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Riemann G, Chrispijn M, Weisscher N, Regeer E, Kupka RW. A Feasibility Study of the Addition of STEPPS in Outpatients With Bipolar Disorder and Comorbid Borderline Personality Features: Promises and Pitfalls. Front Psychiatry 2021; 12:725381. [PMID: 34858221 PMCID: PMC8631960 DOI: 10.3389/fpsyt.2021.725381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/21/2021] [Indexed: 11/15/2022] Open
Abstract
Background: Pharmacotherapy is a cornerstone in bipolar disorder (BD) treatment whereas borderline personality disorder (BPD) is treated primarily with psychotherapy. Given the overlap in symptomatology, patients with BD may benefit from psychotherapy designed for BPD. Aims: This paper reports the findings of a non-controlled open feasibility study of STEPPS training in patients with BD and borderline personality features (BPF). Methods: Outpatients with BD were screened for BPD, and if positive interviewed with SCID-II. Patients with at least three BPF, always including impulsivity and anger burst, were included in the intervention study. Severity of BD and BPD and quality of life were assessed. Descriptive statistics were performed. Results: Of 111 patients with BD 49.5% also screened positive on BPD according to PDQ-4+, and 52.3% of these had BPD according to SCID-II. Very few participants entered the intervention study, and only nine patients completed STEPPS. Descriptive statistics showed improvement on all outcome variables post treatment, but no longer at 6-month follow up. We reflect on the potential reasons for the failed inclusion. Conclusion: Features of BPD were highly prevalent in patients with BD. Still, recruiting patients for a psychological treatment originally designed for BPD proved to be difficult. Feedback of participants suggests that the association of STEPPS with "borderline" had an aversive effect, which may have caused limited inclusion for screening and subsequent drop-out for the treatment. Therefore, STEPPS should be adapted for BD to be an acceptable treatment option. Clinical Trial Registration: www.ClinicalTrials.gov/3856, identifier: NTR4016.
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Affiliation(s)
- Georg Riemann
- Department of Applied Psychology, Saxion University of Applied Sciences, Deventer, Netherlands.,Dimence Mental Health, Center for Bipolar Disorders, Deventer, Netherlands
| | - Melissa Chrispijn
- Dimence Mental Health, Center for Bipolar Disorders, Deventer, Netherlands
| | - Nadine Weisscher
- Geestelijke Gezondheids Zorg (GGZ) Heuvelrug, Center for Mental Health, Driebergen, Netherlands
| | - Eline Regeer
- Center for Bipolar Disorders, Altrecht Institute for Mental Health Care, Utrecht, Netherlands
| | - Ralph W Kupka
- Center for Bipolar Disorders, Altrecht Institute for Mental Health Care, Utrecht, Netherlands.,Amsterdam University Medical Center (UMC), Department of Psychiatry, VU University, Amsterdam, Netherlands.,Geestelijke Gezondheids Zorg (GGZ) InGeest, Center for Mental Health Care, Amsterdam, Netherlands
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Penders KA, Peeters IG, Metsemakers JF, van Alphen SP. Personality Disorders in Older Adults: a Review of Epidemiology, Assessment, and Treatment. Curr Psychiatry Rep 2020; 22:14. [PMID: 32025914 PMCID: PMC7002365 DOI: 10.1007/s11920-020-1133-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
PURPOSE OF REVIEW The aim of the paper is reviewing recent literature on the epidemiology, assessment, and treatment of personality disorders (PDs) among older adults (≥ 60 years). RECENT FINDINGS Since 2015, 12 primary empirical studies have been published addressing PDs in older adults; 3 addressing epidemiological aspects, 6 on assessment, 2 exploring both epidemiology and assessment, and 1 examining treatment. PD research in older adults is steadily growing and is predominantly focused on assessment. The studies showed that PDs were rather prevalent ranging from 10.6-14.5% in community-dwelling older adults, to 57.8% in nursing home-residing older adults. The Severity Indices of Personality Problems-Short Form, Gerontological Personality disorders Scale, and Assessment of DSM-IV Personality Disorders turned out to be promising instruments for assessing PDs in later life. Furthermore, schema therapy seems to be a feasible and effective intervention. Despite promising findings, there is an urgent need for studies addressing PDs in older adults, especially studies investigating epidemiological aspects and treatment options. Furthermore, new areas of interest arise such as PDs in other settings, and behavioral counseling.
