Definit un subtipus impulsiu de Transtorn Límit de la Personalitat

El Trastorn Límit de la Personalitat (TLP) és una patologia molt heterogènia. Aquest treball ha permès determinar-ne un subtipus amb major homogeneïtat clínica: els casos que presenten aquest trastorn juntament amb el Trastorn per Dèficit d'Atenció i Hiperactivitat (TDAH). Aquest subtipus presenta un perfil de pacient marcadament més impulsiu, amb més problemes d'abús de drogues i més tendència a la conducta suïcida. També s'observa una major freqüència d'altres trastorns de personalitat caracteritzats per la impulsivitat, com el Trastorn Antisocial de Personalitat, de perfil completament oposat al Trastorn Evitatiu de Personalitat, observat exclusivament al grup 'TLP-no TDAH'.El Trastorno Límite de la Personalidad (TLP) es una patología muy heterogénea. Este trabajo ha permitido determinar un subtipo con mayor homogeneidad clínica: los casos que presentan este trastorno junto con el Trastorno por Déficit de Atención e Hiperactividad (TDAH). Este subtipo presenta un perfil de paciente marcadamente más impulsivo, con más problemas de abuso de drogas y más tendencia a la conducta suicida. También se observa una mayor frecuencia de otros trastornos de personalidad caracterizados por la impulsividad, como el Trastorno Antisocial de Personalidad, de perfil completamente opuesto al Trastorno Evitativo de Personalidad, observado exclusivamente en el grupo 'TLP-no TDAH'

Assessing family relations in borderline personality disorder: A relational approach

Borderline personality disorder; Marital relation; Parental bondingTrastorno límite de la personalidad; Relación matrimonial; Vínculo parentalTrastorn límit de la personalitat; Relació matrimonial; Vincle parentalThe aims of the current study are to describe the basic family relationships, parental bonding patterns, and dyadic adjustment of families with offspring diagnosed with borderline personality disorder (BPD) and to explore the correlations between these variables related to family relations and BPD symptomatology. The sample consisted of 194 participants, including parents from the control (N = 76) and clinical group (N = 76), and patients with BPD (N = 42). All progenitors completed a measure of family relations, parental bonding, and dyadic adjustment. Patients completed a measure of parental bonding and borderline symptomatology. The results showed significant differences between both groups in marital and parental functioning, marital satisfaction, dyadic adjustment, and care. Correlations among family variables and BPD symptomatology were also found. In summary, findings underscore the significance of comprehending the complexity of family relationships in BPD while advocating for a relational perspective when examining the family dynamics.The authors would like to thank the State Research Agency of the Government of Spain for the aid to R + D + i projects with reference number PSI 2017-83146-R. The study is being carried out as part of a project financed by the State Research Agency of the Government of Spain for the aid to R + D + i projects with reference number PSI 2017-83146-R

Inhaled Loxapine as a Rapid Treatment for Agitation in Patients with Personality Disorder : A Prospective Study on the Effects of Time

Agitation in patients diagnosed with personality disorders (PD) is one of the most frequent crises in emergency departments (ED). Although many medications have been tested, their effectiveness has been small or non-significant, and no specific drugs are supported by the available evidence. This study aimed to evaluate the efficacy of Inhaled loxapine (IL) as a therapeutic option for agitated patients with PD. A naturalistic, unicentric, prospective study was carried out. Thirty subjects diagnosed with PD and attending the ED with episodes of agitation were recruited most of whom were women diagnosed with Borderline Personality Disorder. Subjects were treated with a single dose of IL (9.1 mg). Efficacy was assessed with the Clinical Global Impression scale, the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Patients were followed 60 minutes after administration to measure IL effect and its duration. IL exhibited an overall efficacy in managing mild to severe agitation, with a quick onset of effect and persistence. 'Effect of time', where IL efficacy is maintained over time, is more marked in higher-severity agitation. No additional treatments were needed to improve agitation during the follow-up time. Results suggest that IL could be a safe and effective option to manage agitation in PD

Trastorno límite de la personalidad: diferentes manifestaciones de un mismo trastorno

