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Serotonin, personality and borderline personality disorder



Serotonin is one of the neurotransmitters implicated in normal personality. Many psychobiological models of personality include some dimensions related to serotonin. For instance, the harm avoidance dimension of the biosocial model developed by Cloninger is related to serotonergic activity. Higher scores on the harm avoidance dimension should theoretically reflect increased serotonergic activity. However, correlation studies related serotonin activity to harm avoidance dimension have not yielded consistent findings. These controversial results are probably related to the complexity of the neurotransmitter systems, and the different assessment techniques used in these studies. Finally, recent genetic studies have examined the association between personality dimensions and serotonergic receptor polymorphisms with mixed results. Serotonin is not only related to some dimensions of normal personality. Several psychopathological disorders are associated with serotonergic dysfunction. More particularly, borderline personality disorder (BPD) can be defined by many of the symptoms associated with serotonergic dysregulation, including affective lability, suicidal behaviours, impulsivity and loss of impulse control. Indeed, several reports have demonstrated the efficacy of selective serotonin re-uptake drugs in treating the depressive and impulsive symptoms of patients with BPD. Moreover, some challenge studies have reported a lower serotonergic activity in BPD. Because these challenges are not specific, we have assessed the serotonergic activity in BPD with the flesinoxan challenge. Preliminary results showed that the prolactine responses to flesinoxan were significantly lower in BPD patients compared to those observed in controls.
Acta Neu ropsych iatri ca 200 2: 14: 66–70 Copyright CActa Neuropsy chiatrica 2 002
Printed in Denmark. All rights reserved ISSN 0924-2708
Serotonin, personality and borderline
personality disorder
Hansenne M, Pitchot W, Ansseau M. Serotonin, personality and M. Hansenne, W. Pitchot,
borderline personality disorder. M. Ansseau
Acta N europsychiatrica 2002: 14:66–70. CBlackwell Munk sgaard University of Lie
`ge, Department of Psychiatry, Lie
`ge, Belgium
Serotonin is one of the neurot ransmitters implicated in nor mal
per sona lity. M any psychobiological models of per sonality include
some dimensions related to seroton in. For inst ance, the ha r m
avoidance dimension of the biosocial model developed by Cloninger
is related t o sero tonergic activity. Higher scores on the har m
avoidance dimension should theoretically reflect increased
serotonergic activity. H owever, correlat ion stud ies related serotonin
activity to harm avoidance dimension have not yielded consistent
findings. T hese con troversial results are p robab ly related to t he
complexity of the neurotr ansmitter systems, and the different
assessment techniques used in these studies. Finally, recent genetic
studies have examined the association b etween personality
dimensions and serotonergic recept or polymor ph isms with mixed
results. Serotonin is not only related to some dimensions of normal
per sona lity. Several psychopat hological disorder s are associated
with serot oner gic dysfunct ion. M ore par t icularly, b orderline
per sona lity disord er (BPD ) can b e defined by ma ny of the
symptoms associated with serotonergic dysregulation, includ ing
affective lability, suicidal behaviour s, impulsivity and loss of
impulse cont rol. Indeed , several reports have demonstr a ted the
efficacy of selective serotonin re-uptake dru gs in t reating th e
depressive and impulsive sympt oms o f patients with BPD. M oreover, Keywords: serotonin; personality; borderline personality
some cha llenge studies have rep orted a lower seroto nergic act ivity disorder
in BPD. Because t hese cha llenges are n ot specific, we have assessed
Correspondence: Michel Hansenne PhD, University of Lie
the seroton ergic activity in BP D with t he flesinoxa n challenge. Department of Psychiatry, CHU Sart Tilman (B35),
Preliminar y result s showed tha t the prolactine responses to flesinoxan B-4000 Lie
`ge, Belgium.
were significantly lower in BPD pat ients compared to t hose Tel: 00 32 4 3667960; Fax: 00 32 4 3667283;
observed in controls. E-mail: Michel.Hansenne/
Serotonin is one of the neurotra nsmitt er s impli-
cated in no r m al personality. M a ny psychobiologi-
cal models of p er so nality includ e some dimensions
related to serotonin. For instance, in the Zucker-
man model of personality (1), the dimension of im-
pulsive unsocialized sensation seeking (ImpU SS) is
negatively cor related with serot oner gic d imension.
Again, the har m avoidance dimension of the bi-
osocial m odel d eveloped by Clo ninger (2) is related
66 cBlackwell Munksgaard, Acta Neu ropsy chiatr ica, 14 ,2,6670
to serotonergic activity. Serotonin is not only re-
lat ed t o some dimensions of normal person ality.
