Cognitive Correlates of Borderline Personality Disorder Features in Youth with Bipolar Spectrum Disorders and Bipolar Offspring
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Participants
2.2. Clinical Assessments
2.3. Psychiatric Symptoms
2.4. Cognitive Testing
2.4.1. Affective Processing
2.4.2. Executive Functions
2.4.3. Sustained Attention
2.5. Statistical Analysis
2.5.1. Demographic and Clinical Characteristics
2.5.2. Cognitive Characteristics and Borderline Personality Features
2.5.3. Relationship Between Borderline Personality Features and Cognitive Characteristics
3. Results
3.1. Demographic and Clinical Characteristics
3.2. Cognitive Characteristics
3.3. Borderline Personality Features
3.4. Relationship Between Borderline Personality Features and Cognition
3.5. Effect of Possible Confounding Variables
BD (N = 39) | BD-OFF (N = 18) | HCs (N = 50) | χ2/F | p-Value | HC vs. BD p-Value | HC vs. BD d | HC vs. BD-OFF p-Value | HC vs. BD-OFF d | BD vs. BD-OFF p-Value | BD vs. BD-OFF d | |
---|---|---|---|---|---|---|---|---|---|---|---|
AGN-RTs-positive (mean ± SD) | 5.27 ± 9.76 | 4.65 ± 1.08 | 5.24 ± 1.32 | 1.67 | 0.194 | 1.000 | 0.007 | 0.288 | 0.339 | 0.272 | 0.787 |
AGN-RTs-negative (mean ± SD) | 4.99 ± 1.24 | 4.90 ± 1.26 | 4.82 ± 1.19 | 0.19 | 0.824 | 1.000 | 0.063 | 1.000 | 0.248 | 1.000 | 0.302 |
AGN-CEs-positive (mean ± SD) | 5.30 ± 4.28 | 5.59 ± 3.89 | 4.71 ± 3.88 | 0.41 | 0.666 | 1.000 | 0.399 | 1.000 | 0.153 | 1.000 | 0.233 |
AGN-CEs-negative (mean ± SD) | 6.09 ± 4.74 | 6.81 ± 4.23 | 4.93 ± 4.09 | 1.38 | 0.258 | 0.690 | 0.378 | 0.426 | 0.119 | 1.000 | 0.232 |
AGN-omissions-positive (mean ± SD) | 6.74 ± 5.60 | 4.34 ± 3.27 | 5.07 ± 5.08 | 1.71 | 0.187 | 0.406 | 0.183 | 1.000 | 0.210 | 0.348 | 0.042 |
AGN-omissions-negative (mean ± SD) | 7.07 ± 6.13 | 4.84 ± 3.43 | 5.16 ± 5.27 | 1.62 | 0.203 | 0.331 | 0.110 | 1.000 | 0.253 | 0.509 | 0.148 |
CGT-delay aversion (mean ± SD) | 0.53 ± 0.29 | 0.61 ± 0.17 | 0.59 ± 0.21 | 1.08 | 0.344 | 0.060 | 0.122 | 1.000 | 0.167 | 0.738 | 0.041 |
CGT-deliberation time (mean ± SD) | 3350.90 ± 1900.63 | 3059.4 ± 1195.63 | 2423.70 ± 901.90 | 4.76 | 0.011 | 0.010 | 0.292 | 0.341 | 0.449 | 1.000 | 0.124 |
CGT-overall proportion bet (mean ± SD) | 0.56 ± 0.16 | 0.52 ± 0.09 | 0.51 ± 0.13 | 1.45 | 0.240 | 0.296 | 0.074 | 1.000 | 0.239 | 0.956 | 0.153 |
CGT-quality of decision making (mean ± SD) | 0.90 ± 0.10 | 0.88 ± 0.09 | 0.86 ± 0.13 | 1.04 | 0.356 | 0.456 | 0.066 | 1.000 | 0.146 | 1.000 | 0.074 |
CGT-risk adjustment (mean ± SD) | 0.26 ± 0.99 | 0.31 ± 0.61 | 0.54 ± 0.91 | 1.04 | 0.357 | 0.521 | 0.228 | 1.000 | 0.190 | 1.000 | 0.076 |
CGT-risk taking (mean ± SD) | 0.58 ± 0.16 | 0.56 ± 0.11 | 0.54 ± 0.14 | 0.77 | 0.466 | 0.653 | 0.138 | 1.000 | 0.275 | 1.000 | 0.133 |
RVPA (mean ± SD) | 0.80 ± 0.07 | 0.83 ± 0.06 | 0.84 ± 0.06 | 2.65 | 0.077 | 0.073 | 0.117 | 1.000 | 0.261 | 0.729 | 0.141 |
RVP-mean latency (mean ± SD) | 618.76 ± 197.69 | 620.41 ± 231.74 | 558.63 ± 147.98 | 1.01 | 0.368 | 0.642 | 0.153 | 0.869 | 0.569 | 1.000 | 0.423 |
RVP-probability of false alarms (mean ± SD) | 0.04 ± 0.08 | 0.04 ± 0.07 | 0.02 ± 0.05 | 0.85 | 0.433 | 0.720 | 0.329 | 1.000 | 0.200 | 1.000 | 0.164 |
RVP-probability of hit (mean ± SD) | 0.37 ± 0.18 | 0.43 ± 0.22 | 0.45 ± 0.19 | 1.33 | 0.272 | 0.334 | 0.105 | 1.000 | 0.45 | 1.000 | 0.368 |
SOC-moves (mean ± SD) | 5.85 ± 1.88 | 7.06 ± 1.66 | 6.64 ± 1.99 | 3.12 | 0.048 | 0.047 | 0.549 | 1.000 | 0.174 | 0.094 | 0.341 |
BD (N = 39) | BD-OFF (N = 18) | HCs (N = 50) | χ2/F | p-Value | HC vs. BD p-Value | HC vs. BD d | HC vs. BD-OFF p-Value | HC vs. BD-OFF d | BD vs. BD-OFF p-Value | BD vs. BD-OFF d | |
---|---|---|---|---|---|---|---|---|---|---|---|
BPFS-AI (mean ± SD) | 19.31 ± 4.35 | 16.50 ± 5.58 | 12.50 ± 3.30 | 30.06 | <0.001 | <0.001 | 1.764 | 0.002 | 2.399 | 0.057 | 3.559 |