La presente tesis doctoral tiene como objetivo estudiar si es posible reducir la heterogeneidad clínica del Trastorno Límite de Personalidad (TLP) al agrupar a los pacientes en base al predominio sintomatológico de determinados componentes de su psicopatología. La hipótesis principal es que el TLP representa una categoría diagnóstica en la cual se pueden diferenciar grupos de pacientes en función del componente predominante. El trabajo plantea tres hipótesis secundarias que han sido puestas a prueba en tres estudios exploratorios, ya publicados, que componen la tesis doctoral. Los resultados de estos estudios muestran como los pacientes TLP con un Trastorno por Déficit de Atención y/o Hiperactividad (TDAH) comórbido muestran puntuaciones más altas en impulsividad y una mayor presencia de clínica del espectro impulsivo, en relación a los pacientes sin dicha comorbilidad; como los síntomas del TLP se ajustan mejor a un modelo de tres componentes (desregulación conductual, desregulación afectiva y alteración relacional) que a un modelo unidimensional; y finalmente, que el predominio de alguno de estos componentes define grupos de pacientes TLP que presentan una mayor homogeneidad clínica intra-grupo y diferenciables entre ellos. Teniendo en cuenta estos resultados, se puede considerar el TLP como un trastorno formado por tres componentes de su psicopatología. Esta conclusión no invalida la categoría TLP y puede ser útil para explicar la complejidad de su conceptualización. En este sentido, se observa como el predominio de un determinado componente de la psicopatología permite delimitar subgrupos de pacientes clínicamente homogéneos. Cada subgrupo presenta un perfil específico de trastornos comórbidos, que tienen síntomas comunes a los del fenotipo TLP que caracteriza al grupo. La consideración del TLP como un trastorno formado por tres componentes de su psicopatología permite plantear diferentes líneas de investigación que pueden dar respuesta a los resultados contradictorios previos en relación a la etiopatogenia, el diagnóstico y el tratamiento del TLP.The present doctoral thesis aims to study whether it is possible to reduce the clinical heterogeneity of Borderline Personality Disorder (BPD) when grouping patients based on the symptomatological predominance of certain components of its psychopathology. The main hypothesis is that BPD represents a diagnostic category where groups of patients can be differentiated according to the predominant component. Three secondary hypotheses are proposed and tested in three already published exploratory studies, which make up the thesis. Results of these studies show that BPD patients with a comorbid Attention Deficit-Hyperactivity Disorder (ADHD) exhibit higher scores in impulsivity and a higher presence of impulsive spectrum clinic, compared to those patients without the comorbidity; BPD symptoms fit better to a model of three components (behavioral dysregulation, affective dysregulation, disturbed relatedness) than to a unidimensional model; and finally, the predominance of one of these components defines groups of BPD patients with higher intra-group clinical homogeneity and differentiable between them. Given these results, BPD can be considered a disorder composed of three components of its psychopathology. This conclusion does not invalidate BPD category and could be useful to explain its conceptualization complexity. In this sense, the predominance of a particular psychopathological component allows defining clinically homogeneous subgroups of patients. Each subgroup shows a specific profile of comorbid disorders, which have common symptoms with the BPD phenotype that characterizes the group. The consideration of BPD as a disorder consisting of three components of its psychopathology allows proposing different research lines that can answer the previous conflicting results regarding the etiopathogenesis, diagnosis and treatment of BPD

Discrimination of Borderline Personality Disorder (BPD) and Attention-Deficit/Hyperactivity Disorder (ADHD) in adolescents: Spanish version of the Borderline Personality Features Scale for Children-11 Self-Report (BPFSC-11) Preliminary results

