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O'Dougherty M. Stubborn Families: Logics of Care of a Family Member with Borderline Personality Disorder. Cult Med Psychiatry 2024:10.1007/s11013-024-09853-9. [PMID: 39012417 DOI: 10.1007/s11013-024-09853-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 07/17/2024]
Abstract
This study conducted in-depth, largely unstructured interviews with 31 involved family members in a metropolitan area of the United States (US) Midwest on their experiences of BPD in a close relative. Narrative analysis employing concepts from anthropology (the logic of care and family assemblage) was used to examine the nature and quality of care practices and identify human, environmental, and cultural supports needed for family recovery. Findings indicate that these US family caregivers provided intensive and extensive care over the long term. They acted in situations of risk to their relative, and often disconnected from professional support. Parents labored under unforgiving normalizations: judgments (real or perceived) of not properly raising or "launching" their children and norms of parental self-sacrifice. The dearth of housing options for the young person hindered recovery. While duly recognizing the care practices provided by family members for a relative with BPD, I argue that there is a significant omission. Our conceptualizing of supports for family members of a relative with BPD needs to encompass supports for their own recovery. Respite, mental health care for caregivers, housing, support groups, and collaborative care (with professionals, peers and family members) could productively assist recovery of all family members.
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Affiliation(s)
- Maureen O'Dougherty
- Social Science Department, Metropolitan State University, 700 East Seventh Street, Saint Paul, MN, 55106-5000, USA.
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2
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Berg L, Pringsheim TM, Lerario M, Martino D. Psychological Factors Associated with Functional Tic-like Behaviours during the COVID-19 Pandemic. Res Child Adolesc Psychopathol 2024; 52:1157-1172. [PMID: 38427218 DOI: 10.1007/s10802-024-01184-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Abstract
Functional tic-like behaviours (FTLB) are a female predominant functional neurological disorder that escalated in incidence during the SARS CoV2 pandemic. This study compared social and adaptive functioning, social media use, pandemic experiences, and psychiatric comorbidities between FTLB (n = 35), Tourette Syndrome (TS) (n = 22), and neurotypical (NT) (n = 25) participants ages 11 to 25 years. The psychiatric comorbidity burden for participants with FTLB was formidable, with frequencies ranging from 1.5 to 10 times higher for major depressive disorder and panic disorder compared to TS and NT participants. Borderline personality disorder (BPD), agoraphobia, social anxiety disorder, and generalized anxiety disorder were also significantly more common in FTLB compared to NT participants. Vulnerable attachment scores, social phobia and social interaction anxiety symptoms were higher in participants with FTLB than NT but not TS. Overall distress tolerance, resilient coping, suggestibility, hours on social media, and exposure to tic and TS content were not significantly different between groups. FTLB participants rated their mental health declined more severely during the pandemic than both TS and NT participants and were more likely to experience trouble sleeping, loneliness, and difficulty affording housing and food than NT participants. Participants with FTLB were significantly more likely to identify as gender minority people than TS and NT, though there were no significant differences based on gender identity in the study variables within the FTLB group. The association and potential pathways explaining how psychiatric disorders may be contributing to FTLB, and why certain groups appear at particular risk are discussed.
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Affiliation(s)
- Lindsay Berg
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Tamara M Pringsheim
- Department of Clinical Neurosciences, Psychiatry, Pediatrics and Community Health Sciences, University of Calgary, Calgary, AB, Canada
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | | | - Davide Martino
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
- Mathison Centre for Mental Health Research and Education, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
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Blay M, Nicot P, Durpoix A, Leaune E, Poulet E, Ulm J, Perroud N. Evaluation of the level of training of French psychiatrists on borderline personality disorder: An online survey. L'ENCEPHALE 2024; 50:257-264. [PMID: 37604716 DOI: 10.1016/j.encep.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/04/2023] [Accepted: 06/08/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Borderline personality disorder is a common and treatable personality disorder that is often underdiagnosed and untreated, mainly due to a lack of training of psychiatrists and to a lack of accessibility to specialized therapies. However, no study has been conducted in France regarding this issue. Thus, we aimed to evaluate on a national scale the level of training, knowledge, and general attitude toward BPD diagnosis of French psychiatrists. METHODS We conducted an online survey in an unselected population of residents and senior French psychiatrists between January and March 2022, the results of which are presented descriptively. RESULTS 228 psychiatrists fully answered the questionnaire, and 21 more psychiatrists answered it partially. We found that most of the responders were unsatisfied with the residency training or the continuing medical education offered regarding BPD, a lack of training resulting in a low level of self-confidence regarding BPD management, in a low number of evidence-based therapies trained psychiatrists in issues regarding diagnostic disclosure, and in misconceptions regarding some aspects of the disorder. CONCLUSIONS These results underlie a clear lack of training of French psychiatrists, as well as a request from the latter for more opportunities to learn. This calls for a rethinking of the teaching system to incorporate more knowledge and tools related to BPD.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Addictology and Psychiatry Outpatient Center, Santé Basque Development group, Lyon, France.