BPFS-IPs (mean ± SD) | 13.79 ± 4.48 | 12.56 ± 4.62 | 10.98 ± 4.39 | 4.41 | 0.015 | 0.012 | 0.633 | 0.605 | 0.351 | 0.996 | 0.270 |
BPFS-NRs (mean ± SD) | 15.44 ± 4.97 | 14.06 ± 5.39 | 10.02 ± 3.88 | 16.39 | <0.001 | <0.001 | 1.215 | 0.005 | 0.860 | 0.874 | 0.266 |
BPFS-SH (mean ± SD) | 16.31 ± 5.74 | 14.78 ± 5.55 | 10.82 ± 3.32 | 15.63 | <0.001 | <0.001 | 0.171 | 0.009 | 0.866 | 0.773 | 0.271 |
BPFS-TOT (mean ± SD) | 64.85 ± 16.24 | 57.89 ± 17.65 | 44.32 ± 12.09 | 22.08 | <0.001 | <0.001 | 1.430 | 0.003 | 0.897 | 0.299 | 0.410 |
AGN-RTs-Positive | AGN-RTs-Negative | AGN-CEs-Positive | |||||||
---|---|---|---|---|---|---|---|---|---|
β | t | p-Value | β | t | p-Value | β | t | p-Value | |
BPFS-AI | −0.165 | −1.141 | 0.260 | 0.242 | 1.678 | 0.100 | −0.105 | −0.740 | 0.463 |
BPFS-IPs | −0.171 | −1.230 | 0.0225 | 0.154 | 1.074 | 0.288 | −0.124 | −0.906 | 0.370 |
BPFS-NRs | −0.284 | −2.047 | 0.047 | 0.185 | 1.284 | 0.205 | −0.074 | −0.528 | 0.600 |
BPFS-SH | −0.405 | −2.814 | 0.007 | 0.198 | 1.330 | 0.190 | −0.133 | −0.920 | 0.362 |
BPFS-TOT | −0.320 | −2.293 | 0.027 | 0.237 | 1.647 | 0.106 | −0.134 | −0.952 | 0.346 |
AGN-CEs-Negative | AGN-Omissions-Positive | AGN-Omissions-Negative | |||||||
β | t | p-Value | β | t | p-Value | β | t | p-Value | |
BPFS-AI | −0.005 | −0.037 | 0.970 | 0.083 | 0.612 | 0.544 | 0.038 | 0.278 | 0.782 |
BPFS-IPs | 0.005 | 0.036 | 0.971 | −0.193 | −1.491 | 0.142 | −0.159 | −1.200 | 0.236 |
BPFS-NRs | −0.061 | −0.460 | 0.647 | 0.010 | 0.078 | 0.939 | 0.013 | 0.092 | 0.927 |
BPFS-SH | −0.181 | −1.327 | 0.191 | 0.194 | 1.419 | 0.162 | 0.186 | 1.388 | 0.187 |
BPFS-TOT | −0.079 | −0.592 | 0.557 | 0.033 | 0.242 | 0.810 | 0.029 | 0.210 | 0.835 |
CGT-Delay Aversion | CGT-Deliberation Time | CGT-Overall Proportion Bet | |||||||
---|---|---|---|---|---|---|---|---|---|
β | t | p-Value | β | t | p-Value | β | t | p-Value | |
BPFS-AI | −0.014 | −0.095 | 0.925 | 0.093 | 0.694 | 0.491 | 0.119 | 0.809 | 0.422 |
BPFS-IPs | −0.389 | −2.920 | 0.005 | 0.186 | 1.476 | 0.147 | 0.367 | 2.766 | 0.008 |
BPFS-NRs | −0.205 | −1.426 | 0.161 | 0.213 | 1.671 | 0.101 | 0.236 | 1.676 | 0.100 |
BPFS-SH | −0.189 | −1.262 | 0.213 | 0.237 | 1.800 | 0.078 | 0.212 | 1.439 | 0.157 |
BPFS-TOT | −0.247 | −1.723 | 0.092 | 0.228 | 1.776 | 0.082 | 0.289 | 2.058 | 0.045 |
CGT-Quality of Decision Making | CGT-Risk Adjustment | CGT-Risk Taking | |||||||
β | t | p-Value | β | t | p-Value | β | t | p-Value | |
BPFS-AI | −0.242 | −1.638 | 0.108 | −0.155 | −1.057 | 0.296 | 0.134 | 0.901 | 0.372 |
BPFS-IPs | −0.066 | −0.451 | 0.654 | −0.102 | −0.719 | 0.476 | 0.366 | 2.732 | 0.009 |
BPFS-NRs | −0.235 | −1.634 | 0.109 | −0.218 | −1.544 | 0.129 | 0.253 | 1.788 | 0.080 |
BPFS-SH | −0.335 | −2.298 | 0.026 | −0.226 | −1.538 | 0.131 | 0.243 | 1.641 | 0.107 |
BPFS-TOT | −0.271 | −1.878 | 0.067 | −0.217 | −1.519 | 0.135 | 0.308 | 2.188 | 0.034 |
RVPA | RVP-Mean Latency | |||||
---|---|---|---|---|---|---|
β | t | p-Value | β | t | p-Value | |
BPFS-AI | −0.052 | −0.312 | 0.757 | 0.017 | 0.114 | 0.910 |
BPFS-IPs | −0.057 | −0.361 | 0.720 | 0.150 | 1.075 | 0.290 |
BPFS-NRs | −0.079 | −0.499 | 0.621 | 0.106 | 0.754 | 0.456 |
BPFS-SH | −0.037 | −0.211 | 0.834 | 0.173 | 1.136 | 0.264 |
BPFS-TOT | −0.071 | −0.435 | 0.667 | 0.141 | 0.973 | 0.337 |
RVP-Probability of False Alarm | RVP-Probability of Hit | |||||
β | t | p-Value | β | t | p-Value | |
BPFS-AI | −0.014 | −0.088 | 0.930 | −0.071 | −0.425 | 0.673 |
BPFS-IPs | 0.075 | 0.498 | 0.622 | −0.056 | −0.357 | 0.724 |
BPFS-NRs | 0.100 | 0.661 | 0.513 | 0.050 | 0.314 | 0.756 |
BPFS-SH | 0.034 | 0.206 | 0.838 | −0.040 | −0.232 | 0.818 |
BPFS-TOT | 0.062 | 0.395 | 0.695 | −0.035 | −0.211 | 0.834 |
SOC-Moves | |||
---|---|---|---|
β | t | p-Value | |
BPFS-AI | −0.190 | −1.418 | 0.162 |
BPFS-IPs | 0.006 | 0.050 | 0.960 |
