BACKGROUND: According to recent data, dissociation may play an important role in borderline personality disorder (BPD), nevertheless specific influences of psychotropic medication on dissociative symptoms in BPD and their therapeutic indications are largely unknown. The purpose of this study was to assess relationships of dissociative symptoms in BPD patients with levels of psychotropic medication and compare these results with a subgroup of patients with schizophrenia. MATERIALS AND METHODS: In this study, we investigated 52 BPD patients and compared the results with a control group of 36 schizophrenia patients. In all participants, we assessed actual day doses of antipsychotic medication in chlorpromazine equivalents and antidepressant medication in fluoxetine equivalents. Dissociative symptoms were measured by Dissociative Experiences Scale (DES), and other psychopathological symptoms were measured using Health of the Nation Outcome Scales. RESULTS: Results indicate that dissociative symptoms measured by DES were significantly correlated with antipsychotic medication (Spearman R=0.45, P<0.01) in chlorpromazine equivalents and antidepressant medication in fluoxetine equivalents (0.36, P<0.01). These relationships between medication and dissociative symptoms were not found in the control group of schizophrenia patients. CONCLUSION: The results suggest that levels of antipsychotic medication and antidepressant medication are significantly associated with dissociative symptoms in BPD but not in schizophrenia.

Center for Neuropsychiatric Research of Traumatic Stress Department of Psychiatry and UHSL 1st Faculty of Medicine Charles University Prague Czech Republic

Central European Institute of Technology Faculty of Medicine Masaryk University Brno Czech Republic

Psychotherapeutic and Psychosomatic Clinic ESET Prague Czech Republic

Zobrazit více v PubMed

Bob P. Pain, dissociation and subliminal self-representations. Conscious Cogn. 2008;17(1):355–369. PubMed

Bob P. Dissociation, epileptiform discharges and chaos in the brain: Toward a neuroscientific theory of dissociation. Act Nerv Super. 2012;54(3–4):84–107.

Breuer J, Freud S. Studies in hysteria. New York: Basic Books; 1895.

Stone MH. Toward a psychobiological theory of borderline personality disorder: Is irritability the red thread that runs through borderline conditions? Dissociation: Progress in the Dissociative Disorders. 1988;1(2):2–15.

Crawford HJ. Brain dynamics and hypnosis: attentional and disattentional processes. Int J Clin Exp Hypn. 1994;42:204–232. PubMed

Hilgard ER. Divided Consciousness: Multiple Control in Human Thought and Action. New York, NY: Wiley; 1986.

Rainville P, Hofbauer RK, Bushnell MC, Duncan GH, Price DD. Hypnosis modulates activity in brain structures involved in the regulation of consciousness. J Cogn Neurosci. 2002;14(6):887–901. PubMed

Vermetten E, Douglas Bremner J. Functional brain imaging and the induction of traumatic recall: a cross-correlational review between neuroimaging and hypnosis. Int J Clin Exp Hypn. 2004;52(3):280–312. PubMed

Egner T, Jamieson G, Gruzelier J. Hypnosis decouples cognitive control from conflict monitoring processes of the frontal lobe. Neuroimage. 2005;27(4):969–978. PubMed

Raz A, Fan J, Posner MI. Hypnotic suggestion reduces conflict in the human brain. Proc Natl Acad Sci U S A. 2005;102(28):9978–9983. PubMed PMC

Bob P, Mashour GA. Schizophrenia, dissociation, and consciousness. Conscious Cogn. 2011;20(4):1042–1049. PubMed

Korzekwa MI, Dell PF, Links PS, Thabane L, Fougere P. Dissociation in borderline personality disorder: a detailed look. J Trauma Dissociation. 2009;10(3):346–367. PubMed

Pec O, Bob P, Lysaker PH. Trauma, Dissociation and Synthetic Meta-cognition in Schizophrenia. Act Nerv Super. 2015;57(2):59–70.

Zanarini MC, Jager-Hyman S. Dissociation in borderline personality disorder. In: Dell PF, O’Neil JA, editors. Dissociation and the Dissociative Disorders DSM-V and Beyond. New York, NY: Routledge; 2009. pp. 487–493.

Hunter AM, Korb AS, Cook IA, Leuchter AF. Rostral anterior cingulate activity in major depressive disorder: state or trait marker of responsiveness to medication? J Neuropsychiatry Clin Neurosci. 2013;25(2):126–133. PubMed

Kopelman A, Andreasen NC, Nopoulos P. Morphology of the anterior cingulate gyrus in patients with schizophrenia: relationship to typical neuroleptic exposure. Am J Psychiatry. 2005;162(10):1872–1878. PubMed

Korb AS, Hunter AM, Cook IA, Leuchter AF. Rostral anterior cingulate cortex theta current density and response to antidepressants and placebo in major depression. Clin Neurophysiol. 2009;120(7):1313–1319. PubMed PMC

Mulert C, Juckel G, Brunnmeier M, et al. Rostral anterior cingulate cortex activity in the theta band predicts response to antidepressive medication. Clin EEG Neurosci. 2007;38(2):78–81. PubMed

Wang Q, Cheung C, Deng W, et al. White-matter microstructure in previously drug-naive patients with schizophrenia after 6 weeks of treatment. Psychol Med. 2013;43(11):2301–2309. PubMed

Yücel M, Brewer WJ, Harrison BJ, et al. Anterior cingulate activation in antipsychotic-naïve first-episode schizophrenia. Acta Psychiatr Scand. 2007;115(2):155–158. PubMed

Kim C, Chung C, Kim J. Task-dependent response conflict monitoring and cognitive control in anterior cingulate and dorsolateral prefrontal cortices. Brain Res. 2013;1537:216–223. PubMed

Newman LA, Creer DJ, McGaughy JA. Cognitive control and the anterior cingulate cortex: how conflicting stimuli affect attentional control in the rat. J Physiol Paris. 2015;109(1–3):95–103. PubMed PMC

Yan H, Tian L, Yan J, et al. Functional and anatomical connectivity abnormalities in cognitive division of anterior cingulate cortex in schizophrenia. PLoS One. 2012;7(9):e45659. PubMed PMC

Raven JC. Guide to the Standard Progressive Matrices. London: HK Lewis; 1960.