| | - Pierre Nicot
- Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, 69500 Bron, France
| | - Amaury Durpoix
- University Hospital of Strasbourg, Strasbourg, France; University of Strasbourg, Strasbourg, France
| | - Edouard Leaune
- Suicide Prevention Center, Vinatier Hospital Center, Bron, France; Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, 69500 Bron, France
| | - Emmanuel Poulet
- Psychiatry Crisis Unit, Edouard Herriot Hospital, Lyon, France; Université Claude Bernard Lyon 1, CNRS, INSERM, Centre de Recherche en Neurosciences de Lyon CRNL U1028 UMR5292, PSYR2, 69500 Bron, France
| | - Justin Ulm
- Percy Army Instruction Hospital, Clamart, France; Val de Grâce School, Paris, France
| | - Nader Perroud
- Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospitals of Geneva, Geneva, Switzerland; University of Geneva, Geneva, Switzerland
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4
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Lau P, Amestoy ME, Roth M, Monson C. Patient-related factors associated with patient retention and non-completion in psychosocial treatment of borderline personality disorder: A systematic review. Personal Ment Health 2024. [PMID: 38807472 DOI: 10.1002/pmh.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/22/2024] [Accepted: 05/12/2024] [Indexed: 05/30/2024]
Abstract
The potential efficacy of psychosocial interventions in the treatment of borderline personality disorder (BPD) is impacted by significant treatment non-completion (TNC), with meta-analytic studies reporting rates of attrition of between 25% and 28%. Increasing patient retention could facilitate outcomes and improve resource utilization, given limited healthcare services. A systematic search of PsycINFO, CINAHL, EMBASE, CENTRAL, and Web of Science Core Collection identified 33 articles that met the criteria for inclusion. Although substantial heterogeneity in terms of methodology and quality of analysis limited conclusions that could be drawn in the narrative review, a few consistent patterns of findings were elucidated, such as Cluster B personality disorder comorbidities and lower therapeutic alliance were associated with TNC. Interestingly, the severity of BPD symptoms was not a predictor of TNC. These findings are discussed in terms of their potential theoretical contribution to TNC. Clinically, there may be value in applying mindfulness and motivational interviewing strategies early on in treatment for individuals who present uncertainty about engaging in treatment. Further research to develop this empirical landscape includes focusing on high-powered replications, examining burgeoning lines of research, and investigating dynamic predictors of TNC.