BPFS-NRs | −0.084 | −0.650 | 0.519 |
BPFS-SH | 0.009 | 0.067 | 0.947 |
BPFS-total | −0.074 | −0.559 | 0.578 |
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
BD | Bipolar Disorder |
BD-OFF | BD-Offspring |
BDP | Borderline Disorder Personality |
HC(s) | Healthy Control(s) |
BPFS-C | Borderline Personality Features Scale for Children |
CANTAB | Cambridge Neuropsychological Test Automated Battery |
CGT | Cambridge Gambling Task |
SOC | Stockings of Cambridge |
AGN | Affective Go/No-Go |
RVP | Rapid Visual Processing |
ANOVAs | Analysis of Variance |
DSM | Diagnostic and Statistical Manual of Mental Disorders |
ADHD | Attention-Deficit Hyperactivity Disorder |
BD-NOS | BD-Not Otherwise Specified |
COBY | Course and Outcome of Bipolar Youth |
MINI-KID | Mini International Neuropsychiatric Interview for Children and Adolescents |
WASI-II | Wechsler Abbreviated Scale of Intelligence–Second Edition |
CDRS-R | Children’s Depression Rating Scale–Revised |
YMRS | Young Mania Rating Scale |
IQ | Intelligence Quotient |
References
- Ghaemi, S.N.; Dalley, S.; Catania, C.; Barroilhet, S. Bipolar or Borderline: A Clinical Overview. Acta Psychiatr. Scand. 2014, 130, 99–108. [Google Scholar] [CrossRef] [PubMed]
- Fornaro, M.; Orsolini, L.; Marini, S.; De Berardis, D.; Perna, G.; Valchera, A.; Ganança, L.; Solmi, M.; Veronese, N.; Stubbs, B. The Prevalence and Predictors of Bipolar and Borderline Personality Disorders Comorbidity: Systematic Review and Meta-Analysis. J. Affect. Disord. 2016, 195, 105–118. [Google Scholar] [CrossRef]
- Zimmerman, M.; Morgan, T.A. Problematic Boundaries in the Diagnosis of Bipolar Disorder: The Interface with Borderline Personality Disorder. Curr. Psychiatry Rep. 2013, 15, 422. [Google Scholar] [CrossRef]
- Carpiniello, B.; Lai, L.; Pirarba, S.; Sardu, C.; Pinna, F. Impulsivity and Aggressiveness in Bipolar Disorder with Co-Morbid Borderline Personality Disorder. Psychiatry Res. 2011, 188, 40–44. [Google Scholar] [CrossRef]
- Dunayevich, E.; Sax, K.W.; Keck, P.E.; McElroy, S.L.; Sorter, M.T.; McConville, B.J.; Strakowski, S.M. Twelve-Month Outcome in Bipolar Patients With and Without Personality Disorders. J. Clin. Psychiatry 2000, 61, 134–139, Erratum in J. Clin. Psychiatry 2000, 61, 529. [Google Scholar] [CrossRef]
- Frías, Á.; Baltasar, I.; Birmaher, B. Comorbidity Between Bipolar Disorder and Borderline Personality Disorder: Prevalence, Explanatory Theories, and Clinical Impact. J. Affect. Disord. 2016, 202, 210–219. [Google Scholar] [CrossRef]
- Bayes, A.; Parker, G.; Fletcher, K. Clinical Differentiation of Bipolar II Disorder from Borderline Personality Disorder. Curr. Opin. Psychiatry 2014, 27, 14–20. [Google Scholar] [CrossRef] [PubMed]
- Akbari, V.; Rahmatinejad, P.; Mohammadi, S.D. Comparing Neurocognitive Profile of Patients with Borderline Personality and Bipolar–II Disorders. Iran. J. Psychiatry 2019, 14, 113–119. [Google Scholar] [CrossRef] [PubMed]
- Feliu-Soler, A.; Soler, J.; Elices, M.; Pascual, J.C.; Pérez, J.; Martín-Blanco, A.; Santos, A.; Crespo, I.; Pérez, V.; Portella, M.J. Differences in Attention and Impulsivity Between Borderline Personality Disorder and Bipolar Disorder. Psychiatry Res. 2013, 210, 1307–1309. [Google Scholar] [CrossRef]
- Gvirts, H.; Braw, Y.; Harari, H.; Lozin, M.; Bloch, Y.; Fefer, K.; Levkovitz, Y. Executive Dysfunction in Bipolar Disorder and Borderline Personality Disorder. Eur. Psychiatry 2015, 30, 959–964. [Google Scholar] [CrossRef]
- Lozano, V.; Soriano, M.F.; Aznarte, J.I.; Gómez-Ariza, C.J.; Bajo, M.T. Interference Control Commonalities in Patients with Schizophrenia, Bipolar Disorder, and Borderline Personality Disorder. J. Clin. Exp. Neuropsychol. 2016, 38, 238–250. [Google Scholar] [CrossRef] [PubMed]
