Persistent psychotic symptoms and neurocognitive deficits in borderline personality disorder

Persistent psychotic symptomatology might be present in a group of patients with borderline personality disorder (BPD) according to recent research findings.

Investigate whether psychotic symptoms could be associated to greater cognitive and functional impairment in BPD patients.

In this observational, cross-sectional study (PI14/01449 and PI17/01023), we investigated the incidence of persistent psychotic symptoms in BPD patients and its association with specific neurocognitive impairments. A sample of 120 patients with diagnosis of BPD according to DSM IV TR was studied.

A substantial number of BPD patients (52, 43,3%) presented psychotic symptoms for a period longer than 6 months. Among BPD patients with psychotic symptoms, 25 (48%) presented hallucinations, 35 (67,3%) presented delusional thoughts and 8 patients (15%) presented both. BPD psychotic patients had greater global severity at the CGI than non-psychotic patients (p 0.02). Psychotic BPD patients had greater impairment in attention (Hedges g = -0.36, 95% CI = -0.72 to 0.00) and in the executive functions domain (Hedges g = -0.48, 95% CI = -0.84 to -0.12) including working memory and cognitive flexibility. There were no differences of neurocognitive performance between patients with hallucinations and patients with delusional thoughts.

Persistent psychotic symptoms are present in one third of BPD patients and are probably associated with neurocognitive and social impairment. Thus, it is a priority to extensively investigate the nature of interactions between psychosis, BPD psychopathology and neurocognitive impairment, in order to better understand BPD phenotypes and to design adjusted treatment interventions.