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Affiliation(s)
- Parky Lau
- Toronto Metropolitan University (formerly Ryerson University), Toronto, ON, Canada
| | - Maya E Amestoy
- University of Toronto Scarborough, Scarborough, ON, Canada
| | - Maya Roth
- Toronto Metropolitan University (formerly Ryerson University), Toronto, ON, Canada
- St Joseph's Healthcare London, London, ON, Canada
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Candice Monson
- Toronto Metropolitan University (formerly Ryerson University), Toronto, ON, Canada
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Zhong Y, Hu Q, Chen J, Li Y, Chen R, Li Y, Cong E, Xu Y. The impact of childhood trauma on Adolescent Depressive Symptoms: the Chain Mediating role of borderline personality traits and self-control. BMC Psychiatry 2024; 24:377. [PMID: 38773436 PMCID: PMC11110299 DOI: 10.1186/s12888-024-05829-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/09/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND The adolescent depression associated with childhood trauma has been confirmed, but the underlying mechanisms remain unclear. This study aims to explore the chain-mediated role of borderline personality traits and self-control in the relationship between childhood trauma and adolescent depression. METHODS A cross-sectional study was conducted on 2,664 students from a senior high school through online questionnaires from October to December 2022 in Henan, China. Childhood Trauma Questionnaire-Short Form, Borderline Personality Dimension of Personality Diagnostic Questionnaire-4, Self-Control Scale, and Children's Depression Inventory were used to measure childhood trauma, borderline personality traits, and self-control. RESULTS The prevalence of depression in adolescents was 21.17%, while the prevalence of borderline personality was 12.00%. childhood trauma (r = 0.50, p < 0.001) and borderline personality traits (r = 0.60, p < 0.001) were positively correlated with adolescent depressive symptoms, while self-control was negatively correlated with depressive symptoms (r = - 0.50, p < 0.001). Borderline personality traits and Self-control both play a mediating role in childhood trauma and depressive symptoms, and the mediating effect values are 0.116 (95%CI = [0.098, 0.137]), and 0.022 (95%CI = [0.012, 0.032]) respectively. The chain mediating effect of borderline personality traits and self-control on the relationship between childhood trauma and depressive symptoms was significant (effect value: 0.034, 95%CI = [0.028, 0.042]). CONCLUSIONS Childhood trauma can predict depressive symptoms in adolescents due to the formation of borderline personality traits and the reduction of self-control. These findings are important for understanding the formation of personality traits, self-control abilities and coping strategies shaped by traumatic experiences in adolescents.
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Affiliation(s)
- Yingyan Zhong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qianying Hu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianhua Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuting Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Rumeng Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Enzhao Cong
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- School of Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China.
| | - Yifeng Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Kujovic M, Benz D, Riesbeck M, Mollamehmetoglu D, Becker-Sadzio J, Margittai Z, Bahr C, Meisenzahl E. Comparison of 8-vs-12 weeks, adapted dialectical behavioral therapy (DBT) for borderline personality disorder in routine psychiatric inpatient treatment-A naturalistic study. Sci Rep 2024; 14:11264. [PMID: 38760498 PMCID: PMC11101618 DOI: 10.1038/s41598-024-61795-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 05/09/2024] [Indexed: 05/19/2024] Open
Abstract
Dialectical behavior therapy (DBT) is widely acknowledged as an effective treatment for individuals with borderline personality disorder (BPD). However, the optimal treatment duration within DBT remains a topic of investigation. This retrospective, naturalistic non-randomized study aimed to compare the efficacy of 8 week and 12 week DBT interventions with equivalent content, focusing on the change of BPD-specific symptomatology as the primary outcome and depressive symptoms as the secondary outcome. Overall, 175 patients who participated in DBT and received either 8 week or 12 week intervention were included in the analysis. Routine inpatient treatment was adapted from standard DBT with the modules: skill training, interpersonal skills, dealing with feelings, and mindfulness. Measurements were taken at baseline, mid-point, and endpoint. The borderline symptom list-23 (BSL-23) was used for the assessment of borderline-specific symptoms, while the Beck depression inventory-II (BDI-II) was used for the assessment of depressive symptoms. Statistical analysis was conducted using linear mixed models. Effect sizes were calculated for both measures. The results of the analysis indicated an improvement in both groups over time. Effect sizes were d = 1.29 for BSL-23 and d = 1.79 for BDI-II in the 8 week group, and d = 1.16 for BSL-23 and d = 1.58 for BDI-II in the 12 week group. However, there were no differences in the change of BPD-specific symptoms or the severity of depressive symptoms between the 8 week and 12 week treatment duration groups. Based on these findings, shorter treatment durations, like 8 weeks, could be a viable alternative, offering comparable therapeutic benefits, potential cost reduction, and improved accessibility. However, further research is needed to explore factors influencing treatment outcomes and evaluate the long-term effects of different treatment durations in DBT for BPD.Trial registration: drks.de (DRKS00030939) registered 19/12/2022.