Several psychopath ological disorder s a re associ-
ated wit h serot onergic dysfunction. More par t icu-
larly, borderline personality disorder (BPD ) can be
defined by ma ny of the symptoms associated with
serotonergic dysregulation, including affective la-
bility, suicidal behaviours, impulsivity and loss of
impulse control. This review presents some recent
findings on serot onin, personality and BPD. M ore
particularly, t his review focuses on the bioso cial
Serotonin, personality and BPD
model of Cloninger and o n the flesinoxan chal-
lenge t est.
Serotonin and personality
Cloninger and colleagu es have proposed a bioso-
cial model of personality based on fou r temp era-
ments (novelty seeking, harm avoidance, reward
dependence and persistence) and three characters
(self-directedness, cooperativeness and self-tran -
scendence) (3). N ovelty seeking is defined as the
tendency to respond actively to novel stimuli lead-
ing to pursuit of rewards an d escape from punish-
ment. Harm avoidance corresponds to the
tendency toward an inh ibitor y response to signa ls
of aversive stimuli that lead to avoidance of pun-
ishment a nd non-reward. Reward dependence is
defined as the ten dency fo r a positive response to
signals of reward to mainta in or resist behavioural
extinctio n. Persisten ce is described in ter ms of per-
severance despite frustrat ion a nd fat igue. Self-di-
rectedness refers to the ability of a n individua l to
control, regulate and adap t his behaviou r to fit the
situation in accord with individua lly chosen goals
and values. Coo pera tiveness is for mulated to ac-
count for individual differences in ident ification
with and acceptance of other people. Self-tra n-
scendence is a charact er istic associated with spiri-
tuality, and refers generally to identification with
everything conceived as essential and con sequen-
tial parts of a unified whole. The temperament and
character inventory (TCI) is a 226-item self-ques-
tionnaire developed by Cloninger an d colleagues
to assess the seven dimensions o f person ality (4).
According t o this model, three o f the four tem-
peraments were associated with a specific central
neurotransmitter. Novelty seeking was theoretic-
ally associated to dop aminergic activity; ha r m
avoidan ce to serot onergic activity; and reward de-
pendence to noradren ergic activity. More par t icu-
larly, higher scores on the har m avoidance
dimension should theoretically reflect increased
serotonergic activity. This is directly suppor t ed by
the fact that an inverse relationship was noted be-
tween aggression and har m avoidan ce, as well as
between aggression and central 5-HT functioning
The relationship between harm avoidance and
serotonergic activity has been evaluated in several
studies. Pfohl et a l. (7) have described a higher
score of th e har m avoidance dimension in obsess-
ive-compulsive disorder (OCD) patients compared
to controls, but without any association between
this dimension and plat elet imipramine b inding. I n
another study, the score of the harm avoidance di-
mension was higher in a group of bulimic wo men
compared to nor ma l wom en, but t he whole blo od
serotonin levels were no t related to this dimension
(8). In t he study by L imson et al. (9) there were no
significant co rrelations between cerebro spina l fluid
concent rations of t he serotonin metabolite 5-hy-
droxyind oleacetic acid and har m avoidance scores.
However, given the complexity o f the neurotra ns-
mitter systems, these studies cannot be considered
as evidence against a relationship between sero-
tonergic activity and t he har m avoidance dimen-
sion. In cont rast, N elson and Cloninger (10) have
demonstrated that harm avoidance and reward de-
pendence scores were found to significantly predict
the response t o the 5-HT2 recepto r anta gonist and
5-HT reup take inhibito r an tidep ressant nefazo-
done in depressed patients. More recently, Gerra
et al. (11) foun d tha t harm avoidance scores cor re-
lated significantly with prolactin (PR L) response
to d-fenfluramine in healthy volunteers.
Recently, our group has developed a serotonergic
challenge test using flesinoxan (12). Flesinoxan is a
highly pot ent and selective 5-HT1A agonist in-
ducing a significant and dose-dependent release of
PRL and cortisol in normal subjects. In contrast,
depressed pat ients exhibited a blunt ed cortisol re-
sponse, and m ore p articula rly those with a history
of suicide a ttempts. F lesinoxan challenge was a
goo d ca n d id a t e to a ssess the relationship between
har m avoidance a nd serot onergic activity. In a fir st
study (13), we have reported a positive association
between the PRL response to flesinoxan a nd the
harm avoidance dimension in a group of depressed
patients. This result appears consistent in light of
the studies noted above. However, a major pitfall of
this study was the state dependence of harm avoid-
ance dimension in depression. Indeed, as harm
avoidance has been shown in this and other studies
(14,15) to correlate with the severity of depression,
the positive relationship between harm avoidance
and t he PRL respo nse to flesinoxan could b e due to
th e depressive sta tus. Therefore, th e same design h as
been carried out in a sample of non -depressed sub-
jects (16). This second study o stensibly replicat es
and extends t he first one (13) an d is consistent with
the results of G erra et al. (11)
However, an important limitation of these
studies is the selective effect of flesinoxan o n th e
5-HT1A recept ors. Ind eed, the pharmacologically
induced PR L response to flesinoxan is an indirect
ind ex of serot onergic neurotra nsmission a nd could
involve area s of the br a in not related with t h e neu-
ral substrat e of har m avoida nce hypot hesized by
Cloninger. M o reover, the lack o f a placebo-con-
trolled flesinoxan challenge limits th e conclusions
of this stud y. Th erefore, to examine exha ustively
the hypothesized link between har m avoida nce and
Hansenne et al.
serotonergic activity, futu re studies should be con-
ducted using agonist and antagonist serotonergic
agents in non-pa tient gro ups.