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Affiliation(s)
- Krystle A.P. Penders
- 0000 0001 0481 6099grid.5012.6Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University (UM), P.O. box 616, 6200 MD Maastricht, The Netherlands ,Department of Treatment and Guidance, Envida, Maastricht, The Netherlands
| | - Inge G.P. Peeters
- 0000 0001 0481 6099grid.5012.6Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University (UM), P.O. box 616, 6200 MD Maastricht, The Netherlands ,0000 0004 0480 1382grid.412966.eDepartment of Integrated Care, Maastricht University Medical Centre + (MUMC+), Maastricht, The Netherlands
| | - Job F.M. Metsemakers
- 0000 0001 0481 6099grid.5012.6Department of Family Medicine, School CAPHRI, Care and Public Health Research Institute, Maastricht University (UM), P.O. box 616, 6200 MD Maastricht, The Netherlands
| | - Sebastiaan P.J. van Alphen
- 0000 0001 2290 8069grid.8767.eFaculty of Psychology & Educational Sciences, Department of Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium ,Department of Old Age Psychiatry, Mondriaan Hospital, Heerlen-Maastricht, The Netherlands ,0000 0001 0943 3265grid.12295.3dSchool of Social and Behavioral Sciences, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
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Sleep CE, Wygant DB, Miller JD. Examining the Incremental Utility of DSM-5 Section III Traits and Impairment in Relation to Traditional Personality Disorder Scores in a Female Correctional Sample. J Pers Disord 2018; 32:738-752. [PMID: 28972814 DOI: 10.1521/pedi_2017_31_320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Personality disorders (PDs) are challenging to assess and are associated with great individual and societal costs. In response to the limitations of categorical models, the DSM-5 included an alternative model (i.e., Section III), which uses impairment (Criterion A) and pathological traits (Criterion B) to diagnose PDs. Although numerous studies have illustrated dimensional trait models' ability to capture personality psychopathology, less attention has been paid to personality impairment. The present investigation sought to examine Criterion A's ability to contribute incrementally to the prediction of antisocial (ASPD), borderline (BPD), and narcissistic personality disorders (NPD), and Interpersonal-Affective (F1) and Impulsive-Antisocial (F2) features of psychopathy. The current study used 200 female inmates and found that impairment contributed to the prediction of BPD, NPD, and psychopathy F1 scores and did not add to the prediction of ASPD and psychopathy F2 scores. Difficulties in distinguishing between personality impairment and personality disordered traits are discussed.
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Affiliation(s)
| | - Dustin B Wygant
- Department of Psychology, Eastern Kentucky University, Richmond, Kentucky
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Carlier IVE, Andree Wiltens DH, van Rood YR, van Veen T, Dekker J, van Hemert AM. Treatment course and its predictors in patients with somatoform disorders: A routine outcome monitoring study in secondary psychiatric care. Clin Psychol Psychother 2018; 25:550-564. [PMID: 29573030 DOI: 10.1002/cpp.2191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 02/14/2018] [Accepted: 02/14/2018] [Indexed: 12/27/2022]
Abstract
AIM Somatoform disorders are common and often chronic. It would be helpful to distinguish those patients who are likely to have a positive treatment course from those who are likely to follow a negative course. Such studies of different somatoform disorders are scarce, especially in secondary psychiatric care. This study examined the 6-month treatment course of psychological, physical symptoms, and functioning, and its predictors in a naturalistic sample of secondary psychiatric care outpatients with somatoform disorders. METHOD The present study used routine outcome monitoring data of patients with somatoform disorders regarding their 6-month treatment course of psychological and physical symptoms as well as functioning. The following patient groups were included: total group of somatoform disorders (N = 435), and undifferentiated somatoform disorder (N = 242), pain disorder (N = 102), body dysmorphic disorder (N = 51), and hypochondriasis (N = 40). Measures were Mini-International Neuropsychiatric Interview plus, Brief Symptom Inventory, Montgomery-Ǻsberg Depression Rating Scale, Brief Anxiety Scale, Short Form Health Survey 36, and Physical Symptom Checklist (PSC). RESULTS The study population generally showed high co-morbidity, especially with anxiety and mood disorders. The PSC total score, body dysmorphic disorder, and hypochondriasis were significant predictors for the treatment course of symptoms (Brief Symptom Inventory), whereas the PSC total score was the only significant predictor for the course of functioning (Short Form Health Survey 36). CONCLUSION Secondary psychiatric care outpatients with somatoform disorders showed high co-morbidity with anxiety and mood disorders, and an unfavourable 6-month course of both symptoms and functioning. Clinical implications are discussed, such as additional treatment of co-morbidity in somatoform disorders.
