Abstract

At least one in four patients with substance use disorder (SUD) meet criteria for personality disorder and overlapping neurocognitive deficits may reflect shared neurobiological mechanisms. We studied neurocognition in females attending residential SUD treatment by comparing SUD with (n = 20) or without (n = 30) comorbid personality disorder. Neuropsychological testing included working memory, inhibition, shifting, verbal fluency, design fluency, psychomotor speed, immediate and delayed verbal memory, processing speed, premorbid functioning, cognitive screening, and self-reported executive function. As expected, whole-sample deficits included working memory (d = –.91), self-reported executive function (d = –.87), processing speed (d = –.40), delayed verbal memory recall (d = –.39), premorbid functioning (d = –.51), and cognitive screening performance (d = –.61). Importantly, the comorbid personality disorder group showed greater self-reported executive dysfunction (d = –.67) and poorer shifting performance (d = –.65). However, they also evidenced better working memory (d = .84), immediate (d = .95) and delayed (d = .83) verbal memory, premorbid functioning (d = .90), and cognitive screening performance (d = .77). Overall executive dysfunction deficits were concordant with those observed in previous SUD studies. Surprisingly, comorbid personality disorder was associated with a pattern indicating poorer subjective (self-report) but better objective performance on a number of tasks, apart from shifting deficits that may relate to emotion dysregulation. Subjective emotional dysfunction may influence the cognitive deficits observed in the personality disorder group.

摘要

至少有四分之一的物质使用障碍 (SUD) 患者符合人格障碍的标准，重叠的神经认知缺陷可能反映了共同的神经生物学机制。我们通过比较 SUD 与 ( n  = 20) 或没有 ( n  = 30) 共病人格障碍，研究了参加住院 SUD 治疗的女性的神经认知。神经心理学测试包括工作记忆、抑制、转移、语言流畅性、设计流畅性、心理运动速度、即时和延迟语言记忆、处理速度、病前功能、认知筛查和自我报告的执行功能。正如预期的那样，整个样本缺陷包括工作记忆 ( d = –.91)、自我报告的执行功能 ( d = –.87)、处理速度 (d = –.40）、语言记忆回忆延迟（d = –.39）、病前功能（d = –.51）和认知筛查表现（d = –.61）。重要的是，共病人格障碍组表现出更大的自我报告执行功能障碍 ( d = –.67) 和更差的转移表现 ( d = –.65)。然而，他们还表现出更好的工作记忆 ( d = .84)、即时 ( d = .95) 和延迟 ( d = .83) 言语记忆、病前功能 ( d = .90) 和认知筛查表现 ( d=.77）。总体执行功能障碍缺陷与之前 SUD 研究中观察到的缺陷一致。令人惊讶的是，除了可能与情绪失调有关的转移缺陷外，共病人格障碍与一种模式相关，表明在许多任务上主观（自我报告）较差但客观表现较好。主观情绪障碍可能会影响在人格障碍组中观察到的认知缺陷。