- Saunders, K.E.; Goodwin, G.M.; Rogers, R.D. Borderline Personality Disorder, but Not Euthymic Bipolar I Disorder, Is Associated with Prolonged Post-Error Slowing in Sensorimotor Performance. J. Affect. Disord. 2016, 198, 163–170. [Google Scholar] [CrossRef] [PubMed]
- Saunders, K.E.A.; Goodwin, G.M.; Rogers, R.D.; Dphil; Sci, F.M. Cpsychol Insensitivity to the Magnitude of Potential Gains or Losses When Making Risky Choices: Women with Borderline Personality Disorder Compared with Bipolar Disorder and Controls. J. Pers. Disord. 2016, 30, 530–544. [Google Scholar] [CrossRef] [PubMed]
- Haaland, V.Ø.; Landrø, N.I. Decision Making as Measured with the Iowa Gambling Task in Patients with Borderline Personality Disorder. J. Int. Neuropsychol. Soc. 2007, 13, 699–703. [Google Scholar] [CrossRef]
- Dell’osso, B.; Berlin, H.A.; Serati, M.; Altamura, A.C. Neuropsychobiological Aspects, Comorbidity Patterns and Dimensional Models in Borderline Personality Disorder. Neuropsychobiology 2010, 61, 169–179. [Google Scholar] [CrossRef]
- Hagenhoff, M.; Franzen, N.; Koppe, G.; Baer, N.; Scheibel, N.; Sammer, G.; Gallhofer, B.; Lis, S. Executive Functions in Borderline Personality Disorder. Psychiatry Res. 2013, 210, 224–231. [Google Scholar] [CrossRef]
- Ruocco, A.C.; Bahl, N. Material-Specific Discrepancies in Verbal and Visual Episodic Memory in Borderline Personality Disorder. Psychiatry Res. 2014, 220, 694–697. [Google Scholar] [CrossRef]
- Tournikioti, K.; Ferentinos, P.; Michopoulos, I.; Alevizaki, M.; Soldatos, C.R.; Dikeos, D.; Douzenis, A. Clinical and Treatment-related Predictors of Cognition in Bipolar Disorder: Focus on Visual Paired Associative Learning. Eur. Arch. Psychiatry Clin. Neurosci. 2017, 267, 661–669. [Google Scholar] [CrossRef]
- Glahn, D.C.; Bearden, C.; Cakir, S.; Barrett, J.; Najt, P.; Monkul, E.S.; Maples, N.; Velligan, D.; Soares, J.C. Differential Working Memory Impairment in Bipolar Disorder and Schizophrenia: Effects of Lifetime History of Psychosis. Bipolar Disord. 2006, 8, 117–123. [Google Scholar] [CrossRef]
- Glahn, D.C.; Bearden, C.E.; Barguil, M.; Barrett, J.; Reichenberg, A.; Bowden, C.L.; Soares, J.C.; Velligan, D.I. The Neurocognitive Signature of Psychotic Bipolar Disorder. Biol. Psychiatry 2007, 62, 910–916. [Google Scholar] [CrossRef]
- Glahn, D.C.; Almasy, L.; Barguil, M.; Hare, E.; Peralta, J.M.; Kent, J.W.; Dassori, A.; Contreras, J.; Pacheco, A.; Lanzagorta, N.; et al. Neurocognitive Endophenotypes for Bipolar Disorder Identified in Multiplex Multigenerational Families. Arch. Gen. Psychiatry 2010, 67, 168–177. [Google Scholar] [CrossRef]
- Cahill, C.M.; Walter, G.; Malhi, G.S. Neurocognition in Bipolar Disorder and Juvenile Bipolar Disorder. J. Can. Acad. Child Adolesc. Psychiatry 2009, 18, 221–230. [Google Scholar]
- Meyer, S.E.; Carlson, G.A.; Wiggs, E.A.; Martinez, P.E.; Ronsaville, D.S.; Klimes–Dougan, B.; Gold, P.W.; Radke–Yarrow, M. A Prospective Study of the Association Among Impaired Executive Functioning, Childhood Attentional Problems, and the Development of Bipolar Disorder. Dev. Psychopathol. 2004, 16, 461–476. [Google Scholar] [CrossRef]
- Doyle, A.E.; Wozniak, J.; Wilens, T.E.; Henin, A.; Seidman, L.J.; Petty, C.; Fried, R.; Gross, L.M.; Faraone, S.V.; Biederman, J. Neurocognitive Impairment in Unaffected Siblings of Youth with Bipolar Disorder. Psychol. Med. 2009, 39, 1253–1263. [Google Scholar] [CrossRef]
- Bauer, I.E.; Frazier, T.W.; Meyer, T.D.; Youngstrom, E.; Zunta–Soares, G.B.; Soares, J.C. Affective Processing in Pediatric Bipolar Disorder and Offspring of Bipolar Parents. J. Child Adolesc. Psychopharmacol. 2015, 25, 684–690. [Google Scholar] [CrossRef] [PubMed]
- Bora, E.; Yucel, M.; Pantelis, C. Cognitive Endophenotypes of Bipolar Disorder: A Meta-Analysis of Neuropsychological Deficits in Euthymic Patients and Their First-Degree Relatives. J. Affect. Disord. 2009, 113, 1–20. [Google Scholar] [CrossRef] [PubMed]