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Affiliation(s)
- I V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Y R van Rood
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - T van Veen
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Dekker
- Department of Psychiatry and Department of Rehabilitation Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - A M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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van Alebeek A, van der Heijden PT, Hessels C, Thong MS, van Aken M. Comparison of Three Questionnaires to Screen for Borderline Personality Disorder in Adolescents and Young Adults. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2017. [DOI: 10.1027/1015-5759/a000279] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Abstract. One of the most common personality disorders among adolescents and young adults is the Borderline Personality Disorder (BPD). The objective of current study was to assess three questionnaires that can reliably screen for BPD in adolescents and young adults (N = 53): the McLean Screening Instrument for BPD (MSI-BPD; Zanarini et al., 2003 ), the Personality Diagnostic Questionnaire 4th edition – BPD scale (PDQ-4 BPD; Hyler, 1994 ), and the SCID-II Patient Questionnaire – BPD scale (SCID-II-PQ BPD). The nine criteria of BPD according to the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV; APA, 1994 ) were measured with the Structural Clinical Interview for DSM-IV Axis II disorders – BPD scale (SCID-II; First, Spitzer, Gibbon, Williams, & Benjamin, 1995 ). Correlations between the questionnaires and the SCID-II were calculated. In addition, the sensitivity and specificity of the questionnaires were tested. All instruments predicted the BPD diagnosis equally well.
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Affiliation(s)
| | - Paul T. van der Heijden
- Centre for Adolescent Psychiatry, Reinier van Arkel Mental Health Institute, ‘s-Hertogenbosch, The Netherlands
- Vincent van Gogh Institute, Venray, The Netherlands
- Radboud University Nijmegen, The Netherlands
| | | | | | - Marcel van Aken
- Centre for Adolescent Psychiatry, Reinier van Arkel Mental Health Institute, ‘s-Hertogenbosch, The Netherlands
- Utrecht University, The Netherlands
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Dépistage des troubles de la personnalité avec la version française du Personality Diagnostic Questionnaire-4+ dans une population psychiatrique : une étude préliminaire. ANNALES MEDICO-PSYCHOLOGIQUES 2016. [DOI: 10.1016/j.amp.2014.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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A comparative analysis of personality pathology profiles among patients with pure depressive-, pure anxiety-, and pure somatoform disorders. J Affect Disord 2014; 168:322-30. [PMID: 25086291 DOI: 10.1016/j.jad.2014.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/09/2014] [Accepted: 07/09/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Depressive-, anxiety-, and somatoform disorders are among the most common psychiatric disorders. The assessment of comorbid personality pathology or traits in these disorders is relevant, because it can lead to the exacerbation of them or to poorer remission rates. To date, no research findings have been published on the comparison of these three prevalent patient groups with regard to comorbid dimensional personality pathology. METHODS Data of participants (18-60 years) came from a web-based Routine Outcome Monitoring (ROM) programme. The present study used baseline data and was designed to compare personality pathology profiles between three separate outpatient groups: pure anxiety disorders (n=1633), pure depressive disorders (n=1794), and pure somatoform disorders (n=479). Personality pathology was measured with the Dimensional Assessment of Personality Pathology-Short Form (DAPP-SF). RESULTS The pure depressive disorder group, in comparison to the other two disorder groups, exhibited the worst psychopathological and functional health image and most personality pathology. In the pure anxiety disorder group, the highest mean was found for the personality trait Anxiousness; and in the pure depressive disorder group for the traits Identity problems, Affective lability, Anxiousness, and Restricted expression. LIMITATIONS The cross-sectional nature of the study limits the conclusions that can be drawn. CONCLUSIONS The assessment of comorbid personality pathology in depressive-, anxiety-, somatoform disorders is clinically relevant, whether a patient has a personality disorder or not. This way, treatment could partly be focused on specific personality traits that may be counterproductive for treatment outcome, especially in depressive disorders.