The association b etween serotonergic function
and harm avoidance dimension of the Cloninger
model wa s also investigated using genetic markers.
Indeed, recent genetic st udies have examined th e
association between personality dimensions and
serotonergic recepto r polymorphisms with mixed
results. No association was observed between indi-
viduals grouped by th e long a nd sho r t for ms of
the serotonin transporter gene and the personality
dimension of har m avoidan ce (17). In contra st, an
association between harm avoidance and the short
for m of the serotonin t ransporter gene (5-
HTTLPR) has been reported in another study
(18). In a recent stu dy, no con tribution of the 5-
HTR2a polymorphism on harm avoidance per son-
ality trait emerged (19).
Serotonin and BPD
BPD is defined in DSM -IV (20) as ‘a patter n of
instab ility in interpersonal relationships, self-im-
age, and affects, and mar ked imp ulsivity’. The syn-
drome of BPD may be classified into four groups
of symptoms: affective, impulsive, ego/inter p er-
sonal an d psychotic. Several of t hese symptom s are
associat ed with seroto nergic dysfunction, and
more particularly a ffective lability, suicida l behav-
iours and impulsive aggression. Based on this
sta tement , serotonin upt ake inhibitors were
studied openly in BPD pa tient s soon aft er the re-
lease o f flu oxetine. Th ree reports have demon-
strated t he efficacy of fluoxetine in treating the
depressive and impu lsive sympt oms of patients
with BPD (21–23). However, these stu dies were not
double-blind, which could lead to bias in collecting
the dat a. The first d oub le-blind, placebo-con-
trolled study conducted among a small group of
BPD pat ients demonstrated clear efficacy for
fluoxetine over placebo alo ng a number of dimen -
sions, including d epression, anxiety and global
function (24). The second controlled fluoxetine
study among BPD pat ients repo r ted improvemen t
in a number of symptoms, but this improvement
was not st atistically significant, except fo r ag-
gression against objects (25). In another contro lled
tr ial in 40 out -patients with personality disorders
including 13 with BPD, fluoxetine had a n anti-ag-
gressive effect on impulsive aggressive individuals
with personality disorder including BPD (26). I n
an open tr ial with sertr aline, significant redu ction
in irr itability and aggression were repor ted in BPD
(27). Significant improvement of BPD patients was
also reported with venlafaxine (28). H owever, more
con tro lled trials with larger patient po pulatio ns
are necessary to replicate these results.
Platelet studies have been carr ied out in BPD to
assess the serotonergic function in this disorder.
Platelet 5-HT was higher in patients with BPD
than in non-bord erline patients and nor mal con-
trols, and was positively correlated with the dispo-
sition to exp erience anger (29,30).
Another way to assess fur ther the role of th e 5-
HT function in BPD is the use of specific phar ma-
cological probes. Cocar ro et al. (5) administered
the non -specific 5-HT releaser/reupta ke b locker
fenfluramine to p atients with major depressive dis-
order s and/o r personality disorders including BPD
and foun d that PR L respo nse was blunted com-
pared to non -borderline perso nality disorder an d
normal control subjects, independent of the co-
morbidity o f major affective disord er. M oreover,
PR L response was negatively cor related with im-
pulsive aggression and with histor y of suicide
attempts. In contrast , M a r tial et al. [31] have re-
ported higher PRL response and lower cor tisol re-
sponse to fenflura mine in five BPD women
compa red to cont rols. Recently, Soloff et al. (32)
performed a st udy using positron-emission tomo-
grap hy (PET) during a fen flura mine challenge test
in BPD. Th e results shown tha t patients with BPD
have lower responses to serotonergic stimulation in
areas of prefrontal cortex, a region a ssociat ed with
regulation o f impulsive behaviour. Hollander et al.
(33) found higher cortisol levels and mar ginally
blunted PR L response to the partial 5-HT agonist
meta-chlorophenylpipera zine (m-CPP) in eight
male pat ients with BPD comp ared to contro ls.
However, the result s amon g women (four subjects)
are no t significant. This gender difference, as no ted
by the a uthors, might b e attr ibut able t o circulat ing
ovarian hormones. The authors also reported that
m-CPP ind uced a distinctive spacy (deper sona l-
ized/deua lized) and high (euph oric) behavioural
reaction in the p atients. The same group found in
a larger samp le of BPD patients a significant as-
sociation between th e presence of a spacy and high
behavioural response to m-CP P and increased
PR L and cortisol peak on m-CPP challenge (34).