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Affiliation(s)
- Milenko Kujovic
- Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
| | - Daniel Benz
- Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Mathias Riesbeck
- Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Devin Mollamehmetoglu
- Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Julia Becker-Sadzio
- University Hospital for Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, Tübingen Center for Mental Health, University Hospital Tübingen, Tübingen, Germany
| | - Zsofia Margittai
- Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Bahr
- Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Eva Meisenzahl
- Department of Psychiatry and Psychotherapy, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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Mancinelli F, Nolte T, Griem J. Attachment and borderline personality disorder as the dance unfolds: A quantitative analysis of a novel paradigm. J Psychiatr Res 2024; 175:470-478. [PMID: 38823203 DOI: 10.1016/j.jpsychires.2024.03.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 06/03/2024]
Abstract
Current research on personality disorders strives to identify key behavioural and cognitive facets of patient functioning, to unravel the underlying root causes and maintenance mechanisms. This process often involves the application of social paradigms - however, these often only include momentary affective depictions rather than unfolding interactions. This constitutes a limitation in our capacity to probe core symptoms, and leaves potential findings uncovered which could help those who are in close relationships with affected individuals. Here, we deployed a novel task in which subjects interact with four unknown virtual partners in a turn-taking paradigm akin to a dance, and report on their experience with each. The virtual partners embody four combinations of low/high expressivity of positive/negative mood. Higher scores on our symptomatic measures of attachment anxiety, avoidance, and borderline personality disorder (BPD) were all linked to a general negative appraisal of all the interpersonal experiences. Moreover, the negative appraisal of the partner who displayed a high negative/low positive mood was tied with attachment anxiety and BPD symptoms. The extent to which subjects felt responsible for causing partners' distress was most strongly linked to attachment anxiety. Finally, we provide a fully-fledged exploration of move-by-move action latencies and click distances from partners. This analysis underscored slower movement initiation from anxiously attached individuals throughout all virtual interactions. In summary, we describe a novel paradigm for second-person neuroscience, which allowed both the replication of established results and the capture of new behavioural signatures associated with attachment anxiety, and discuss its limitations.
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Affiliation(s)
- Federico Mancinelli
- University of Bonn, Transdisciplinary Research Area "Life and Health", Hertz Chair for Artificial Intelligence and Neuroscience, Bonn, Germany; Scuola Internazionale Superiore di Studi Avanzati, Trieste, Italy.
| | - Tobias Nolte
- Research Department of Clinical, Educational and Health Psychology, University College London, London,UK; Anna Freud National Centre for Children and Families, London, UK
| | - Julia Griem
- Research Department of Clinical, Educational and Health Psychology, University College London, London,UK
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Bud S, Szentágotai-Tătar A. Assessing Measurement Consistency: A Study of the BPFSC Invariance Across Age and Sex in Romanian Adolescents. Psychol Rep 2024:332941241239592. [PMID: 38508200 DOI: 10.1177/00332941241239592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
The Borderline Personality Feature Scale for Children (BPFSC) is a widely used instrument and currently the only dimensional measure to investigate Borderline Personality features in children and adolescents. The present study aimed to investigate the factor structure and measurement invariance across age and sex in a community sample of 634 adolescents (mean age = 16.72, standard deviation = 1.31). To test for measurement invariance, we conducted multi-group confirmatory factor analysis (MG-CFA). Analysis showed residual invariance across age and sex. Based on the results, we conclude that BPFSC is a valid and reliable instrument to assess Borderline Personality features in adolescents. Implications for evidence-based assessment of Borderline Personality features in adolescence are discussed.
