Table 2 Main empirical findings on BPD psychopathology in patients with early psychosis
From: Borderline personality disorder and early psychosis: a narrative review
Gleeson (2011) [29] | Treating co-occurring first-episode psychosis and borderline personality: a pilot randomized controlled trial “Results: The results showed that it was feasible to recruit and assess a high risk and complex group of patients who were agreeable to study participation. Specialist first-episode treatment plus specialist early intervention for borderline personality was an acceptable and safe treatment.” (Gleeson et al. 2012) |
Schultze-Lutter (2012) [30] | Personality disorders and accentuations in at-risk persons with and without conversion to first-episode psychosis: personality disorders and psychosis risk “Conclusions: Unexpectedly, schizotypal PD was infrequent and did not predict conversion. Conversion was best predicted by schizoid PA, indicating more severe, persistent social deficits already at baseline in later converters. This corresponds to premorbid social deficits reported for genetic high-risk children and low social functioning in at-risk patients later converting to psychosis. Further, PDs occurred frequently in at-risk patients irrespective of conversion. As psychopathology and personality relate closely to one another, this result highlights that, beyond the current narrow focus on schizotypal PD, personality-related factors should be considered more widely in the prevention of psychosis.” (Schultze-Lutter et al. 2012) |
Ryan (2017) [31] | Borderline personality pathology in young people at ultra-high risk of developing a psychotic disorder: borderline personality pathology “Conclusions: Many UHR patients present with concurrent borderline personality features. The psychotic experiences reported by UHR patients with borderline personality features were not limited to paranoid ideation, supporting the idea that borderline personality disorder may include a wider range of psychotic symptoms than previously thought. It is further possible that the psychotic symptoms experienced in this group could also be indicative of an emerging psychotic disorder.” (Ryan et al. 2017) |
Francey (2018) [32] | Does co-occurring borderline personality disorder influence acute phase treatment for first-episode psychosis? “Conclusion: Young people with co-occurring clinician-rated BPD and FEP experienced greater difficulty accessing standard care for FEP and received relatively different treatment, including different pharmacotherapy, compared with those FEP patients without BPD. There is a need to develop new clinical guidelines and effective treatments for this specific subgroup with early psychosis and co-occurring BPD that take into account interpersonal and "premorbid" aspects of their presenting problems.” (Francey et al. 2018) |
Paust (2019) [33] | Borderline personality pathology in an at risk mental state sample “Results: We found a significant correlation between borderline symptomatology and positive symptoms assessed by the structured interview for prodromal symptoms. There were no associations between basic symptoms for psychosis and borderline symptoms. In addition, there was no influence of borderline symptomatology on the rate of transition into a manifest schizophrenic disease. Summary: In conclusion, borderline personality disorder should not be an exclusion criterion for the screening for psychosis or for an early intervention treatment. On the other hand, not every patient with borderline personality disorder, (especially those not suffering from hallucinations, unusual thought content, or persecutory ideas) should automatically be screened for the risk of developing a psychotic disorder.” (Paust et al. 2019) |
Carrasco (2021) [26] | Persistent psychotic symptoms and neurocognitive deficits in borderline personality disorder “Neurocognitive impairment and its association with psychotic symptoms in BPD suggest that a substrate of impaired social cognition underlies emotional dysregulation and impulsive behaviors in these patients. In other words, the greater the social cognitive deficit, the higher is the possibility of primitive and paranoid phenomena, such as auditory hallucinations or delusional explanations. This probably associates with inability for mentalization in these patients, and hence, the need of specific psychotherapeutic interventions different of non-psychotic BPD.” (Carrasco et al. 2021) |
Hayward (2021) [21] | A cross-sectional study of auditory verbal hallucinations experienced by people with a diagnosis of borderline personality disorder “Conclusion: The findings suggest that AVH is a legitimate and distressing symptom of BPD and a treatment priority for some patients. The relative independence of AVHs from other BPD symptoms and emotional states suggests that psychological treatment may need to be targeted specifically at the symptom of AVHs. This treatment could be adapted from cognitive behaviour therapy, the psychological intervention that is recommended for the treatment of AVHs in the context of psychosis.” (Hayward et al. 2022) |
Schandrin (2022) [34] | Co-occurring first-episode psychosis and borderline personality pathology in an early intervention for psychosis cohort “Conclusion: BPP is a common occurrence in psychotic disorders and is associated with more severe hallucinations and depression with higher risks of self-harm. Specific interventions need to be developed.” (Schandrin et al. 2022) |