In anot her study with m-CPP, women with a BPD
diagnosis had PRL and cor tisol blunted responses
to this cha llenge (35). Fu r thermo re, these aut hors
repor ted a significan t negat ive correlation between
delta peak PRL values and abuse characteristics,
such as the severity and duration of physical and
sexual abuse. They conclud ed tha t the a ltera tion
of t he serotonergic system was probably no t re-
lated to t he BPD diagnosis per se,buttosustained
traumatization during childhood.
Serotonin, personality and BPD
Since these cha llenges are not specific, we have
assessed the serotonergic activity in BPD with the
flesinoxan ch allenge test. Th is preliminary stud y
was con ducted among 20 BPD pat ients (14
women) with a mean age of 30.5 years (SD 10.2)
and 20 healthy volun teers matched for gender with
a m ean age o f 37. 9 year s (SD 9.6). The age differ-
ence between the two group s was significant (Z
ª2.27, P0.02). T he diagnosis of BPD was
based on the D SM -IV criteria and on the self-
questionnaire from t he Str uctured C linical Inter-
view for DSM -III Axis II (SCID -II ). According
the D SM -IV cr iteria, 16 BPD patients had a cur-
rent diagno sis of major depressive disorder, and
four had a n eating disorder. The patients were free
of medication at least 2 weeks before th e challenge.
Because of th e influence of oestrogen on the pro -
lactin levels during t he men strual cycle, th e flesi-
noxa n challenge test was perfo r med between the
third a nd the 12th day of the menstrual cycle. The
Ethical Committee of the University of Lie
Medical School approved the protocol and all sub-
jects gave their informed consent. There was a sig-
nifica nt d ifference bet ween BP D p at ients (40627
21042 mIU min/mL) and healthy volunteers
(75546 46612 mIU min/mL) for PRL respon se to
flesinoxan (Zª2.92, P0.003). Among the
BPD patients, PR L response to flesinoxa n was
lower in patients with pa st history of suicide
attempts (N8) comp ared to patients with a nega-
tive history (Pª3.04, P!0.002). Because flesi-
noxa n stimulates specifically the 5-H T1A
postsynaptic receptors, these results suggest tha t
BPD patients are character ized by lower 5-HT 1A
recept or sensitivity. Overall, th is stud y is consistent
with previous studies that have reported lower
PRL response to serotonergic challenge tests.
Some limita tions o f the study should be ack nowl-
edged. F irst, the lack of a placebo-contro lled fles-
inoxan challenge limits the conclusions of this
stu dy. Anot her imp ortant limitatio n of this stud y
is the use of a self-repor t questionnaire t o assess
Axis II d iagnoses. G iven the complexity of person-
ality pat hology, a structu red interview schedule
would have been preferable. Th e comorbidity be-
tween Axis II and Axis I diagn ostic limits also the
con clusions. T he PR L blunted resp onse obser ved
among BPD pa tient s could be due t o the co -
morbidity o n Axis I, a nd more particular ly with
major depressive disorder. However, some studies
have reported t hat PR L response to flesinoxan did
not differ between depressed pa tient s and con trols,
but that PRL response was lower in a subgroup
of depressed patients characterized by past suicidal
history (36). A final limitat ion is the lack of beha -
vioural assessment fo r impulsivity, irritability.
Ta ke n t o get h er , t h e d a t a r ep o r t ed a bo ve su p p o r t t h e
implication of serotonin in b oth nor ma l an d dis-
ordered personality. More specifically, serotonergic
activity is related with t he har m avoida nce dimen-
sion of the model developed by Clonin ger. H owever,
some resu lts are not consist ent with t his relation-
ship. T his may indica te that the relatio n bet ween
serotonin and ha r m avoidance is indirect, with the
contribution of other neurot ransmitt er systems. An
alter native hypo thesis is the heterogeneity of the
subjects included in these studies an d the different
tolls for serotonin assessment. Co ncerning BPD, t he
results reported here show a major implication of
th e serotonergic function in the aet iology of th is dis-
order and are consistent with previou s studies which
linked lower seroto nergic activity and impulsivity.
These findings provide interesting track fo r the
pharmacological treatment of this dramatic dis-
order. However, more controlled studies with larger
patients populations are necessary to replicate the
results of existing research.
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... Serotonin or 5-hydroxytryptamine (5-HT) is a monoamine, widely regarded as a key neurotransmitter implicated in the development of normal personality (Hansenne et al., 2002). Its biological function is complex and multifaceted (Young, 2007); however key personality traits such as impulsivity and impulsive aggression, common in patients with borderline personality disorder, have been shown to be associated with reduced serotonergic responsiveness (Coccaro et al., 2015). ...