Abstract Background Although the diagnosis of Borderline Personality Disorder (BPD) during adolescence has been questioned, many recent studies have confirmed its validity. However, some clinical manifestations of BPD could be identifiable in adolescents with other pathologies, such as Attention-Deficit/Hyperactivity Disorder (ADHD). The objective of the present study is to examine the capacity of the self-report Borderline Personality Features Scale Children-11 (BPFSC-11) to discriminate between BPD and ADHD adolescents. Methods One hundred and forty-five participants were grouped based on their diagnosis: 58 with BPD, 58 with ADHD, and 29 healthy volunteers as a control group. Between-group differences and the ROC curve were performed to test if the total score for the BPFSC-11 and/or its factors can significantly discriminate between BPD and other adolescent groups. Results The results show that the total BPFSC-11 score has good discriminant capacity among adolescents diagnosed with BPD, ADHD and healthy volunteers. However, different patterns of discriminative capacity were observed between the three groups for emotional dysregulation and impulsivity/recklessness factors. Conclusions Our results support the hypothesis that the BPFSC-11 is an adequate instrument for discriminating between BPD and ADHD in adolescents, who can present significant psychopathological overlap. Tools to identify BPD in adolescence, as well as for better differential diagnosis, would improve the possibility of offering specific treatments targeting these populations

Circulating virome and inflammatory proteome in patients with ST-elevation myocardial infarction and primary ventricular fibrillation

Primary ventricular fibrillation (PVF) is a life-threatening complication of ST-segment elevation myocardial infarction (STEMI). It is unclear what roles viral infection and/or systemic inflammation may play as underlying triggers of PVF, as a second hit in the context of acute ischaemia. Here we aimed to evaluate whether the circulating virome and inflammatory proteome were associated with PVF development in patients with STEMI. Blood samples were obtained from non-PVF and PVF STEMI patients at the time of primary PCI, and from non-STEMI healthy controls. The virome profile was analysed using VirCapSeq-VERT (Virome Capture Sequencing Platform for Vertebrate Viruses), a sequencing platform targeting viral taxa of 342,438 representative sequences, spanning all virus sequence records. The inflammatory proteome was explored with the Olink inflammation panel, using the Proximity Extension Assay technology. After analysing all viral taxa known to infect vertebrates, including humans, we found that non-PVF and PVF patients only significantly differed in the frequencies of viruses in the Gamma-herpesvirinae and Anelloviridae families. In particular, most showed a significantly higher relative frequency in non-PVF STEMI controls. Analysis of systemic inflammation revealed no significant differences between the inflammatory profiles of non-PVF and PVF STEMI patients. Inflammatory proteins associated with cell adhesion, chemotaxis, cellular response to cytokine stimulus, and cell activation proteins involved in immune response (IL6, IL8 CXCL-11, CCL-11, MCP3, MCP4, and ENRAGE) were significantly higher in STEMI patients than non-STEMI controls. CDCP1 and IL18-R1 were significantly higher in PVF patients compared to healthy subjects, but not compared to non-PVF patients. The circulating virome and systemic inflammation were not associated with increased risk of PVF development in acute STEMI. Accordingly, novel strategies are needed to elucidate putative triggers of PVF in the setting of acute ischaemia, in order to reduce STEMI-driven sudden death burden

Inflammatory biotype of ADHD is linked to chronic stress : a data-driven analysis of the inflammatory proteome

The association between Attention Deficit Hyperactivity Disorder (ADHD) and low-grade inflammation has been explored in children but rarely in adults. Inflammation is characteristic of some, but not all, patients with ADHD and might be influenced by ADHD medication but also lifestyle factors including nutrition, smoking, and stress. It is also still unclear if any specific symptoms are related to inflammation. Therefore, we assessed 96 inflammatory proteins in a deeply phenotyped cohort of 126 adult ADHD participants with a stable medication status using OLINK technology. A data-based, unsupervised hierarchical clustering method could identify two distinct biotypes within the 126 ADHD participants based on their inflammatory profile: a higher inflammatory potential (HIP) and a lower inflammatory protein potential (LIP) group. Biological processes that differed strongest between groups were related to the NF-κB pathway, chemokine signaling, IL-17 signaling, metabolic alterations, and chemokine attraction. A comparison of sample characteristics revealed that the HIP group was more likely to have higher levels of chronic stress (p < 0.001), a higher clinical global impression scale score (p = 0.030), and a higher risk for suicide (p = 0.032). Medication status did not influence protein levels significantly (p ≥ 0.074), but psychotropic co-medication (p ≤ 0.009) did. In conclusion, our data suggest the presence of two distinct biotypes in adults with ADHD. Higher levels of inflammatory proteins in ADHD are linked to higher levels of chronic perceived stress in a linear fashion. Further research on inflammation in adults with ADHD should take stress levels into account