First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin LS. Structured Clinical Interview for DSM-IV Axis II Personality Disorders, (SCID-II) Washington, DC: American Psychiatric Press, Inc; 1997.

Sheehan DV, Lecrubier Y, Sheehan KH, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(Suppl 20):22–33. quiz 34–57. PubMed

Atkins M, Burgess A, Bottomley C, Riccio M. Chlorpromazine equivalents: a consensus of opinion for both clinical and research applications. Psychiatr Bull. 1997;21(04):224–226.

Hayasaka Y, Purgato M, Magni LR, et al. Dose equivalents of antidepressants: Evidence-based recommendations from randomized controlled trials. J Affect Disord. 2015;180:179–184. PubMed

Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry. 2003;64(6):663–667. PubMed

Bernstein EM, Putnam FW. Development, reliability, and validity of a dissociation scale. J Nerv Ment Dis. 1986;174(12):727–735. PubMed

Waller N, Putnam FW, Carlson EB. Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychol Methods. 1996;1(3):300–321.

Bob P. Dissociation processes and their measurement. Ceska Slov Psychiatr. 2000;96(6):301–309.

Ptacek R, Bob P, Paclt I. Dissociative experiences scale – Czech version [kála disociativních zkušeností – Česká verze] Cesk Psychol. 2006;50(3):262–272.

Wing JK, Curtis RH, Beevor AS. HoNOS: Health of the Nation Outcome Scales: Report on Research and Development July 1993–December 1995. London: Royal College of Psychiatrists; 1996.

Pec O, Cechova D, Pecova J, et al. HoNOS (Health of the Nations Outcome Scales) – An adaptation of the tool for the assessment of symptoms and social functions in serious mentally ill in the Czech conditions and its use. Ceska Slov Psychiatr. 2009;105(6–8):245–249.

Barnow S, Arens EA, Sieswerda S, Dinu-Biringer R, Spitzer C, Lang S. Borderline personality disorder and psychosis: a review. Curr Psychiatry Rep. 2010;12(3):186–195. PubMed

Weber K, Miller GA, Schupp HT, et al. Early life stress and psychiatric disorder modulate cortical responses to affective stimuli. Psychophysi-ology. 2009;46(6):1234–1243. PubMed

Korb AS, Hunter AM, Cook IA, Leuchter AF. Rostral anterior cingulate cortex activity and early symptom improvement during treatment for major depressive disorder. Psychiatry Res. 2011;192(3):188–194. PubMed PMC

Botvinick MM, Cohen JD, Carter CS. Conflict monitoring and anterior cingulate cortex: an update. Trends Cogn Sci. 2004;8(12):539–546. PubMed

Kerns JG, Cohen JD, MacDonald AW, 3rd, Cho RY, Stenger VA, Carter CS. Anterior cingulate conflict monitoring and adjustments in control. Science. 2004;303(5660):1023–1026. PubMed

Kerns JG, Cohen JD, MacDonald AW, 3rd, et al. Decreased conflict- and error-related activity in the anterior cingulate cortex in subjects with schizophrenia. Am J Psychiatry. 2005;162(10):1833–1839. PubMed

Friedel RO. Early sea changes in borderline personality disorder. Curr Psychiatry Rep. 2006;8(1):1–4. PubMed

National Collaborating Centre for Mental Health . Borderline Personality Disorder The NICE Guideline on Treatment and Management. Leicester and London: The British Psychological Society and The Royal College of Psychiatrists; 2009.

National Health and Medical Research Council . Clinical Practice Guideline for the Management of Borderline Personality Disorder. Melbourne: National Health and Medical Research Council; 2012.

Paton C, Crawford MJ, Bhatti SF, Patel MX, Barnes TR. The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK mental health services. J Clin Psychiatry. 2015;76(4):e512–e518. PubMed

Paris J, Black DW. Borderline personality disorder and bipolar disorder: what is the difference and why does it matter? J Nerv Ment Dis. 2015;203(1):3–7. PubMed

Ruggero CJ, Zimmerman M, Chelminski I, Young D. Borderline personality disorder and the misdiagnosis of bipolar disorder. J Psychiatr Res. 2010;44(6):405–408. PubMed PMC

Simpson EB, Yen S, Costello E, et al. Combined dialectical behavior therapy and fluoxetine in the treatment of borderline personality disorder. J Clin Psychiatry. 2004;65(3):379–385. PubMed

Herpertz SC, Zanarini M, Schulz CS, Siever L, Lieb K. Möller HJ; WFSBP Task Force on Personality Disorders; World Federation of Societies of Biological Psychiatry (WFSBP). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of personality disorders. World J Biol Psychiatry. 2007;8:212–244. PubMed

Basic symptoms of schizophrenia are related to symptoms of traumatic stress: A pivotal role of sensitization. An observational study

Psychometric Properties of the Independent 36-Item PID5BF+M for ICD-11 in the Czech-Speaking Community Sample