An interventional study of fMRI - Stroop task and fMRI - MID task in Emotional Instability Personality Disorder (Borderline Personality Disorder), Attention Deficit Hyperactivity Disorder and Healthy Controls, sponsored by Karolinska Institutet. Status unknown. Open to female participants aged 16 Years to 18 Years, including healthy volunteers. Per ClinicalTrials.gov, last updated 2016-06-14.
Sponsored by Karolinska Institutet · Not applicable, Interventional, and Basic science
The purpose of this study is to investigate how emotional and non-emotional regulation processes differ in EIP patients (with different levels of ADHD symptoms/ADHD-comorbidity) compared to controls. The investigators will test these participants' abilities to regulate emotional and non-emotional processes, reward anticipation and reward receipt while they undergo functional magnetic resonance imaging (fMRI). The participants' motor inhibition capacity on a behavioral level will also be investigated.
The hypothesis is that EIP patients will present with more deficits in emotion regulation processes compared to controls, even when controlling for ADHD symptoms. It is also hypothesized that higher levels of ADHD symptoms will correlate with dysfunctional non-emotional regulation processes, on a behavioral as well as brain mechanistic level.
Background: Comorbidity of Emotional Instability Personality Disorder (EIP) and Attention Deficit Hyperactivity Disorder (ADHD) is common, and the two patient groups partially exhibit similar problems. The main hypothesis is that the two disorders are mechanistically related. The investigators believe that the mechanisms underlying the problems are linked to two parallel regulating systems in the brain. Here, prefrontal and anterior cingulate systems are in focus. The first system - including the dorsolateral prefrontal cortex (dlPFC) and the caudal anterior cingulate cortex (cACC) - regulates non-emotional (and exteroceptive) information. The other system - including the lateral orbitofrontal prefrontal cortex (lObfc) and rostral anterior cingulate cortex (rACC) - regulates emotional (and interoceptive) information. The hypothesis is that the non-emotional/exteroceptive regulatory system is more affected in ADHD, while the emotional/interoceptive regulatory system is more affected in EIP.
Aims: The aim of this study is to differentiate between dysfunctional emotional regulation processes related to emotional instability symptoms (when controlling for non-emotional ADHD-like symptoms), and dysfunctional non-emotional regulation processes related to ADHD symptoms (when controlling for emotional instability symptoms).
Procedure:
Behavioral task: Stop Signal Task: measures participant's ability to inhibit a motor response. Outcome measures are Stop Signal Reaction Time (SSRT) and Go Reaction Time (GoRT)
fMRI task 1: Stroop task. Divided into 2 sessions of 10 minutes with 2 blocks in each. There are two types of blocks: Emotional Stroop task blocks (happy or fearful faces, with the word "HAPPY" or "FEAR" written across them) and Neutral Stroop task blocks (neutral faces of men and women with the word "MAN" or "WOMAN" written across them). Every other block is Emotional and every other is Neutral (balanced order between participants) so that each participant performs two emotional blocks and two neutral blocks. The task is to decide what emotion or gender is shown in the picture and ignore the word. Responses are made using a button box and reaction time is recorded for all the trials. Blood Oxygen Level Dependent (BOLD) signal is recorded in the brain during the task. Outcome measures are reaction times for the different trial types (incongruent(I) and congruent(C), also order dependent) as well as BOLD signal during these different types of trial.
fMRI task 2: Monetary Incentive Delay task (MID). Divided into 2 session of 10 minutes. Reward task in which the participant may win money (0 Swedish kronor (SEK), 10 SEK or 50 SEK in each trial). There is an anticipation phase in each trial, a response cue during which the participant needs to press a button as fast as she can, and an outcome phase in which feedback is presented of whether the participant has won the anticipated money or not. Outcome measures are BOLD activation during the anticipation phases of different levels of reward, and BOLD activation during the receipt/outcome phase of the different levels of reward. Reaction times for the different reward levels are also recorded.
The overall step-by-step procedure for each participant:
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Additional inclusion criteria EIP patients:
≥4/9 criteria of DSM-IV, measured by SCID-II interview
Exclusion Criteria:
Patients from the DBT unit suffering from symptoms of Emotional Instability (n=30), with different levels of ADHD symptoms as assessed by questionnaires Brown-ADD, ASRS and SDQ. Interventions: * fMRI - Stroop task * fMRI - MID task * Stop Signal task * Structural T1 MRI scan * Structural T2 MRI scan * DTI MRI scan * Resting state MRI scan * FEFA 2 * SCID-II * SDQ * ASRS * AQ * TAS-20 * Raven's SPM * Reading ability * Ishihara's tests for colour deficiency * Additional questionnaire * Brown-ADD * MFQ * STAI-T * BIS * DAWBA * STAI-S * Sleepiness rating x 6 * Motivation rating x 6
Other: fMRI - Stroop task · Other: fMRI - MID task · Behavioral: Stop Signal Task · Other: SCID-II · Other: SDQ · Other: ASRS · Other: AQ · Other: TAS-20 · Other: Raven's SPM · Other: Reading ability · Other: Ishihara's tests for colour deficiency · Other: Additional questionnaire · Other: Brown-ADD · Other: MFQ · Other: STAI-T · Other: BIS · Other: DAWBA · Other: STAI-S · Other: Sleepiness rating · Other: Motivation rating · Behavioral: FEFA2 · Other: Structural T1 MRI scan · Other: Structural T2 MRI scan · Other: DTI MRI scan · Other: Resting state MRI scan
Matched healthy controls (according to age, IQ and socio economic status) recruited from high schools in Stockholm area (n=30). Interventions: * fMRI - Stroop task * fMRI - MID task * Stop Signal task * Structural T1 MRI scan * Structural T2 MRI scan * DTI MRI scan * Resting state MRI scan * FEFA 2 * SCID-II * SDQ * ASRS * AQ * TAS-20 * Raven's SPM * Reading ability * Ishihara's tests for colour deficiency * Additional questionnaire * Brown-ADD * MFQ * STAI-T * BIS * DAWBA * STAI-S * Sleepiness rating x 6 * Motivation rating x 6
Other: fMRI - Stroop task · Other: fMRI - MID task · Behavioral: Stop Signal Task · Other: SCID-II · Other: SDQ · Other: ASRS · Other: AQ · Other: TAS-20 · Other: Raven's SPM · Other: Reading ability · Other: Ishihara's tests for colour deficiency · Other: Additional questionnaire · Other: Brown-ADD · Other: MFQ · Other: STAI-T · Other: BIS · Other: DAWBA · Other: STAI-S · Other: Sleepiness rating · Other: Motivation rating · Behavioral: FEFA2 · Other: Structural T1 MRI scan · Other: Structural T2 MRI scan · Other: DTI MRI scan · Other: Resting state MRI scan
2 x 10 minutes Stroop task (2 x 5 minutes emotional blocks, 2 x 5 minutes non-emotional blocks, order balanced across participants) performed during fMRI scan. See Detailed Study Description.
