Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder
Neurocognitive deficits in decision-making and planning of patients with DSM-III-R borderline personality disorder
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DOI：
10.1017/s0033291702006657
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发表时间：
2002-11-01
影响因子：
6.9
通讯作者：
Sahakian, BJ
中科院分区：
文献类型：
--
作者：
Bazanis, E;Rogers, RD;Sahakian, BJ
背景。在边缘型人格障碍（BPD）背景下发生的反复的自我伤害行为可能反映了决策和计划认知的障碍。然而，目前还没有对诊断为 BPD 的患者的这些特定认知功能进行系统的神经心理学检查。此类研究可能会提高我们对脑功能障碍在 BPD 中可能发挥的作用的理解，并改善与这种疾病相关的心理困难的特征。方法。 42 名被诊断为 DSM-III-R BPD 的精神病患者（其中 41 人有自残史），没有特定“精神病”史或当前主要情感障碍的病史，在完成先前显示对额叶功能障碍敏感的决策和计划的计算机化任务之前进行了临床评估，并进行了先前显示对额叶功能障碍敏感的空间和模式视觉识别记忆测试。 分别是颞叶损伤。将 BPD 患者组的表现与由 42 名受试者组成的非临床对照组进行比较。结果。 BPD 患者在决策任务中的表现特征是，在相互竞争的行为之间进行选择时，会出现延迟和适应不良的选择模式，而在对决策结果进行赌博时，会出现冲动、不受抑制的反应。 BPD 患者在计划任务上也表现出障碍。没有证据表明视觉识别记忆受损。其他分析表明当前药物治疗和既往药物滥用史的影响有限。结论。这些发现表明，BPD 与由额叶回路介导的可分离认知过程的复杂损伤有关。这些损伤可能会介导 BPD 中明显的一些行为变化。需要进一步的工作来检验这些发现的特殊性。
Background. Repeated, self-damaging behaviour occurring in the context of borderline personality disorder (BPD) may reflect impairments in decision-making and planning cognition. However, there has been no systematic neuropsychological examination of these particular cognitive functions in patients diagnosed with BPD. Such investigations may improve our understanding of the possible role of brain dysfunction in BPD and improve the characterization of the psychological difficulties associated with this disorder.Method. Forty-two psychiatric patients with a diagnosis of DSM-III-R BPD (41 of whom gave a history of self-harm), without a history of specified 'psychoses' or current major affective disorder, were clinically assessed before completing computerized tasks of decision-making and planning previously shown to be sensitive to frontal lobe dysfunction, and tests of spatial and pattern visual recognition memory previously shown to be sensitive to frontal lobe damage and temporal lobe damage respectively. The performance of the BPD patient group was compared with that of a non-clinical control group consisting of 42 subjects.Results. The performance of the BPD patients on the decision-making task was characterized by a pattern of delayed and maladaptive choices when choosing between competing actions, and by impulsive, disinhibited responding when gambling on the outcome of their decisions. BPD patients also showed impairments on the planning task. There was no evidence of impaired visual recognition memory. Additional analyses suggested only limited effects of current medication and history of previous substance use disorder.Conclusions. These findings suggest that BPD is associated with complex impairments in dissociable cognitive processes mediated by circuitry encompassing the frontal lobes. These impairments may mediate some of the behavioural changes evident in BPD. Further work is needed to examine the specificity of these findings.