Cognitive and mood functioning in borderline and schizotypal personality disorders

Research suggests many shared clinical features across individuals with Schizotypal Personality Disorder (SPD) and Borderline Personality Disorder (BPD), including problems with attention/ executive functioning and mood. Therefore, aspects of these areas of functioning were compared in SPD and BPD to better characterize their respective difficulties. BPD, SPD, and healthy control (HC) participants were administered measures of cognitive and mood functioning. Compared with healthy controls, SPD patients performed significantly worse on aspects of the Delayed-Matching- to-Sample task, a measure of short-term visual memory abilities; however, the individuals with BPD did not differ from healthy controls. Neither of the patient groups differed from HC’s on measures of processing speed or planning. With regard to mood functioning, the BPD group exhibited significantly higher levels of affective disturbance (e.g., sadness, fear, anger) compared with the SPD patients and HCs. Overall, findings suggest different patterns of fronto-subcortical weakness in each patient group. While SPD patients exhibited relative weakness with short-term memory, BPD patient performance on such measures did not reveal relative weakness compared with HCs but did implicate problems with mood

SA25. Guanfacine Augmentation of Cognitive Remediation Therapy in the Schizophrenia Spectrum: Prospects for Improving Cognitive Performance and Functional Skills

Background: Cognitive remediation therapy (CRT) has demonstrated efficacy for improving cognition in schizophrenia patients. Trials of agents designed to enhance cognition, on the other hand, have been largely negative in schizophrenia, although we have demonstrated substantial positive effects on cognition in the schizophrenia spectrum with guanfacine, an agent that enhances alpha-2 adrenergic activity. However, there have been no controlled trials of the effects of medications that specifically enhance cognition in the schizophrenia spectrum, in conjunction with CRT, to facilitate and consolidate the effectiveness of the remediation nor have there been examinations of the efficacy of CRT in the broader spectrum in participants with schizotypal personality disorder (SPD), a group with a similar pattern of cognitive and functional deficits, albeit less severe, to what is seen in schizophrenia but which is free of many potential confounds of schizophrenia samples. Methods: We enrolled participants with SPD in an 8-week, randomized, double-blind, placebo-controlled trial of guanfacine paired with CRT consisting of 2 computerized training sessions and 2 social skills groups per week. All participants were administered the Matrics Clinical Consensus Battery (MCCB), assessing cognitive performance, and the UCSD Performance Based Skills Assessment (UPSA), assessing functional skills, both pre- and posttreatment. Results: We conducted a series of repeated measures analyses of variance for each of our DVs with time (pre and post) and medication status (guanfacine and placebo) as our IVs. Overall, we found significant main effects for time on MCCB speed of processing, verbal learning, visual learning, and working memory as well as UPSA total score (all P s > .05), suggesting that participants benefited from the intervention. In addition, there was a significant Time × Medication interaction for MCCB planning and organization and UPSA total score ( P s > .05), with individuals in our guanfacine group demonstrating greater improvement following treatment than those in our placebo group. There were no significant improvements on MCCM working memory or attention ( P s >.05). Conclusion: Participants with SPD who were treated with CRT plus guanfacine demonstrated statistically significant improvements in reasoning and problem-solving and in their functional skills, suggesting that guanfacine may be an appropriate agent to augment CRT in the schizophrenia spectrum

Neuropsychological performance in schizotypal personality disorder: evidence regarding diagnostic specificity

Individuals with schizotypal personality disorder (SPD) share cognitive deficits with schizophrenic patients, suggesting that these deficits represent a core feature of the schizophrenia spectrum. We investigated the neuropsychological profile in SPD patients compared with two comparison groups: healthy volunteers (HV) and patients who met criteria for another non-schizophrenia spectrum personality disorder (NSS). We tested 48 DSM-III-R SPD patients, 22 NSS and 32 HV on a neuropsychologic battery that included the California Verbal Learning Test (CVLT), Trail Making A and B, the DOT test of working memory, the Stroop Color–Word Interference, the Paced Auditory Serial Addition Test (PASAT), the Wechsler Memory Scale Visual Reproduction Test (WMSV–R), and the Wechsler Adult Intelligence Scale vocabulary and block design. Normative standards for performance were created using the HV group. SPD patients performed significantly worse compared with HVs; specifically, SPD patients demonstrated impaired performance on the PASAT and the WMSV–R immediate and delayed recall compared to HV. Moreover, SPD patients were impaired in the PASAT and the WMSV–R immediate condition compared with the NSS group. The NSS patients did not differ from HV on any of the cognitive tasks. The interpersonal factor of the schizotypal symptoms inversely correlated with the PASAT score ( r = −.32, p < .006). Compared with HVs, SPD patients demonstrate modest cognitive impairment. These differences reached statistical significance for the PASAT (an auditory working memory task), and the WMSV–R immediate and delayed recall (a learning–recall test). In contrast, performance of NSS patients did not differ from that of HVs. The types of deficits observed in SPD patients are qualitatively similar to but milder than those seen in patients with schizophrenia

Dispositional impulsivity in normal and abnormal samples

Impulsive behaviors, which can include aggression, substance use and suicide, are common and core features of the DSM Axis II Cluster B personality disorders. The construct of dispositional impulsivity is multidimensional and a number of self-report measures have been created to represent features of this trait (e.g., novelty seeking, behavioral disinhibition, nonplanning). Because these questionnaires are rarely administered together in the same sample, little is known about how they are related to one another. The current study was conducted to examine the structure of dimensional impulsive personality traits in a large normative sample ( n = 351). Analyses revealed that dispositional impulsivity was represented by three moderately correlated latent factors labeled thrill seeking, nonplanning and disinhibited behavior. Confirmatory factor analyses were also used to examine the extent to which the internal structure of these impulsive personality traits was similar in a sample defined as abnormal (i.e., DSM-III-R Cluster B PD diagnoses; n = 70). Results revealed that the structure of these traits was consistent across the two samples in a model that constrained factor loadings and structural covariances (NFI = 0.89; CFI = 95; RMSEA = 0.04). In addition, correlational relationships between the impulsivity factor scores and behavioral and sociodemographic factors (e.g., socioeconomic status, substance use) were consistent across the two samples. These results help to establish a common framework for understanding the multidimensional nature of impulsivity. Results from these analyses also lend support to a large body of work that demonstrates that normal and abnormal personality features are related