- de la Serna, E.; Sugranyes, G.; Sanchez-Gistau, V.; Rodriguez-Toscano, E.; Baeza, I.; Vila, M.; Romero, S.; Sanchez-Gutierrez, T.; Penzol, M.J.; Moreno, D.; et al. Neuropsychological Characteristics of Child and Adolescent Offspring of Patients with Schizophrenia or Bipolar Disorder. Schizophr. Res. 2017, 183, 110–115. [Google Scholar] [CrossRef] [PubMed]
- Diwadkar, V.A.; Goradia, D.; Hosanagar, A.; Mermon, D.; Montrose, D.M.; Birmaher, B.; Axelson, D.; Rajarathinem, R.; Haddad, L.; Amirsadri, A.; et al. Working Memory and Attention Deficits in Adolescent Offspring of Schizophrenia or Bipolar Patients: Comparing Vulnerability Markers. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 2011, 35, 1349–1354. [Google Scholar] [CrossRef]
- Klimes-Dougan, B.; Ronsaville, D.; Wiggs, E.A.; Martinez, P.E. Neuropsychological functioning in adolescent children of mothers with a history of bipolar or major depressive disorders. Biol. Psychiatry 2006, 60, 957–965. [Google Scholar] [CrossRef]
- Lin, K.; Lu, R.; Chen, K.; Li, T.; Lu, W.; Kong, J.; Xu, G. Differences in cognitive deficits in individuals with subthreshold syndromes with and without family history of bipolar disorder. J. Psychiatr. Res. 2017, 91, 177–183. [Google Scholar] [CrossRef]
- Simonetti, A.; Kurian, S.; Saxena, J.; Verrico, C.D.; Soares, J.C.; Sani, G.; Saxena, K. Cognitive Correlates of Impulsive Aggression in Youth with Pediatric Bipolar Disorder and Bipolar Offspring. J. Affect. Disord. 2021, 287, 387–396. [Google Scholar] [CrossRef] [PubMed]
- Saxena, K.; Verrico, C.D.; Kahlon, R.; Amin, P.; Arvind, R.P.; Patel, M.; Sharp, C.; Williams, L.; Shah, A. Borderline features in Youth with Bipolar Spectrum Disorders. Adolesc. Psychiatry 2018, 8, 174–184. [Google Scholar] [CrossRef]
- Sheehan, D.V.; Sheehan, K.H.; Shytle, R.D.; Janavs, J.; Bannon, Y.; Rogers, J.E.; Milo, K.M.; Stock, S.L.; Wilkinson, B. Reliability and Validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). J. Clin. Psychiatry 2010, 71, 313–326. [Google Scholar] [CrossRef]
- Wechsler, D. Wechsler Abbreviated Scale of Intelligence; The Psychological Corporation: New York, NY, USA, 1999. [Google Scholar] [CrossRef]
- Axelson, D.; Birmaher, B.; Strober, M.; Gill, M.K.; Valeri, S.; Chiappetta, L.; Ryan, N.; Leonard, H.; Hunt, J.; Iyengar, S.; et al. Phenomenology of children and adolescents with bipolar spectrum disorders. Arch. Gen. Psychiatry 2006, 63, 1139–1148. [Google Scholar] [CrossRef] [PubMed]
- Towbin, K.; Axelson, D.; Leibenluft, E.; Birmaher, B. Differentiating bipolar disorder–Not Otherwise specified and severe mood dysregulation. J. Am. Acad. Child Adolesc. Psychiatry 2013, 52, 466–481. [Google Scholar] [CrossRef]
- Axelson, D.A.; Birmaher, B.; Strober, M.A.; Goldstein, B.I.; Ha, W.; Gill, M.K.; Goldstein, T.R.; Yen, S.; Hower, H.; Hunt, J.I.; et al. Course of subthreshold bipolar disorder in youth: Diagnostic progression from bipolar disorder not otherwise specified. J. Am. Acad. Child Adolesc. Psychiatry 2011, 50, 1001–1016.e3. [Google Scholar] [CrossRef]
- Mayes, T.L.; Bernstein, I.H.; Haley, C.L.; Kennard, B.D.; Emslie, G.J. Psychometric Properties of the Children’s Depression Rating Scale–Revised in Adolescents. J. Child Adolesc. Psychopharmacol. 2010, 20, 513–516. [Google Scholar] [CrossRef] [PubMed]
- 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. [Google Scholar] [CrossRef]
- Chang, B.; Sharp, C.; Ha, C. The criterion validity of the Borderline Personality Features Scale for Children in an adolescent inpatient setting. J. Pers. Disord. 2011, 25, 492–503. [Google Scholar] [CrossRef]
- Cambridge Cognition. CANTAB Cognitive Assessments. Available online: http://www.cantab.com (accessed on 20 February 2025).