BACKGROUND Borderline Personality Disorder (BPD) is a psychiatric disorder associated with significant morbidity and mortality. However, the neurobiological alterations underlying the condition remain poorly understood. As a result, existing treatments remain inadequate. One of the main risk factors for the development of BPD is a history of childhood maltreatment. However, it is considered neither causative nor specific to the condition. Current theory is therefore increasingly moving toward a ‘Gene x Environment’ (GxE) model of the condition. The purpose of the current work was to conduct a systematic literature review, which comprehensively identifies all published molecular level GxE studies that have explored the role of specific genetic loci, in influencing the risk of BPD following exposure to childhood abuse or neglect. METHODS Four electronic databases were used to systematically search for molecular level GxE studies of any design, which focused on the development of BPD following exposure to childhood abuse or neglect, without language or date restrictions. Articles were screened independently by two reviewers and results were synthesised narratively. RESULTS A total of 473 articles were screened of which sixteen were selected for inclusion in our review. Implicated genes were categorised according to their influence on; Neurotransmitter Systems, Neurodevelopment and Neuroendocrine Systems. CONCLUSIONS The identified studies have produced several relevant and statistically significant results. Of particular note, is the repeated finding that genes involved in HPA axis regulation, may be altered by exposure to childhood maltreatment, influencing subsequent susceptibility to BPD. This is both biologically plausible and of potential clinical significance.
... However, some authors suggest that both standing alert (Vicens-Costa et al., 2011) and locomotion Van Reenen et al., 2004) might be measures of coping strategy rather than level of fear. Serotonin has been implicated in mechanisms involved in personality in humans (Hansenne et al., 2002) and from our results this might be true for pigs as well: here we hypothesize that serotonin could be related to either coping strategy or fearfulness, i.e. the "propensity to experience fear or anxiety" . The coherent relation between 5-HT measures in brain and blood, and the behaviours exploration, standing alert and locomotion, does support a possible role for serotonin particularly in the pig's fearfulness. ...
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PhD Thesis. Tail biting in pigs, i.e. the chewing on and biting in tails of conspecifics, is a multifactorial problem leading to impaired pig welfare and health and economic losses in pig farming. In many countries tail docking is used as a preventive measure, but there is increased societal concern about this practice. Therefore, there is an urgent need to understand, prevent, and reduce tail biting and other damaging behaviours directed at pen mates. The main aim of this thesis was to identify biological characteristics of barren and enriched housed pigs that relate to their tendency to develop these damaging oral manipulative behaviours. Tail biting started already early in life and pigs that displayed tail biting post-weaning seemed to stem from litters in which tail biting behaviour was already present. The onset of tail biting behaviour was different for individual pigs, and many pigs were not consistently tail biters throughout different phases of life. It was difficult to predict which pigs would develop tail biting based on their individual behaviour. Groups of pigs with tail biting problems were, however, more easy to identify by increased activity, and increased levels of pig and pen-directed oral manipulative behaviours. Subjecting pigs to an individual behavioural test showed that tail biters may be more fearful. Fearfulness in pigs appeared related to measures of the brain and blood serotonergic system. Moreover, measures of the blood serotonergic system seemed temporarily altered in tail biting pigs mainly during the phase of life in which they displayed this behaviour. Additionally, (tail) biting behaviour may be associated with higher (phenotypic and genotypic) production, such as higher growth. Growth of individual pigs can be affected by the other pigs in a pen. The heritable effect of one pig on the growth of another group member is referred to as an indirect genetic effect. Pigs with a relatively negative indirect genetic effect for growth displayed more biting behaviours, caused more tail damage and destroyed more of the available jute sacks. The presence of strawbedding or jute sacks as enrichment materials for rooting and chewing largely reduced damaging biting behaviours and, consequently, tail damage. Pigs that still develop tail biting behaviour in an enriched environment likely do so due to a (temporary) physiological problem, whereas in barren housed pigs the lack of suitable rooting and chewing material plays a large role. Tail biting behaviour in pigs thus seems to be caused by a variety of temporary states and more stable traits that influence their motivation to display foraging and exploratory behaviours. Therefore, the tale of (tail) biting behaviours in pigs needs a better understanding of underlying physiological processes. Preventing and reducing damaging biting behaviours in pigs requires a joint effort of science, industry and society to optimize housing conditions, feeding, management and breeding of pigs.
... However, some authors suggest that both standing alert [85] and locomotion [90,91] might be measures of coping strategy rather than level of fear. Serotonin has been implicated in mechanisms involved in personality in humans [92] and from our results this might be true for pigs as well: here we hypothesize that serotonin could be related to either coping strategy or fearfulness, i.e. the "propensity to experience fear or anxiety" [80]. The coherent relation between 5-HT measures in brain and blood, and the behaviours exploration, standing alert and locomotion, does support a possible Table 5 Relations a between pig blood-brain 5-HT parameters measured at 13 and 19 weeks of age respectively, and behaviour in during exposure to a novel object (NOe) at 11 weeks of age. ...
