Lampe K, Konrad K, Kroener S, Fast K, Kunert HJ, Herpertz SC. Neuropsychological and behavioural disinhibition in adult ADHD compared to borderline personality disorder. Psychol Med 37: 1717-1729

Department of Psychiatry and Psychotherapy, RWTH Aachen, University Hospital, Rostock, Germany.
Psychological Medicine (Impact Factor: 5.94). 01/2008; 37(12):1717-29. DOI: 10.1017/S0033291707000517
Source: PubMed


Although attention-deficit/hyperactivity disorder (ADHD) is thought to be an inhibitory disorder, the question remains of how specific the inhibitory deficit is in adults and whether it distinguishes ADHD from borderline personality disorder (BPD), with which it shares several clinical features, particularly impulsiveness.
The study assessed various motor and cognitive inhibitory functions (inhibition of prepotent, ongoing and interfering responses) in addition to working memory in adult ADHD patients with and without BPD, compared to subjects with BPD alone and controls. In addition, questionnaire data on various aspects of impulsiveness and anger regulation were assessed in all groups.
ADHD patients performed worse than BPD individuals and controls in two inhibitory tasks: the stop signal task and the conflict module of the Attentional Network Task (ANT). In addition, they exhibited longer reaction times (RTs) and higher intra-individual variance in nearly all attentional tasks. The co-morbid group exhibited poor performance on the stop signal task but not on the conflict task. The BPD group barely differed from controls in neuropsychological performance but overlapped with ADHD in some behavioural problems, although they were less severe on the whole.
Impaired inhibition is a core feature in adults with ADHD. In addition, slow RTs and high intra-individual variance in performance may reflect deficits in the regulation of activation and effort in ADHD patients. ADHD and BPD share some symptoms of behavioural dysregulation without common cognitive deficits, at least in the attentional realm.

