Transcript Research into Borderline Personality Disorder

Research into BPD
SPDN
Jeremy Hall
Borderline Personality Disorder
• First defined by Gunderson
• Core features
– Affective instability
– Interpersonal difficulties
– Impulsivity
• Heritability about 40%
• Strongly associated with early life stress
The Scale of the Problem
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BPD affects 1-2% of the population
BPD accounts for 10% OPD contacts
BPD main diagnosis in 6% admissions
Frequent cause of attendance at A&E
Associated with a 10% risk of suicide
Current Treatments
• 1. Pharmacological Treatments
– Antidepressants only if concurrent depression
– Antipsychotics for perceptual disturbances
– Some evidence for mood stabilisers
– All trials very small
– NICE unable to recommend any treatment
Current Treatments
• 2. Psychological Treatments
– Best evidence is for DBT
– Some evidence also for CBT
– HOWEVER
• Trials generally small
• Limited availability
• Not suitable for all
How can Research help?
• Psychological Research
– Larger studies
– “Real-life” settings
• Biological Research
– Develop measures of deficits in BPD
– Relate these to changes in the brain
– Develop new treatments
Our Research
• Developing measures of BPD symptoms
– Affective responses
– Interpersonal interactions
– Impulsivity
• Determining their specificity to BPD
• Developing translational assessments
Emotion and Impulse Study
• 1. Background information
• 2. Symptom severity
• 3. Computer tests of:
– A. Emotion processing
– B. Social responses
– C. Impulsivity
Who did we study?
• 20 people with symptoms
• 20 people without symptoms
• Age range 20-55
• 75% female
What did we find out?
Background and Symptoms
Some things weren’t different…
40
120
100
30
IQ
Age
80
20
60
40
10
20
0
0
CON
SYMPT
CON
SYMPT
Group
Group
AGE
IQ
… and some things were:
50
20
15
Hamilton
Child Stress
40
30
20
10
5
10
0
0
CON
SYMPT
CON
SYMPT
Group
Group
CHILD STRESS
DEPRESSION
Computer tests 1
Emotion Processing
Expression in faces
Facial Emotion Recognition
Anger
Happiness
Fear
Sadness
Surprise
Disgust
Results: Emotions
12
10
**
Score
8
CON
SYMPT
6
4
2
0
ANG
HAP
SAD
Task
SUR
FEAR
DIS
Emotion Recognition and Trauma
Computer tests 2
Social Responses
Social decisions
Trustworthy?
Social Judgement
APPROACHABLE
NOT APPROACHABLE
Results: Social
32
***
30
**
28
Score
26
CON
SYMPT
24
22
20
18
16
AGE
ATT
DIS
INT
Task
TRU
APP
Social Judgement Bias
BPD
Social Judgement and Trauma
Computer tests 3
Impulsivity
Motor Impulsivity
400
350
SSRT (ms)
300
250
200
150
100
50
0
CON
SYMPT
Group
Delayed Reward
Which would you prefer?:
£10
Straight away
£20
In two weeks
Delayed Reward
100
90
% waiting for later
80
70
60
CON
SYMPT
50
40
30
20
10
0
2
7
30
Delay (days)
180
Conclusions
Conclusions
• We could measure difficulties in core areas:
– Emotion processing
– Social responses
– Impulsivity
• What does this mean in the brain?
Basis in the brain?
PFC
AMY
The future!
Acknowledgements
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CSO / SFC
Merrick Pope
Katie Nicol
All the participants
Contacts
• Jeremy Hall
– Email: [email protected]
– Tel: 0131 537 6313
• Merrick Pope
– Email: [email protected]
– Tel: 0131 537 6390