- Bayes, A.; Spoelma, M.; Parker, G. Comorbid bipolar disorder and borderline personality disorder: Diagnosis using machine learning. J. Psychiatr. Res. 2022, 152, 1–6. [Google Scholar] [CrossRef]
- Joyce, P.R.; Light, K.J.; Rowe, S.L.; Cloninger, C.R.; Kennedy, M.A. Self-mutilation and suicide attempts: Relationships to bipolar disorder, borderline personality disorder, temperament and character. Aust. N. Z. J. Psychiatry 2010, 44, 250–257. [Google Scholar] [CrossRef]
- Murphy, F.C.; Sahakian, B.J.; Rubinsztein, J.S.; Michael, A.; Rogers, R.D.; Robbins, T.W.; Paykel, E.S. Emotional bias and inhibitory control processes in mania and depression. Psychol. Med. 1999, 29, 1307–1321. [Google Scholar] [CrossRef] [PubMed]
- Murphy, F.C.; Rubinsztein, J.S.; Michael, A.; Rogers, R.D.; Robbins, T.W.; Paykel, E.S.; Sahakian, B.J. Decision-making cognition in mania and depression. Psychol. Med. 2001, 31, 679–693. [Google Scholar] [CrossRef] [PubMed]
- Rubinsztein, J.S.; Michael, A.; Paykel, E.S.; Sahakian, B.J. Cognitive impairment in remission in bipolar affective disorder. Psychol. Med. 2000, 30, 1025–1036. [Google Scholar] [CrossRef] [PubMed]
- Sweeney, J.; A Kmiec, J.; Kupfer, D.J. Neuropsychologic impairments in bipolar and unipolar mood disorders on the CANTAB neurocognitive battery. Biol. Psychiatry 2000, 48, 674–684. [Google Scholar] [CrossRef]
- Clark, L.; Sahakian, B.J. Cognitive neuroscience and brain imaging in bipolar disorder. Dialog.-Clin. Neurosci. 2008, 10, 153–165. [Google Scholar] [CrossRef]
- Balanzamartinez, V.; Rubio, C.; Selvavera, G.; Martinezaran, A.; Sanchezmoreno, J.; Salazarfraile, J.; Vieta, E.; Tabaresseisdedos, R. Neurocognitive endophenotypes (Endophenocognitypes) from studies of relatives of bipolar disorder subjects: A systematic review. Neurosci. Biobehav. Rev. 2008, 32, 1426–1438. [Google Scholar] [CrossRef]
- Clark, L.; Sarna, A.; Goodwin, G.M. Impairment of executive function but not memory in first-degree relatives of patients with bipolar i disorder and in euthymic patients with unipolar depression. Am. J. Psychiatry 2005, 162, 1980–1982. [Google Scholar] [CrossRef]
- Bauer, I.E.; Wu, M.-j.; Frazier, T.; Mwangi, B.; Spiker, D.; Zunta-Soares, G.B.; Soares, J.C. Neurocognitive functioning in individuals with bipolar disorder and their healthy siblings: A preliminary study. J. Affect. Disord. 2016, 201, 51–56. [Google Scholar] [CrossRef]
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; American Psychiatric Association: Arlington, VA, USA, 2013. [Google Scholar] [CrossRef]
- Bijttebier, P.; Vertommen, H. Coping strategies in relation to personality disorders. Pers. Individ. Differ. 1999, 26, 847–856. [Google Scholar] [CrossRef]
- Knafo, A.; Guilé, J.-M.; Breton, J.-J.; Labelle, R.; Belloncle, V.; Bodeau, N.; Boudailliez, B.; De La Rivière, S.G.; Kharij, B.; Mille, C.; et al. Coping strategies associated with suicidal behaviour in adolescent inpatients with borderline personality disorder. Can. J. Psychiatry 2015, 60, S46–S54. [Google Scholar] [PubMed]
- Berenson, K.R.; Gregory, W.E.; Glaser, E.; Romirowsky, A.; Rafaeli, E.; Yang, X.; Downey, G. Impulsivity, rejection sensitivity, and reactions to stressors in borderline personality disorder. Cogn. Ther. Res. 2016, 40, 510–521. [Google Scholar] [CrossRef] [PubMed]
- Lawrence, K.A.; Allen, J.S.; Chanen, A.M. Impulsivity in borderline personality disorder: Reward-based decision-making and its relationship to emotional distress. J. Pers. Disord. 2010, 24, 786–799. [Google Scholar] [CrossRef]
- Paret, C.; Jennen-Steinmetz, C.; Schmahl, C. Disadvantageous decision-making in borderline personality disorder: Partial support from a meta-analytic review. Neurosci. Biobehav. Rev. 2017, 72, 301–309. [Google Scholar] [CrossRef]
- Bazanis, E.; Rogers, R.D.; Dowson, J.H.; Taylor, P.; Meux, C.; Staley, C.; Nevinson-Andrews, D.; Taylor, C.; Robbins, T.W.; Sahakian, B.J. Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder. Psychol. Med. 2002, 32, 1395–1405. [Google Scholar] [CrossRef]
- Andreou, C.; Kleinert, J.; Steinmann, S.; Fuger, U.; Leicht, G.; Mulert, C. Oscillatory responses to reward processing in borderline personality disorder. World J. Biol. Psychiatry 2015, 16, 575–586. [Google Scholar] [CrossRef]
- Dimick, M.K.; Sultan, A.A.; Kennedy, K.G.; Rizvi, S.J.; Forbes, E.E.; Sinyor, M.; McIntyre, R.S.; Youngstrom, E.A.; Goldstein, B.I. Risk-Sensitive Decision-Making and Self-Harm in Youth Bipolar Disorder. J. Clin. Psychiatry 2023, 84, 48863. [Google Scholar] [CrossRef] [PubMed]
- Lockwood, J.; Daley, D.; Townsend, E.; Sayal, K. Impulsivity and self-harm in adolescence: A systematic review. Eur. Child Adolesc. Psychiatry 2017, 26, 387–402. [Google Scholar] [CrossRef]