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    • "By measuring how reaction times are influenced by alerting cues, spatial cues, and flanking stimuli (a central arrow was flanked by two arrows pointing either in the same direction or in the opposite direction as the central arrow), the test measures the three attentional networks cited above. This task has determined that executive attention is impaired in adults with ADHD (see [36]), although other studies have shown no impairment [25]. Because a large body of data has shown that performance in this task is clearly related to different brain systems and regions that regulate attention, impairment can indicate physiological changes in brain functioning (see [31] [32]) that cannot be tapped by alterations on subjective measures such as questionnaires. "
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    ABSTRACT: Objective: Adults with attention deficit hyperactivity disorder (ADHD) display affective problems and impaired attention. Mood in ADHD can be improved by mindful awareness practices (MAP), but results are mixed regarding the enhancement of attentional performance. Here we evaluated MAP-induced changes in quality of life (QoL), mood, and attention in adult ADHD patients and controls using more measures of attention than prior studies. Methods: Twenty-one ADHD patients and 8 healthy controls underwent 8 weekly MAP sessions; 22 similar patients and 9 controls did not undergo the intervention. Mood and QoL were assessed using validated questionnaires, and attention was evaluated using the Attentional Network Test (ANT) and the Conners Continuous Performance Test (CPT II), before and after intervention. Results: MAP enhanced sustained attention (ANT) and detectability (CPT II) and improved mood and QoL of patients and controls. Conclusion: MAP is a complementary intervention that improves affect and attention of adults with ADHD and controls.
    BioMed Research International 07/2015; 2015. DOI:10.1155/2015/962857 · 3.17 Impact Factor
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    • "Issues regarding behavioral inhibition, including impulsiveness, aggressiveness, and substance use disorder seem distinctive to several disorders such as attention deficit hyperactive disorder (ADHD) and borderline personality disorder (BPD), which involve impaired neuropsychological functioning and emotional dysregulation (Lampe et al., 2007; Blum et al., 1997; Blum et al., 1995). Reif et al. (2006; 2009) have observed a polymorphic promoter dinucleotide repeat length variation of the NOS1 gene (NOS1 Ex1f-VNTR), which may potentially be related to clinical characteristics of impulsive behaviors (Reif et al., 2009). "
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    ABSTRACT: This paper serves to encourage quantum physicists to engage in psychiatric based research on the brain and its functions (i.e., consciousness, memory, attention). By using physics theorems such as Einstein's theory of relativity and the string theory, both physicists and geneticists alike may be able to elucidate potential links between components of the universe and their effects on the human brain. We have outlined some interesting posits including the cosmos' role in evolutionary biology, alpha bonding in biological molecules, and environmentally induced epigenetic effects on genetics. We also explore how physical forces can influence human memory, behavioral traits, and rates of addiction. Impulsiveness is used to exemplify how environmental changes can contribute to epigenetics and its hereditary alterations. We propose the idea of the presence of a "mental universe," where brain functionality like consciousness is a continuum of physically altered pathways. The realization that the universe and all of its precepts remains a mystery is reflected in the lack of a standardized "unified" physics theorem and mathematical equation that can explain universal dimensions (physical and mental), and as such, so is the complex nature of the functionality of the human brain. We provide herein a suggestion to remedy possible confusion, whereby we attempt to show the relationship of brain as a complex quantum-like organ and the impact of epigenetics on behavioral expression.
    NeuroQuantology 03/2015; 13(1). DOI:10.14704/nq.2015.13.1.799 · 0.54 Impact Factor
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    • "Studies show that despite their resemblance, these disorders are in fact distinct (Davids and Gastpar 2005; Philipsen 2006); ADHD differs from BPD mainly because it relies on inhibitory deficit (Nigg 2001; Lampe et al. 2007; Jacob et al. 2010). Furthermore, we previously compared aspects such as impulsiveness and anger among patients suffering from BPD, ADHD, and comorbid patients affected by both disorders, with the latter group showing higher aggression and substance abuse rates (Prada et al. 2014). "
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    ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is frequently comorbid with borderline personality disorder (BPD). However, few studies have examined how comorbid BPD-ADHD patients, treated or not with methylphenidate (MPH), respond to psychotherapy compared to non-comorbid BPD patients. In this perspective, we used a naturalistic study to compare, during a month-long intensive dialectical behaviour therapy (DBT), the clinical course of BPD patients and comorbid BPD-ADHD patients who were treated or untreated with MPH. Out of the 158 BPD patients recruited, 59 had adult ADHD as a comorbidity; among these, 29 underwent a treatment with MPH or des-methylphenidate, while the 30 others did not. MPH treatment was given non-randomly and only when ADHD was considered to be hampering the capacity of the subjects to follow the therapy. Patients completed the following forms upon admission and after 1 month of treatment: the adult ADHD Self-Report Scale (ASRS v.1.1), the Barratt Impulsiveness Scale (BIS-10), the State-Trait Anger Expression (STAXI), the Beck Depression Inventory II (BDI-II), and the Beck Hopelessness Scale. At baseline, comorbid BPD-ADHD patients showed significantly higher impulsiveness than BPD patients. In the entire sample, there was a significant decrease in all dimensions ranging from small to large effect sizes during the 4-week intensive DBT. BPD-ADHD patients who were undergoing MPH treatment showed a significantly improved response to DBT treatment for Trait-State Anger scores, motor impulsiveness, depression severity, and ADHD severity, when compared to those without stimulant medication. This study outlines the importance of systematically screening BPD patients for ADHD, since a MPH-based treatment will improve the symptoms of patients who are comorbid for BPD and ADHD. Due to the non-random allocation of subjects, more severely affected patients were more readily placed on MPH; this suggests that the more severe the ADHD symptoms, the greater the chance for the patient of being treated.
    ADHD Attention Deficit and Hyperactivity Disorders 01/2015; 7(3). DOI:10.1007/s12402-015-0165-2
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