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Abstract in proceedings. Proceedings of the 46th Congress of the International Society of Applied Ethology, 31 July-4 August 2012, Vienna, Austria : Quality of Life in Designed Environments
... However, some authors suggest that both standing alert [85] and locomotion [90,91] might be measures of coping strategy rather than level of fear. Serotonin has been implicated in mechanisms involved in personality in humans [92] and from our results this might be true for pigs as well: here we hypothesize that serotonin could be related to either coping strategy or fearfulness, i.e. the "propensity to experience fear or anxiety" [80]. The coherent relation between 5-HT measures in brain and blood, and the behaviours exploration, standing alert and locomotion, does support a possible Table 5 Relations a between pig blood-brain 5-HT parameters measured at 13 and 19 weeks of age respectively, and behaviour in during exposure to a novel object (NOe) at 11 weeks of age. ...
Pigs differ in their behavioural responses towards environmental challenges. Individual variation in maladaptive responses such as tail biting, may partly originate from underlying biological characteristics related to (emotional) reactivity to challenges and serotonergic system functioning. Assessing relations between behavioural responses and brain and blood serotonin parameters may help in understanding susceptibility to the development of maladaptive responses. The objective of the current study was, therefore, to assess the relationship between the pigs' serotonergic parameters measured in both blood and brain, and the behaviour of pigs during a novelty test. Pigs (n=31) were subjected to a novelty test at 11 weeks of age, consisting of 5-min novel environment exposure after which a novel object (a bucket) was introduced for 5 min. Whole blood serotonin, platelet serotonin level, and platelet serotonin uptake were determined at 13 weeks of age. Levels of serotonin, its metabolite and serotonin turnover were determined at 19 weeks of age in the frontal cortex, hypothalamus and hippocampus. The behaviour of the pigs was different during exposure to a novel object compared to the novel environment only, with more fear-related behaviours exhibited during novel object exposure. Platelet serotonin level and brain serotonergic parameters in the hippocampus were interrelated. Notably, the time spent exploring the test arena was significantly correlated with both platelet serotonin level and right hippocampal serotonin activity (turnover and concentration). In conclusion, the existence of an underlying biological trait - possibly fearfulness - may be involved in the pig's behavioural responses toward environmental challenges, and this is also reflected in serotonergic parameters.
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Concerns about child sexual abuse within the family environment were raised by the Office of the Children’s Commissioner’s (OCC) Inquiry into child sexual exploitation in gangs and groups. This found that: …so many young people told us…of their early histories of being sexually abused within the family home and of their experiences never being acknowledged (Berelowitz, Clifton, Firmin, Gulyurtlu and Edwards, 2013, p.96). This prompted the OCC to commit to a new two year Inquiry into child sexual abuse within the family environment, for which this report forms the evidence base. What is child sexual abuse within the family environment? Child sexual abuse within the family environment is: Child sexual abuse perpetrated by a family member or that takes place within a family context or environment, whether or not by a family member. This is a broad definition, in accordance with Crown Prosecution Service Guidelines (2013) on the Sexual Offences Act 2003, which states: These offences reflect the modern family unit and take account of situations where someone is living within the same household as a child and assuming a position of trust or authority over that child, as well as relationships defined by blood ties, adoption, fostering, marriage or living together as partners. In much of the research assessed by this work, child sexual abuse within the family environment is referred to as ‘intrafamilial’ (IFCSA). For consistency, this report also uses the term ‘intrafamilial’ and the acronym IFCSA in presenting and discussing research evidence. How this research was conducted This research was focused around three questions: 1. What is known about the nature, scale, scope and impact of intrafamilial child sexual abuse or child sexual abuse linked to the family environment? Where do the gaps in knowledge lie? 2. What is known from the evidence about child protection and other action in response to victims of intrafamilial child sexual abuse or child sexual abuse linked to the family environment? Where are the gaps in these approaches? 3. What are the implications of the above when considering child protection activity and any legislative or formal guidance required to tackle intrafamilial child sexual abuse or child sexual abuse linked to the family environment? In order to answer these questions, we used a method known as rapid evidence assessment (REA). This is a tool for synthesising the available research evidence on a policy issue as comprehensively as possible, within the constraints of a given timetable.