2 x 10 minutes MID task performed during fMRI scan. See Detailed Study Description.
Performed at a computer at first visit, 10 minutes divided into 3 blocks. See Detailed Study Description.
See Detailed Study Description.
See Detailed Study Description.
See Detailed Study Description.
See Detailed Study Description.
See Detailed Study Description.
See Detailed Study Description.
See Detailed Study Description.
See Detailed Study Description.
including questions about somatic disease, current medication, BMI, smoking habits, first menstruation, last menstruation's first day, days without active oral contraceptive pill during last month, claustrophobia, vision impairment.
See Detailed Study Description.
See Detailed Study Description.
See Detailed Study Description.
See Detailed Study Description.
See Detailed Study Description.
See Detailed Study Description.
Acquired 6 times while in MRI-scanner. See Detailed Study Description.
Acquired 6 times while in MRI-scanner. See Detailed Study Description.
Assessing ability to recognise emotional face, performed at a computer at first visit. See Detailed Study Description.
See Detailed Study Description and Outcome Measures.
See Detailed Study Description.
See Detailed Study Description and Outcome Measures.
See Detailed Study Description and Outcome Measures.
fMRI BOLD signal differences between groups - in Stroop task
BOLD signal Neutral and Emotional blocks, and for Congruent and Incongruent trials (order dependent)
Time frame: Acquired during fMRI scan
fMRI signal variations within patient group during Stroop task, depending on level of ADHD symptoms - in Stroop task
BOLD signal Neutral and Emotional blocks, and for Congruent and Incongruent trials (order dependent)
Time frame: Acquired during fMRI scan
Reaction times in Stroop task
Time frame: Acquired during fMRI scan
fMRI BOLD signal differences between groups - in Monetary Incentive Delay task (MID)
BOLD signal during anticipation phase of different levels of reward, and BOLD signal during receipt/outcome phase of different levels of reward.
Time frame: Acquired during fMRI scan
fMRI BOLD signal differences within patient group during MID task, depending on level of ADHD symptoms - in MID task
BOLD signal during anticipation phase of different levels of reward, and BOLD signal during receipt/outcome phase of different levels of reward.
Time frame: Acquired during fMRI scan
Reaction times in MID task
Time frame: Acquired during fMRI scan
Stop Signal reaction times (SSRT) from Stop Signal Task (SST)
Time frame: Data necessary for estimation of SSRT acquired during fMRI scan
Brown-ADD score
Time frame: Acquired from questionnaire at first visit
Mood and Feelings questionnaire
dimensional measurement of depressive symptoms
Time frame: Acquired from questionnaire at first visit
STAI-T score
Measuring anxiety trait level
Time frame: Acquired from questionnaire at first visit
Barratt's impulsivity scale (BIS)
Time frame: Acquired from questionnaire at first visit
STAI-S score
Measuring anxiety state level
Time frame: Baseline, acquired from questionnaire Day 2
Sleepiness score
Acquired 6 times in MRI scanner as follows: 1) Before first Stroop session. 2) Between Stroop session 1 and 2. 3) After Stroop session 2. 4) Before first MID session. 5) Between MID session 1 and 2. 6) After MID session 2.
Time frame: Acquired during MRI scan, on Day 2
Motivation score
Acquired 6 times in MRI scanner as follows: 1) Before first Stroop session. 2) Between Stroop session 1 and 2. 3) After Stroop session 2. 4) Before first MID session. 5) Between MID session 1 and 2. 6) After MID session 2.
Time frame: Acquired during MRI scan, on Day 2
Structural MRI data - volume
Time frame: Acquired during MRI scan
Structural MRI data - surface area
Time frame: Acquired during MRI scan
Structural MRI data - thickness
Time frame: Acquired during MRI scan
Functional Connectivity (FC)
Measuring the FC value between ROIs defined in hypothesis to determine strength of connectivity between these different brain regions.
Time frame: Acquired during resting state MRI scan
Fractional Anisotropy (FA) of white matter
Time frame: Acquired during Diffusion Tensor Imaging (DTI) scan
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Plan to share: Yes
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