Our findings indicate that EMS and EDB are associated, and that the factors that potentially mediate the association differ significantly among ED subgroups. These results are consistent with the notion that EMSs play a specific role in the development and maintenance of ED behaviors.

Neuropsychological deficits in BPD patients and the moderator effects of co-occurring mental disorders: A meta-analysis

Studies have shown that patients with borderline personality disorder (BPD) have co-occurring disorders; literature has also suggested that BPD patients have impairments in neuropsychological functioning, as seen in a previous meta-analysis (Ruocco, 2005). This meta-analysis showed that neuropsychological functioning are marked areas of concern in BPD; however, this meta-analytic research did not assess the effects of co-occurring disorders on neuropsychological functioning in BPD patients. The current meta-analysis takes this into consideration and a systematic review of cross-sectional studies comparing neuropsychological performance of individuals with BPD with age-matched healthy comparison subjects was carried out. Potential moderators (i.e., age, gender, education level, and co-morbid mental disorders) were analyzed. Significant deficits were observed in the decision making, memory, executive functioning, processing speed, verbal intelligence, and visuospatial abilities. BPD patients with more education and with parents of a higher educational level had better neuropsychological functioning. Globally, BPD samples with a higher percentage of co-morbid personality disorders, major depression, eating disorders, or any substance abuse disorders performed worse than patients with a less percentage; however, anxiety disorders and PTSD co-morbidity did not affect the cognitive performance of the BPD group. Differences are seen dependent on neuropsychological domain and specific co-morbidity. These findings highlight the clinical relevance of characterizing cognitive functioning in BPD and the importance of considering demographic and clinical moderators in future analyses.

Mental state decoding impairment in major depression and borderline personality disorder: meta-analysis.

BACKGROUND Patients with major depression and borderline personality disorder are characterised by a distorted perception of other peoples intentions. Deficits in mental state decoding are thought to be the underlying cause of this clinical feature. AIMS To examine, using meta-analysis, whether mental state decoding abilities in patients with major depression and borderline personality disorder differ from those of healthy controls. METHOD A systematic review of 13 cross-sectional studies comparing Reading in the Mind of the Eyes Test (RMET) accuracy performance of patients with major depression or borderline personality disorder and healthy age-matched controls (n = 976). Valence scores, where reported, were also assessed. RESULTS Large significant deficits were seen for global RMET performance in patients with major depression (d = -0.751). The positive RMET valence scores of patients with depression were significantly worse; patients with borderline personality disorder had worse neutral scores. Both groups were worse than controls. Moderator analysis revealed that individuals with comorbid borderline personality disorder and major depression did better than those with borderline personality disorder alone on accuracy. Those with comorbid borderline personality disorder and any cluster B or C personality disorder did worse than borderline personality disorder alone. Individuals with both borderline personality disorder and major depression performed better then those with borderline personality disorder without major depression for positive valence. CONCLUSIONS These findings highlight the relevance of RMET performance in patients with borderline personality disorder and major depression, and the importance of considering comorbidity in future analysis.

The neuropsychology of borderline personality disorder: relationship with clinical dimensions and comparison with other personality disorders.

Patients with borderline personality disorder show various neuropsychological dysfunctions. However, the exact pattern of this dysfunction and its severity in comparison with other personality disorders are not known. The purpose of this study was to compare the neuropsychological performance of borderline patients (n = 50) with that of patients with other personality disorders (n = 30) and healthy controls (n = 30) using the Repeatable Brief Assessment of Neuropsychological Status (RBANS) test battery. Borderline patients showed deficient attention, immediate and delayed memory, and relatively spared visuospatial and language functions compared with controls (effect size range: 0.34-0.99). The neuropsychological deficit was less pronounced in patients with other personality disorders compared with controls (effect size range: 0.18-0.66). However, there was no statistically significant difference between patients with borderline and other personality disorders. The neuropsychological deficit significantly correlated with the impulsivity sector score of the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD). These results suggest that borderline patients are impaired in neuropsychological domains sensitive for frontal and temporal lobe functioning, and this deficit is related to impulsivity.