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Affiliation(s)
- Samuel Bud
- Evidence-Based Assessment and Psychological Interventions Doctoral School, Babeş-Bolyai University, Cluj-Napoca, Romania
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
| | - Aurora Szentágotai-Tătar
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeş-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania
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9
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Liu Y, Chen C, Zhou Y, Zhang N, Liu S. Twenty years of research on borderline personality disorder: a scientometric analysis of hotspots, bursts, and research trends. Front Psychiatry 2024; 15:1361535. [PMID: 38495902 PMCID: PMC10941281 DOI: 10.3389/fpsyt.2024.1361535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 02/19/2024] [Indexed: 03/19/2024] Open
Abstract
Borderline personality disorder (BPD), a complex and severe psychiatric disorder, has become a topic of considerable interest to current researchers due to its high incidence and severity of consequences. There is a lack of a bibliometric analysis to visualize the history and developmental trends of researches in BPD. We retrieved 7919 relevant publications on the Web of Science platform and analyzed them using software CiteSpace (6.2.R4). The results showed that there has been an overall upward trend in research interest in BPD over the past two decades. Current research trends in BPD include neuroimaging, biological mechanisms, and cognitive, behavioral, and pathological studies. Recent trends have been identified as "prevention and early intervention", "non-pharmacological treatment" and "pathogenesis". The results are like a reference program that will help determine future research directions and priorities.
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Affiliation(s)
- Yuanli Liu
- Department of Psychology, School of Humanities and Social Sciences, Anhui Agricultural University, Hefei, China
| | - Chaomei Chen
- College of Computing & Informatics, Drexel University, Philadelphia, PA, United States
| | - Ying Zhou
- Department of Psychology, School of Education, China University of Geosciences, Wuhan, China
| | - Na Zhang
- Department of Information Management, Anhui Vocational College of Police Officers, Hefei, China
| | - Shen Liu
- Department of Psychology, School of Humanities and Social Sciences, Anhui Agricultural University, Hefei, China
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Babajide O, Kjaergaard AD, Deng W, Kuś A, Sterenborg RBTM, Åsvold BO, Burgess S, Teumer A, Medici M, Ellervik C, Nick B, Deloukas P, Marouli E. The role of thyroid function in borderline personality disorder and schizophrenia: a Mendelian Randomisation study. Borderline Personal Disord Emot Dysregul 2024; 11:2. [PMID: 38355654 PMCID: PMC10868101 DOI: 10.1186/s40479-024-00246-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/20/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Genome-wide association studies have reported a genetic overlap between borderline personality disorder (BPD) and schizophrenia (SCZ). Epidemiologically, the direction and causality of the association between thyroid function and risk of BPD and SCZ are unclear. We aim to test whether genetically predicted variations in TSH and FT4 levels or hypothyroidism are associated with the risk of BPD and SCZ. METHODS We employed Mendelian Randomisation (MR) analyses using genetic instruments associated with TSH and FT4 levels as well as hypothyroidism to examine the effects of genetically predicted thyroid function on BPD and SCZ risk. Bidirectional MR analyses were employed to investigate a potential reverse causal association. RESULTS Genetically predicted higher FT4 was not associated with the risk of BPD (OR: 1.18; P = 0.60, IVW) or the risk of SCZ (OR: 0.93; P = 0.19, IVW). Genetically predicted higher TSH was not associated with the risk of BPD (OR: 1.11; P = 0.51, IVW) or SCZ (OR: 0.98, P = 0.55, IVW). Genetically predicted hypothyroidism was not associated with BPD or SCZ. We found no evidence for a reverse causal effect between BPD or SCZ on thyroid function. CONCLUSIONS We report evidence for a null association between genetically predicted FT4, TSH or hypothyroidism with BPD or SCZ risk. There was no evidence for reverse causality.
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Affiliation(s)
- Oladapo Babajide
- Queen Mary University of London, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Alisa D Kjaergaard
- Aarhus University Hospital, Steno Diabetes Center, Hedeager Aarhus, Denmark
| | - Weichen Deng
- Queen Mary University of London, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Aleksander Kuś
- Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Rosalie B T M Sterenborg
- Erasmus Medical Center, Academic Center for Thyroid Diseases, Department of Internal Medicine, Rotterdam, Netherlands
- Erasmus Medical Center, Department of Epidemiology, Rotterdam, Netherlands
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bjørn Olav Åsvold
- Department of Public Health and Nursing, Department of Endocrinology, Clinic of Medicine, NTNU, Norwegian University of Science and Technology &, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stephen Burgess
- University of Cambridge, MRC Biostatistics Unit, Cambridge Institute of Public Health, Cambridge, UK
- Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Alexander Teumer
- Institute of Community Medicine, University Medicine Greifswald, Greifswald, Germany
- DZHK German Center for Cardiovascular Research, Berlin, Germany
| | - Marco Medici
- Erasmus Medical Center, Academic Center for Thyroid Diseases, Department of Internal Medicine, Rotterdam, Netherlands
| | - Christina Ellervik
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pathology, Harvard Medical School, Boston, MA, USA
- Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bass Nick
- Division of Psychiatry, University College London, Mental Health Neuroscience, London, UK
| | - Panos Deloukas
- Queen Mary University of London, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK
| | - Eirini Marouli
- Queen Mary University of London, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, London, UK.