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Pilleron S, Clément JP, Ndamba-Bandzouzi B, Mbelesso P, Dartigues JF, Preux PM, Guerchet M. Is dependent personality disorder associated with mild cognitive impairment and dementia in Central Africa? A result from the EPIDEMCA programme. Int Psychogeriatr 2014; 27:1-10. [PMID: 25177857 DOI: 10.1017/s104161021400180x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACT Background: To date, no studies have examined the relationship between cognitive disorders and personality disorders. Our aim was to investigate the association between dependent personality disorder (DPD) and cognitive disorders in Central Africa. Methods: Between 2011 and 2012, a cross-sectional multicenter population-based study was carried out in rural and urban areas of the Central African Republic (CAR) and the Republic of Congo (ROC). Participants aged ≥65 years were interviewed using the Community Screening Interview for Dementia (CSI-D). Elderly people who performed poorly (CSI-D cognitive tests score or COGSCORE ≤ 24.5/30) were clinically assessed by neurologists and underwent further psychometric testing. The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition and Petersen criteria were required for the diagnosis of dementia and mild cognitive impairment (MCI) respectively. DPD was assessed using the Personality Diagnostic Questionnaire-4+. Socio-demographic, vascular, and psychological factors were also documented. Multivariate multinomial logistic regression models were used to estimate the associations. Results: Of the 2,002 participants screened, 860 and 912 had data for cognitive status and DPD in CAR and ROC respectively. In fully adjusted models, DPD was significantly associated with MCI in ROC (Odds Ratio (OR) = 2.2, 95% CI: 1.0-4.7) and CAR (OR = 2.1, 95% CI: 1.1-4.0) and with dementia only in ROC (OR = 4.8, 95% CI: 2.0-11.7). Conclusions: DPD was associated with cognitive disorders among elderly people in Central Africa. This association should be confirmed in other contexts. This study paves the way for research on the association between personality and cognitive impairment in Africa.
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Affiliation(s)
- Sophie Pilleron
- INSERM UMR1094,Tropical Neuroepidemiology,University of Limoges,Limoges,France
| | - Jean-Pierre Clément
- INSERM UMR1094,Tropical Neuroepidemiology,University of Limoges,Limoges,France
| | | | - Pascal Mbelesso
- INSERM UMR1094,Tropical Neuroepidemiology,University of Limoges,Limoges,France
| | | | - Pierre-Marie Preux
- INSERM UMR1094,Tropical Neuroepidemiology,University of Limoges,Limoges,France
| | - Maëlenn Guerchet
- INSERM UMR1094,Tropical Neuroepidemiology,University of Limoges,Limoges,France
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Abstract
Although the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) has shown validity in adult samples, only one study has explored its validity in adolescents and, to our knowledge, the measure has not been validated with inpatient adolescents. The aim of the current study was to evaluate the reliability, and convergent and criterion validity, of the MSI-BPD in an effort to establish the clinical utility of the MSI-PBD as a screening measure for BPD in inpatient adolescents. A total of 121 adolescents from an acute care inpatient unit were recruited for the study. Convergent validity was examined with established measures of BPD in adolescents, including the use of receiver operating characteristics analyses to establish a clinical cutoff score for the MSI-BPD in predicting a diagnosis of BPD. Criterion validity was examined by using this clinical cutoff to investigate group differences in suicidal ideation and Axis I symptoms, known correlates of BPD. Findings demonstrated support for validity of the MSI-BPD when used among inpatient adolescents, and established a clinical cutoff of 5.5. Taken together, this study demonstrates adequate validity for the MSI-BPD, and suggests it is a valuable screening measure for BPD in adolescent inpatients.
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