Emotional and Non-emotional Regulation in Patients With Emotional Instability and ADHD

NCT ID: NCT02797873

Last Updated: 2016-06-14

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2016-08-31

Study Completion Date

2018-05-31

Brief Summary

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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.

Detailed Description

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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:

* Participants: 30 young women from the Emotional Instability Unit at Child and Adolescent Psychiatry in Stockholm (Dialectic Behavioral Therapy unit ("DBT-teamet")), with traits of emotional instability and with varying levels of ADHD symptoms. 30 matched healthy controls.
* Tests:

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:

* Telephone screening (both participant and guardian): information about the study, MRI safety screening, check initial inclusion/exclusion criteria are met.
* Informed consent: sent by post to all legal guardians and the participant. Returned by post to test leader.
* The Strengths and Difficulties Questionnaire (SDQ) and socio-economic status questionnaires sent to one legal guardian and returned to test leader upon completion.
* Visit/Day 1: Assessment with questionnaires, interviews and behavioral testing (For selection of participants: Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV (SCID)-II interview Borderline and Antisocial parts, SDQ, Adult Self-Report Scale (ASRS), Autism Spectrum Quotient (AQ), Toronto Alexithymia Scale (TAS)-20, Ravens SPM, reading test, color vision test, questionnaire with additional questions. For characterization of participants: Brown-Attention Deficit Disorder (ADD), Mood and Feelings Questionnaire (MFQ), State and Trait Anxiety Inventory-Trait (STAI-T), Barratt's Impulsivity Scale (BIS)). Frankfurter Test und Training des Erkennens von fazialem Affekt (FEFA) 2 test (face recognition) and Stop signal test (SST). Approximately 3 hours.
* DAWBA computerized interview at home. Both participant and one legal guardian complete this.
* Additional information from patient records gathered, to verify current and previous diagnoses.
* Visit/Day 2: Assessments with questionnaires (STAI-S, last menstruation, sleepiness rating, motivation rating). MRI-scan: session 1: T1, Stroop session 1, Stroop session 2, T2. Break. Session 2: MID session 1, MID session 2. Break. Session 3: resting state, DTI. Assessments after scan: debriefing questionnaire, "After MID task" questionnaire. Approximately 3 hours.

Conditions

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Emotional Instability Personality Disorder (Borderline Personality Disorder) Attention Deficit Hyperactivity Disorder Healthy Controls

Study Design

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Allocation Method

NON_RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

BASIC_SCIENCE

Blinding Strategy

NONE

Study Groups

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EIP

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

Group Type EXPERIMENTAL

fMRI - Stroop task

Intervention Type OTHER

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.

fMRI - MID task

Intervention Type OTHER

2 x 10 minutes MID task performed during fMRI scan. See Detailed Study Description.

Stop Signal Task

Intervention Type BEHAVIORAL

Performed at a computer at first visit, 10 minutes divided into 3 blocks. See Detailed Study Description.

SCID-II

Intervention Type OTHER

See Detailed Study Description.

SDQ

Intervention Type OTHER

See Detailed Study Description.

ASRS

Intervention Type OTHER

See Detailed Study Description.

AQ

Intervention Type OTHER

See Detailed Study Description.

TAS-20

Intervention Type OTHER

See Detailed Study Description.

Raven's SPM

Intervention Type OTHER

See Detailed Study Description.

Reading ability

Intervention Type OTHER

See Detailed Study Description.

Ishihara's tests for colour deficiency

Intervention Type OTHER

See Detailed Study Description.

Additional questionnaire

Intervention Type OTHER

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.

Brown-ADD

Intervention Type OTHER

See Detailed Study Description.

MFQ

Intervention Type OTHER

See Detailed Study Description.

STAI-T

Intervention Type OTHER

See Detailed Study Description.

BIS

Intervention Type OTHER

See Detailed Study Description.

DAWBA

Intervention Type OTHER

See Detailed Study Description.

STAI-S

Intervention Type OTHER

See Detailed Study Description.

Sleepiness rating

Intervention Type OTHER

Acquired 6 times while in MRI-scanner. See Detailed Study Description.

Motivation rating

Intervention Type OTHER

Acquired 6 times while in MRI-scanner. See Detailed Study Description.

FEFA2

Intervention Type BEHAVIORAL

Assessing ability to recognise emotional face, performed at a computer at first visit. See Detailed Study Description.

Structural T1 MRI scan

Intervention Type OTHER

See Detailed Study Description and Outcome Measures.

Structural T2 MRI scan

Intervention Type OTHER

See Detailed Study Description.

DTI MRI scan

Intervention Type OTHER

See Detailed Study Description and Outcome Measures.

Resting state MRI scan

Intervention Type OTHER

See Detailed Study Description and Outcome Measures.

Healthy controls

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

Group Type EXPERIMENTAL

fMRI - Stroop task

Intervention Type OTHER

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.

fMRI - MID task

Intervention Type OTHER

2 x 10 minutes MID task performed during fMRI scan. See Detailed Study Description.

Stop Signal Task

Intervention Type BEHAVIORAL

Performed at a computer at first visit, 10 minutes divided into 3 blocks. See Detailed Study Description.

SCID-II

Intervention Type OTHER

See Detailed Study Description.

SDQ

Intervention Type OTHER

See Detailed Study Description.

ASRS

Intervention Type OTHER

See Detailed Study Description.

AQ

Intervention Type OTHER

See Detailed Study Description.