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11
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Leichsenring F, Fonagy P, Heim N, Kernberg OF, Leweke F, Luyten P, Salzer S, Spitzer C, Steinert C. Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies. World Psychiatry 2024; 23:4-25. [PMID: 38214629 PMCID: PMC10786009 DOI: 10.1002/wps.21156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2024] Open
Abstract
Borderline personality disorder (BPD) was introduced in the DSM-III in 1980. From the DSM-III to the DSM-5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self-image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self-mutilation behavior, and transient stress-related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi-structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self-mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization-based therapy, transference-focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic-like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high-quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.
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Affiliation(s)
- Falk Leichsenring
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Nikolas Heim
- International Psychoanalytic University, Berlin, Germany
| | - Otto F Kernberg
- Personality Disorders Institute, Weill Cornell Medical College, New York, NY, USA
| | - Frank Leweke
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
| | - Patrick Luyten
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Simone Salzer
- International Psychoanalytic University, Berlin, Germany
| | - Carsten Spitzer
- Department of Psychosomatics and Psychotherapy, University of Rostock, Rostock, Germany
| | - Christiane Steinert
- Department of Psychosomatics and Psychotherapy, University of Giessen, Giessen, Germany
- International Psychoanalytic University, Berlin, Germany
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12
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Garikana S, Jain P, Megna JL, Leontieva L. Borderline Personality Disorder With Atypical Traits in a 30-Year-Old Female: A Case Report. Cureus 2024; 16:e55166. [PMID: 38558669 PMCID: PMC10980538 DOI: 10.7759/cureus.55166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
In this paper, we report an atypical presentation of borderline personality disorder (BPD) in a 30-year-old female with a history of childhood molestation and trauma and a prior diagnosis of post-traumatic stress disorder (PTSD). The patient was hospitalized due to anxiety, depression, and guilt over her relapse into alcohol use disorder. During her hospital stay, we diagnosed her with BPD based on psychiatric examination, clinical interviews, and patient history. While the patient exhibited some of the typical characteristics of BPD, such as an instability of interpersonal and romantic relationships, there were numerous findings that were atypical of BPD. These include a demonstration of mature defense mechanisms such as sublimation and altruism, high levels of occupational functioning, strong maternal caregiving behavior, and no history of self-harm. Further analysis of the patient's personality traits helped us identify that this presentation could be best characterized as a high-functioning internalizing subtype of BPD as identified in prior literature.
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Affiliation(s)
- Sarah Garikana
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Pratik Jain
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - James L Megna
- Psychiatry and Behavioral Sciences, State University of New York Upstate Medical University, Syracuse, USA
| | - Luba Leontieva
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
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13
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Dell’Osso L, Bonelli C, Nardi B, Giovannoni F, Pronestì C, Cremone IM, Amatori G, Pini S, Carpita B. Rethinking Clozapine: Lights and Shadows of a Revolutionary Drug. Brain Sci 2024; 14:103. [PMID: 38275523 PMCID: PMC10813979 DOI: 10.3390/brainsci14010103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
The current literature globally highlights the efficacy of Clozapine in several psychiatric disorders all over the world, with an FDA indication for reducing the risk of repeated suicidal behavior in patients with schizophrenia or schizoaffective disorder. A growing field of research is also stressing a possible broader beneficial effect of Clozapine in promoting neuroprotection and neurotrophism. However, this drug is linked to several life-threatening side effects, such as agranulocytosis, myocarditis and seizures, that limit its use in daily clinical practice. For this work, a search was performed on PubMed using the terms "Clozapine indications", "Clozapine adverse effects", "Clozapine regenerative effects", and "Clozapine neuroplasticity" with the aim of reviewing the scientific literature on Clozapine's treatment indications, adverse effects and potential regenerative role. The results confirmed the efficacy of clozapine in clinical practice, although limited by its adverse effects. It appears crucial to raise awareness among clinicians about the potential benefits of using Clozapine, as well educating medical personnel about its risks and the early identification of possible adverse effects and their management.