- Simeon, D.; Stanley, B.; Frances, A.; Mann, J.J.; Winchel, R.; Stanley, M. Self-mutilation in personality disorders: Psychological and biological correlates. Am. J. Psychiatry 1992, 149, 221–226. [Google Scholar] [CrossRef]
- Schuermann, B.; Kathmann, N.; Stiglmayr, C.; Renneberg, B.; Endrass, T. Impaired decision making and feedback evaluation in borderline personality disorder. Psychol. Med. 2011, 41, 1917–1927. [Google Scholar] [CrossRef]
- Winter, D.; Herbert, C.; Koplin, K.; Schmahl, C.; Bohus, M.; Lis, S. Negative evaluation bias for positive self-referential information in borderline personality disorder. PLoS ONE 2015, 10, e0117083. [Google Scholar] [CrossRef] [PubMed]
- Hyniewska, S.; Dąbrowska, J.; Makowska, I.; Jankowiak-Siuda, K.; Rymarczyk, K. The borderline bias in explicit emotion interpretation. Front. Psychol. 2021, 12, 733742. [Google Scholar] [CrossRef]
- Yang, H.; Liu, Q.; Peng, W.; Liu, Z.; Chu, J.; Zheng, K.; Cao, W.; Yi, J. Impaired impulse inhibition of emotional stimuli in patients with borderline personality disorder. Sci. Rep. 2021, 11, 16628. [Google Scholar] [CrossRef]
- Bortolla, R.; Roder, E.; Ramella, P.; Fossati, A.; Maffei, C. Emotional responsiveness in borderline personality disorder: The role of basal hyperarousal and self-reported emotional regulation. J. Nerv. Ment. Dis. 2019, 207, 175–183. [Google Scholar] [CrossRef]
- García-Blanco, A.C.; Perea, M.; Livianos, L. Mood-congruent bias and attention shifts in the different episodes of bipolar disorder. Cogn. Emot. 2013, 27, 1114–1121. [Google Scholar] [CrossRef]
- Simonetti, A.; Lijffijt, M.; Kahlon, R.S.; Gandy, K.; Arvind, R.P.; Amin, P.; Arciniegas, D.B.; Swann, A.C.; Soares, J.C.; Saxena, K. Early and late cortical reactivity to passively viewed emotional faces in pediatric bipolar disorder. J. Affect. Disord. 2019, 253, 240–247. [Google Scholar] [CrossRef] [PubMed]
- Moccia, L.; Bartolucci, G.; Pepe, M.; Marcelli, I.; Grisoni, F.; Brugnami, A.; Caso, R.; Bardi, F.; Calderoni, C.; Giannico, A.M.; et al. Heart rate variability as a potential predictor of response to intranasal esketamine in patients with treatment-resistant depression: A preliminary report. J. Clin. Med. 2024, 13, 4767. [Google Scholar] [CrossRef] [PubMed]
- Kærsgaard, S.; Meluken, I.; Kessing, L.; Vinberg, M.; Miskowiak, K. Increased sensitivity to positive social stimuli in monozygotic twins at risk of bipolar vs. unipolar disorder. J. Affect. Disord. 2018, 232, 212–218. [Google Scholar] [CrossRef]
- Bettis, A.H.; Benningfield, M.M.; Dao, A.; Dickey, L.; Pegg, S.; Venanzi, L.; Kujawa, A. Self-injurious thoughts and behaviors and alterations in positive valence systems: A systematic review of the literature. J. Psychiatr. Res. 2022, 156, 579–593. [Google Scholar] [CrossRef]
- Selby, E.A.; Nock, M.K.; Kranzler, A. How does self-injury feel? Examining automatic positive reinforcement in adolescent self-injurers with experience sampling. Psychiatry Res. 2014, 215, 417–423. [Google Scholar] [CrossRef]
- Jones, S.H.; Bentall, R.P. A review of potential cognitive and environmental risk markers in children of bipolar parents. Clin. Psychol. Rev. 2008, 28, 1083–1095. [Google Scholar] [CrossRef] [PubMed]
- Nijjar, R.; Ellenbogen, M.A.; Hodgins, S. Personality, coping, risky behavior, and mental disorders in the offspring of parents with bipolar disorder: A comprehensive psychosocial assessment. J. Affect. Disord. 2014, 166, 315–323. [Google Scholar] [CrossRef] [PubMed]
- Ostiguy, C.S.; Ellenbogen, M.A.; Linnen, A.-M.; Walker, E.F.; Hammen, C.; Hodgins, S. Chronic stress and stressful life events in the offspring of parents with bipolar disorder. J. Affect. Disord. 2009, 114, 74–84. [Google Scholar] [CrossRef]
- Durdurak, B.B.; Altaweel, N.; Upthegrove, R.; Marwaha, S. Understanding the development of bipolar disorder and borderline personality disorder in young people: A meta-review of systematic reviews. Psychol. Med. 2022, 52, 3769–3782. [Google Scholar] [CrossRef] [PubMed]
- Simonetti, A.; Bernardi, E.; Kurian, S.; Restaino, A.; Calderoni, C.; De Chiara, E.; Bardi, F.; Sani, G.; Soares, J.C.; Saxena, K. Understanding pediatric bipolar disorder through the investigation of clinical, neuroanatomic, neurophysiological and neurocognitive dimensions: A pilot study. Brain Sci. 2025, 15, 152. [Google Scholar] [CrossRef]
- Henin, A.; Biederman, J.; Mick, E.; Sachs, G.S.; Hirshfeld-Becker, D.R.; Siegel, R.S.; McMurrich, S.; Grandin, L.; Nierenberg, A.A. Psychopathology in the offspring of parents with bipolar disorder: A controlled study. Biol. Psychiatry 2005, 58, 554–561. [Google Scholar] [CrossRef]
- Callovini, T.; Montanari, S.; Bardi, F.; Barbonetti, S.; Rossi, S.; Caso, R.; Mandracchia, G.; Margoni, S.; Brugnami, A.; Paolini, M.; et al. Obstetric outcomes in women on lithium: A systematic review and meta-analysis. J. Clin. Med. 2024, 13, 4872. [Google Scholar] [CrossRef]