Objective Schizophrenia (SCZ) and bipolar disorder (BD) are common psychotic disorders, which show some overlaps in genetic aetiology. Researchers have conducted a number of studies to investigate the relationship between SCZ and the 1354C/T genetic polymorphism of 5-hydroxytryptamine receptor 2A (HTR2A–1354C/T), as well as the associations between BD and the HTR2A–1354C/T polymorphism. However, the results were conflicting. To provide a more robust estimate about the effects of the HTR2A–1354C/T polymorphism on the risk of these two psychotic disorders, we performed this meta-analysis.Methods We used the pooled odds ratios (ORs) with 95% confidence intervals (95% CIs) to investigate the relationships between SCZ and the 1354C/T polymorphism of HTR2A, as well as the associations between BD and HTR2A–1354C/T. Publication bias was tested by Begg's test and inverted funnel plot, and heterogeneity was checked by Cochran's Q statistic and the inconsistency index (I 2).Results Eight studies were concerned with SCZ, analysing a cumulative total of 2953 cases and 3153 controls; six papers studied BD, using a total of 923 cases and 928 controls. There was no significant association found between HTR2A–1354C/T and SCZ in the overall population (T allele vs. C allele, OR = 1.035, 95% CI 0.912–1.175, p = 0.596) or in the subgroups Caucasian population and Asian population. Moreover, there was no significant association between the HTR2A–1354C/T polymorphism and BD in the overall population (T allele vs. C allele, OR = 1.038, 95% CI = 0.607–1.772, p = 0.892).Conclusion On the basis of these results, the HTR2A–1354C/T polymorphism is unlikely to be a risk factor for SCZ and BD.
Yi-gan san (YGS, yokukan-san in Japanese) was developed in 1555 by Xue Kai as a remedy for restlessness and agitation in children. Prompted by the increasing life expectancy of the Japanese population, geriatricians have begun to use this traditional regimen for behavioral and psychological symptoms of dementia in the elderly. Moreover, we reported that YGS therapy is a well-tolerated and effective remedy that improves the symptoms of borderline personality disorder and neuroleptics induced tardive dyskinesia. In a pilot investigation, we administered YGS as an open-label adjunct to antipsychotic medication to patients with treatment-resistant schizophrenia. The present review summarizes the available data supporting the clinical testing of YGS for psychiatric disorders. In addition, we extend our discussion to the potential applications of YGS for combining this treatment with cellular and molecular therapy.
Background In bulimia nervosa (BN), borderline personality disorder (BPD) and major depression (MDD) are frequently comorbid conditions. Executive function has been found to be impaired in BPD and MDD, but the impact of comorbidity on neuropsychological function has rarely been investigated. Objective To investigate neuropsychological function in BN with a focus on comorbid BPD and MDD. Methods One hundred forty-four medication-free female patients entering a study of psychological treatments for BN performed a brief battery of neuropsychological tests. Comorbid MDD and BPD were systematically identified using standard interviews. Neuropsychological test results were compared. Results Forty-one subjects had comorbid BPD and 35 had comorbid MDD, while 15 had both. There was no effect of comorbid MDD, but there was a significant effect of BPD and a significant interaction between the diagnosis of MDD and BPD on executive tasks (trail making and Stroop). Thus, compared with subjects without BPD, subjects with BPD performed significantly worse on tests of executive function, while the group with both comorbidities performed even worse. Conclusions There appears to be an additive effect of BPD and MDD resulting in impaired executive neuropsychological function. Future studies on either disorder and on BN should examine and account for the effect of comorbidity.
The Correctional Service of Canada (CSC) has received international praise for its new policies with female prisoners serving federal sentences of two or more years. Regarded as progressive, even radical, other countries have looked toward Canada for inspiration in the design of their own policies [Carlen, (2002) Criminal Justice 2(2)]. CSC’s “women-centered” mental health agenda, however, while rhetorically progressive, remains consistent with disciplinary processes which prioritize self-regulation and aim to correct or normalize those considered failed citizens [Kemshall, (2002), The Howard Journal 41(1), 41–58]. Using Nicolas Rose’s concept of governance through self-regulation [Rose 1991, b Rose (1996). Inventing Ourselves: Psychology, Power and Personhood. Cambridge: Cambridge University Press; Rose (2000). British Journal of Criminology 40, 321–339] as a theoretical framework, we argue that correctional mental health practices privileges a psychological discourse which serves to regulate women prisoners as opposed to empowering or supporting them. We examine the over use of psychiatric labelling of women, such as that of Boderline Personality Disorder, and the resulting treatment regime, Dialectical Behavior Therapy, to illustrate that the CSC has constructed women prisoners as disorderly and disordered and thus in need of taming. This discussion is followed by recommendations for new directions in feminist mental health treatment for women in prison that more adequately confront the inherent tensions and contradictions of prison therapeutic services and that incorporate multi-faceted understandings of the mental health needs of women offenders. We conclude with some policy and research implications of adopting a feminist informed mental health correctional strategy.
