Albermann Mona, Emery Sophie, Baumgartner Noemi, Strumberger Michael, Erb Suzanne, Wöckel Lars, Müller-Knapp Ulrich, Rhiner Bruno, Contin-Waldvogel Brigitte, Bachmann Silke, Schmeck Klaus, Berger Gregor, Häberling Isabelle
Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Zürich, Switzerland.
Psychiatric Hospital St. Gallen Nord, Wil, Switzerland.
Front Hum Neurosci. 2023 Jun 22;17:957753. doi: 10.3389/fnhum.2023.957753. eCollection 2023.
Executive functions (EF) consolidate during adolescence and are impaired in various emerging psychiatric disorders, such as pediatric Major Depressive Disorder (pMDD) and Borderline Personality Disorder. Previous studies point to a marked heterogeneity of deficits in EF in pMDD. We examined the hypothesis that deficits in EF in adolescents with pMDD might be related to comorbid Borderline Personality features (BPF).
We examined a sample of 144 adolescents (15.86 ± 1.32) diagnosed with pMDD. Parents rated their child's EF in everyday life with the Behavior Rating Inventory of Executive Function (BRIEF) and BPF with the Impulsivity and Emotion Dysregulation Scale (IED-27). The adolescents completed equivalent self-rating measures. Self- and parent-ratings of the BRIEF scores were compared with paired t-Tests. Correlation and parallel mediation analyses, ICC, and multiple regression analyses were used to assess symptom overlap, parent-child agreement, and the influence of depression severity.
Over the whole sample, none of the self- or parent-rated BRIEF scales reached a mean score above T > 65, which would indicate clinically impaired functioning. Adolescents tended to report higher impairment in EF than their parents. Depression severity was the strongest predictor for BPF scores, with predicting parent-rated BPF and predicting self-rated BPF. Furthermore, the Behavioral Regulation Index, which includes EF closely related to behavioral control, significantly mediated the relationship between depression severity and IED-27 factors and but not
On average, adolescents with depression show only subtle deficits in executive functioning. However, increased EF deficits are associated with the occurrence of comorbid borderline personality features, contributing to a more severe overall psychopathology. Therefore, training of executive functioning might have a positive effect on psychosocial functioning in severely depressed adolescents, as it might also improve comorbid BPF.
www.ClinicalTrials.gov, identifier NCT03167307.
执行功能（EF）在青春期得到巩固，在各种新发精神疾病中受损，如儿童重度抑郁症（pMDD）和边缘型人格障碍。先前的研究指出，pMDD患者的执行功能缺陷存在明显异质性。我们检验了这样一个假设，即患有pMDD的青少年的执行功能缺陷可能与共病的边缘型人格特征（BPF）有关。
我们对144名被诊断为pMDD的青少年（15.86±1.32岁）进行了研究。父母使用执行功能行为评定量表（BRIEF）对孩子在日常生活中的执行功能进行评分，使用冲动和情绪失调量表（IED - 27）对BPF进行评分。青少年完成了等效的自评量表。使用配对t检验比较BRIEF分数的自评和父母评分。采用相关分析、平行中介分析、组内相关系数（ICC）和多元回归分析来评估症状重叠、亲子一致性以及抑郁严重程度的影响。
在整个样本中，自评或父母评的BRIEF量表均未达到T>65的平均分数，这表明临床功能未受损。青少年倾向于报告比父母更高的执行功能受损情况。抑郁严重程度是BPF分数的最强预测因素，分别预测父母评的BPF和自评的BPF。此外，行为调节指数（其中包括与行为控制密切相关的执行功能）显著中介了抑郁严重程度与IED - 27因素 和 之间的关系，但未中介与 的关系。
平均而言，患有抑郁症的青少年仅表现出轻微的执行功能缺陷。然而，执行功能缺陷的增加与共病边缘型人格特征的出现有关，导致整体精神病理学更为严重。因此，执行功能训练可能对重度抑郁青少年的心理社会功能产生积极影响，因为它也可能改善共病BPF。