- Carcone, D.; Lee, A.C.; Ruocco, A.C. Disrupted relationship between hippocampal activation and subsequent memory performance in borderline personality disorder. J. Affect. Disord. 2020, 274, 1041–1048. [Google Scholar] [CrossRef]
- Szczepaniak, M.; Chowdury, A.; Soloff, P.H.; Diwadkar, V.A. Stimulus valence, episodic memory, and the priming of brain activation profiles in borderline personality disorder. Psychol. Med. 2021, 52, 4177–4187. [Google Scholar] [CrossRef]
- Winter, D.; Elzinga, B.; Schmahl, C. Emotions and memory in borderline personality disorder. Psychopathology 2013, 47, 71–85. [Google Scholar] [CrossRef]
- Sani, G.; Margoni, S.; Brugnami, A.; Ferrara, O.M.; Bernardi, E.; Simonetti, A.; Monti, L.; Mazza, M.; Janiri, D.; Moccia, L.; et al. The Nrf2 pathway in depressive disorders: A systematic review of animal and human studies. Antioxidants 2023, 12, 817. [Google Scholar] [CrossRef] [PubMed]
- Di Nicola, M.; Pepe, M.; Montanari, S.; Spera, M.C.; Panaccione, I.; Simonetti, A.; Sani, G. Vortioxetine improves physical and cognitive symptoms in patients with post-COVID-19 major depressive episodes. Eur. Neuropsychopharmacol. 2023, 70, 21–28. [Google Scholar] [CrossRef] [PubMed]
- Sani, G.; Kotzalidis, G.D.; Vöhringer, P.; Pucci, D.; Simonetti, A.; Manfredi, G.; Savoja, V.; Tamorri, S.M.; Mazzarini, L.; Pacchiarotti, I.; et al. Effectiveness of short-term olanzapine in patients with bipolar I disorder, with or without comorbidity with substance use disorder. J. Clin. Psychopharmacol. 2013, 33, 231–235. [Google Scholar] [CrossRef] [PubMed]
BD (N = 39) | BD-OFF (N = 18) | HCs (N = 50) | F or χ2 | p-Value | ||
---|---|---|---|---|---|---|
Demographics | ||||||
Age (y), mean ± SD | 12.83 ± 3.22 | 12.37 ± 2.79 | 12.08 ± 3.06 | 0.65 | 0.524 | |
Sex, n (%) | 0.35 | 0.841 | ||||
Female | 22 (56.4) | 9 (50.0) | 29 (58.0) | |||
Male | 17 (43.6) | 9 (50.0) | 21 (42.0) | |||
Years of education, mean ± SD | 7.08 ± 2.96 | 4.64 ± 3.26 | 6.33 ± 2.90 | 11.38 | <0.001 | |
Race, n (%) | 9.79 | 0.134 | ||||
Asian | 0 (0) | 0 (0) | 3 (6) | |||
African American | 7 (17.9) | 2 (11.1) | 14 (28.0) | |||
Caucasian | 29 (74.4) | 15 (83.3) | 33 (66.0) | |||
Other | 3 (7.7) | 1 (5.6) | 0 (0) | |||
Ethnicity, n (%) | 0.37 | 0.830 | ||||
Hispanic | 8 (20.5) | 5 (27.8) | 11 (22.4) | |||
Non-Hispanic | 31 (79.5) | 13 (72.2) | 38 (77.6) | |||
I.Q., mean ± SD | 105.17 ± 13.46 | 91.27 ± 10.23 | 103.19 ± 14.01 | 6.09 | 0.003 | |
Clinical | ||||||
CDRS, mean ± SD | 54.97 ± 11.59 | 44.81 ± 12.69 | 32.59 ± 5.66 | 59.82 | <0.001 | |
YMRS, mean ± SD | 15.10 ± 10.53 | 4.69 ± 3.81 | 3.08 ± 3.07 | 34.39 | <0.001 | |
BD type, n (%) | ||||||
Type 1 | 29 (74.4) | 0 (0) | 0 (0) | - | - | |
Type II | 2 (5.1) | 0 (0) | 0 (0) | - | - | |
Not otherwise specified | 8 (20.5) | 0 (0) | 0 (0) | - | - | |
Comorbidity, n (%) | ||||||
None | 10 (26.3) | 12 (66.7) | 50 (100) | 53.82 | <0.001 | |
MDD | 0 (0) | 2 (11.1) | 0 (0) | 10.08 | 0.006 | |
ADHD | 24 (61.5) | 4 (22.2) | 0 (0) | 43.12 | <0.001 | |
OCD | 5 (13.2) | 0 (0) | 0 (0) | 9.39 | 0.009 | |
Panic Disorder | 2 (5.1) | 0 (0) | 0 (0) | 3.55 | 0.169 | |
GAD | 10 (25.6) | 2 (11.1) | 0 (0) | 14.47 | <0.001 | |
Current pharmacotherapy, n (%) | ||||||
ADs | 16 (41.0) | 4 (22.2) | 0 (0) | 24.44 | <0.001 | |
APs | 27 (69.2) | 4 (22.2) | 0 (0) | 51.51 | <0.001 | |
MSs | 12 (30.8) | 1 (5.6) | 0 (0) | 20.32 | <0.001 | |
Stimulants | 19 (48.7) | 20 (18.7) | 0 (0) | 36.67 | <0.001 | |
BDZs | 0 (0) | 0 (0) | 0 (0) | - | - |
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Simonetti, A.; Kurian, S.; Bernardi, E.; Restaino, A.; Bardi, F.; Calderoni, C.; Sani, G.; Soares, J.C.; Saxena, K. Cognitive Correlates of Borderline Personality Disorder Features in Youth with Bipolar Spectrum Disorders and Bipolar Offspring. Brain Sci. 2025, 15, 390. https://doi.org/10.3390/brainsci15040390
Simonetti A, Kurian S, Bernardi E, Restaino A, Bardi F, Calderoni C, Sani G, Soares JC, Saxena K. Cognitive Correlates of Borderline Personality Disorder Features in Youth with Bipolar Spectrum Disorders and Bipolar Offspring. Brain Sciences. 2025; 15(4):390. https://doi.org/10.3390/brainsci15040390
Chicago/Turabian StyleSimonetti, Alessio, Sherin Kurian, Evelina Bernardi, Antonio Restaino, Francesca Bardi, Claudia Calderoni, Gabriele Sani, Jair C. Soares, and Kirti Saxena. 2025. "Cognitive Correlates of Borderline Personality Disorder Features in Youth with Bipolar Spectrum Disorders and Bipolar Offspring" Brain Sciences 15, no. 4: 390. https://doi.org/10.3390/brainsci15040390
APA StyleSimonetti, A., Kurian, S., Bernardi, E., Restaino, A., Bardi, F., Calderoni, C., Sani, G., Soares, J. C., & Saxena, K. (2025). Cognitive Correlates of Borderline Personality Disorder Features in Youth with Bipolar Spectrum Disorders and Bipolar Offspring. Brain Sciences, 15(4), 390. https://doi.org/10.3390/brainsci15040390