• Dysfunction of the central serotonergic system has been variously associated with depression and with suicidal and/or impulsive aggressive behavior. To evaluate central serotonergic function in relation to these variables, prolactin responses to a singledose challenge with fenfluramine hydrochloride (60 mg orally), a serotonin releasing/uptake-inhibiting agent, were examined in 45 male patients with clearly defined major affective (n = 25) and/or personality disorder (n 20) and in 18 normal male control patients. Prolactin responses to fenfluramine among all patients were reduced compared with responses of controls. Reduced prolactin responses to fenfluramine were correlated with history of suicide attempt in all patients but with clinician and selfreported ratings of impulsive aggression in patients with personality disorder only; there was no correlation with depression. These results suggest that reduced central serotonergic function is present in a subgroup of patients with major affective and/or personality disorder and is associated with history of suicide attempt in patients with either disorder, but with impulsive aggression in patients with personality disorder only.
In this study, we describe a psychobiological model of the structure and development of personality that accounts for dimensions of both temperament and character. Previous research has confirmed four dimensions of temperament: novelty seeking, harm avoidance, reward dependence, and persistence, which are independently heritable, manifest early in life, and involve preconceptual biases in perceptual memory and habit formation. For the first time, we describe three dimensions of character that mature in adulthood and influence personal and social effectiveness by insight learning about self-concepts. Self-concepts vary according to the extent to which a person identifies the self as (1) an autonomous individual, (2) an integral part of humanity, and (3) an integral part of the universe as a whole. Each aspect of self-concept corresponds to one of three character dimensions called self-directedness, cooperativeness, and selftranscendence, respectively. We also describe the conceptual background and development of a self-report measure of these dimensions, the Temperament and Character Inventory. Data on 300 individuals from the general population support the reliability and structure of these seven personality dimensions. We discuss the implications for studies of information processing, inheritance, development, diagnosis, and treatment. (Arch Gen Psychiatry. 1993;50:975-990)
• Alcoholics as a group have been consistently reported to show differences from controls on various personality-inventories. Moreover, neurobiologic substrates have been postulated to underlie personality dimensions. Therefore, we compared alcoholics with controls on measures of personality and investigated relationships between measures of personality and cerebrospinal fluid monoamine metabolite concentrations. The alcoholics were significantly different from controls on many personality measurements. There were significant, negative correlations between interview-derived lifetime aggression scores and cerebrospinal fluid concentrations of both the serotonin metabolite 5-hydroxyindoleacetic acid and the dopamine metabolite homovanillic acid. However, there were no significant correlations between any cerebrospinal fluid monoamine metabolite concentrations and scores on personality inventories.
Background: Evidence of an inverse relationship between central serotonergic (serotonin [5-hydroxytryptamine]) system function and impulsive aggressive behavior has been accumulating for more than 2 decades. If so, pharmacological enhancement of serotonin activity should be expected to reduce impulsive aggressive behavior in subjects in whom this behavior is prominent.Methods: A double-blind, placebo-controlled trial of the selective serotonin-uptake inhibitor fluoxetine hydrochloride was conducted in 40 nonmajor-depressed, nonbipolar or schizophrenic, DSM-III-R personality—disordered individuals with current histories of impulsive aggressive behavior and irritability. Measures included the Overt Aggression Scale—Modified for Outpatients, Clinical Global Impression Rating of Improvement, and several secondary measures of aggression, depression, and anxiety.Results: Fluoxetine, but not placebo, treatment resulted in a sustained reduction in scores on the lrritability and Aggression subscales of the Overt Aggression Scale—Modified for Outpatients that was first apparent during months 2 and 3 of treatment, respectively. Fluoxetine was superior to placebo in the proportion of "responders" on the Clinical Global Impression Rating of Improvement: first at the end of month 1, and then finally demonstrating a sustained drug-placebo difference from the end of month 2 through the end of month 3 of treatment. These results were not influenced by secondary measures of depression, anxiety, or alcohol use.Conclusion: Fluoxetine treatment has an antiaggressive effect on impulsive aggressive individuals with DSM-III-R personality disorder.
22 patients with borderline or schizotypal personality disorder or both participated in a 12-wk trial of fluoxetine. There were significant reductions in self-injury and in scores on the Hopkins Symptom Checklist regardless of diagnosis. Controlled trials of fluoxetine and investigations of the serotonergic system in these disorders would be useful. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Self-directed aggression, whether in the form of non-suicidal self-mutilation or suicidal behavior, is a prominent feature of personality disorders. We hypothesized that self-injurious behavior, like suicidal behavior, represents a form of self-directed aggression, and may, like suicidal behavior and impulsive aggression, be associated with a decrease in central serotonin function in personality disorder patients. Ninety-seven patients with DSM-III personal ity disorder underwent d,l-fenfluramine challenge as an assessment of serotonergic activity. Patients with a history of self-mutilation or suicide had blunted prolactin and cortisol responses to d,l-fenfluramine compared to those with neither, and those with both had the most blunted responses to fenfluramine. These data raise the possibility that the central 5-HT abnormality, previously associated with suicidal behavior, may be associated with self-directed violence and not necessarily specifically with suicidal intent.