TAS-20

Intervention Type OTHER

See Detailed Study Description.

Raven's SPM

Intervention Type OTHER

See Detailed Study Description.

Reading ability

Intervention Type OTHER

See Detailed Study Description.

Ishihara's tests for colour deficiency

Intervention Type OTHER

See Detailed Study Description.

Additional questionnaire

Intervention Type OTHER

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.

Brown-ADD

Intervention Type OTHER

See Detailed Study Description.

MFQ

Intervention Type OTHER

See Detailed Study Description.

STAI-T

Intervention Type OTHER

See Detailed Study Description.

BIS

Intervention Type OTHER

See Detailed Study Description.

DAWBA

Intervention Type OTHER

See Detailed Study Description.

STAI-S

Intervention Type OTHER

See Detailed Study Description.

Sleepiness rating

Intervention Type OTHER

Acquired 6 times while in MRI-scanner. See Detailed Study Description.

Motivation rating

Intervention Type OTHER

Acquired 6 times while in MRI-scanner. See Detailed Study Description.

FEFA2

Intervention Type BEHAVIORAL

Assessing ability to recognise emotional face, performed at a computer at first visit. See Detailed Study Description.

Structural T1 MRI scan

Intervention Type OTHER

See Detailed Study Description and Outcome Measures.

Structural T2 MRI scan

Intervention Type OTHER

See Detailed Study Description.

DTI MRI scan

Intervention Type OTHER

See Detailed Study Description and Outcome Measures.

Resting state MRI scan

Intervention Type OTHER

See Detailed Study Description and Outcome Measures.

Interventions

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fMRI - Stroop task

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.

Intervention Type OTHER

fMRI - MID task

2 x 10 minutes MID task performed during fMRI scan. See Detailed Study Description.

Intervention Type OTHER

Stop Signal Task

Performed at a computer at first visit, 10 minutes divided into 3 blocks. See Detailed Study Description.

Intervention Type BEHAVIORAL

SCID-II

See Detailed Study Description.

Intervention Type OTHER

SDQ

See Detailed Study Description.

Intervention Type OTHER

ASRS

See Detailed Study Description.

Intervention Type OTHER

AQ

See Detailed Study Description.

Intervention Type OTHER

TAS-20

See Detailed Study Description.

Intervention Type OTHER

Raven's SPM

See Detailed Study Description.

Intervention Type OTHER

Reading ability

See Detailed Study Description.

Intervention Type OTHER

Ishihara's tests for colour deficiency

See Detailed Study Description.

Intervention Type OTHER

Additional questionnaire

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.

Intervention Type OTHER

Brown-ADD

See Detailed Study Description.

Intervention Type OTHER

MFQ

See Detailed Study Description.

Intervention Type OTHER

STAI-T

See Detailed Study Description.

Intervention Type OTHER

BIS

See Detailed Study Description.

Intervention Type OTHER

DAWBA

See Detailed Study Description.

Intervention Type OTHER

STAI-S

See Detailed Study Description.

Intervention Type OTHER

Sleepiness rating

Acquired 6 times while in MRI-scanner. See Detailed Study Description.

Intervention Type OTHER

Motivation rating

Acquired 6 times while in MRI-scanner. See Detailed Study Description.

Intervention Type OTHER

FEFA2

Assessing ability to recognise emotional face, performed at a computer at first visit. See Detailed Study Description.

Intervention Type BEHAVIORAL

Structural T1 MRI scan

See Detailed Study Description and Outcome Measures.

Intervention Type OTHER

Structural T2 MRI scan

See Detailed Study Description.

Intervention Type OTHER

DTI MRI scan

See Detailed Study Description and Outcome Measures.

Intervention Type OTHER

Resting state MRI scan

See Detailed Study Description and Outcome Measures.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Undergone puberty
* Right-handed
* Monophasic contraceptives
* Speak Swedish fluently


≥4/9 criteria of DSM-IV, measured by SCID-II interview

Exclusion Criteria

* Impaired vision \> +/- 5 D or other vision problem (squinting or severe astigmatism)
* BMI \<17, BMI \>35 due to possible hormonal disturbance
* Some medical drugs: benzodiazepines, neuroleptics, mood stabilisers, central stimulants, other neuro pharmaceuticals. (SSRIs are ok)
* Not suitable for MRI scan (metal implants or severe claustrophobia)
* AQ-score \>26
* Alexithymia (≥52 in TAS20 questionnaire or poor score in facial recognition test (FEFA2));
* Mental retardation (IQ \<70 according to Ravens SPM)
* Reading difficulties (reading speed \>2 standard deviations slower than normal population of same age
* Established addiction problems (nicotine ok)
* Color blindness (\>10 points on Ishihara-test)
* Psychotic disorder (according to medical history, DAWBA, medical records)
* Anorexia nervosa that has required hospital care
* Bipolar disorder (according to DAWBA and medical records)
* Neurological disease (according to medical history and medical records)
* Endocrinological disease
* Other disease, condition or treatment that may substantially affect cognition
Minimum Eligible Age

16 Years

Maximum Eligible Age

18 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Karolinska Institutet

OTHER

Sponsor Role lead

Responsible Party

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Predrag Petrovic

MD, PhD, Associate Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Central Contacts

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Predrag Petrovic

Role: CONTACT

Other Identifiers

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2015/127-31/1_EI_ADHD

Identifier Type: -

Identifier Source: org_study_id

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