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Affiliation(s)
| | - Chiara Bonelli
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, 67 Via Roma, 56126 Pisa, Italy; (L.D.); (B.N.); (F.G.); (C.P.); (I.M.C.); (G.A.); (S.P.); (B.C.)
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14
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Tran T, Stanzel K, Nguyen H, Thean P, French D, Popplestone S, Fisher J. Effects of a residential psychoeducational parenting program on maternal anxiety and fatigue symptoms. J Reprod Infant Psychol 2024:1-17. [PMID: 38198123 DOI: 10.1080/02646838.2024.2303468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/03/2024] [Indexed: 01/11/2024]
Abstract
AIMS To evaluate the effects of a 5-day residential psychoeducational program on maternal anxiety and fatigue symptoms among women admitted with their unsettled infants and determine the psychological, social and demographic characteristics which are associated with the effect sizes. METHODS This is a secondary analysis of routinely collected data from mothers with children aged up to 24 months who were admitted to and completed the residential early parenting psychoeducational program at Masada Private Hospital Early Parenting Centre in Melbourne. Maternal anxiety symptoms were assessed using the Edinburgh Postnatal Depression Scale Three-item Anxiety subscale and maternal fatigue symptoms were the Modified Fatigue Assessment Scale at preadmission, predischarge and follow-up 6-weeks post discharge. RESULTS Overall, 1220 admissions were included in analyses. Cohen's d for reductions in the anxiety symptoms during the program was 0.64 (95% CI 0.59 to 0.70) and from pre-discharge to post-discharge was 0.14 (95% CI 0.09 to 01.9), and for fatigue was 1.21 (95% CI 1.11 to 1.32). Higher borderline personality disorder symptoms and experiencing more stressful life events were associated with lower mean reductions in anxiety and fatigue symptoms. Women with a history of mental health problems had lower anxiety symptom reductions. Women who were older or had younger babies had lower fatigue score reductions. CONCLUSION This study confirms the effectiveness of a 5-day residential early parenting psychoeducational program provided by a private sector facility in reducing postnatal anxiety and fatigue rapidly, with effects maintained to at least 6-weeks post-discharge.
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Affiliation(s)
- Thach Tran
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karin Stanzel
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Hau Nguyen
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Patsy Thean
- Early Parenting Centre, Ramsay Health Care - Masada Private Hospital, Melbourne, Australia
| | | | - Sally Popplestone
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Fisher
- Global and Women's Health, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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15
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Banerjee D, Ray R. Endoxifen in Treatment of Individuals with Borderline Personality Disorder with Predominant Impulsivity: A Case Series. CONSORTIUM PSYCHIATRICUM 2023; 4:66-73. [PMID: 38618630 PMCID: PMC11009975 DOI: 10.17816/cp13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/14/2023] [Indexed: 04/16/2024] Open
Abstract
Endoxifen, a protein kinase C inhibitor, has been approved for use in manic episodes in India. One of the symptom traits that it predominantly targets is impulsivity. Impulsivity can also be a symptom dimension of other mental health conditions, one of which is Borderline Personality Disorder (BPD). Management of BPD is challenging, with limited pharmacological options that are symptom-directed and psychotherapy sessions that are fraught with early dropouts and lack of compliance. Impulsive behaviors represent a major reason for seeking help in BPD, especially with regard to non-suicidal self-injury, substance abuse, high-risk sexual behavior, aggression, etc. Here, we present a case series comprising five individuals with a diagnosis of BPD whose treatment regimens were changed and endoxifen added at a dose of 8 mg once daily. Clinical improvement was monitored using the Borderline Evaluation of Severity Over Time (BEST). All the subjects improved in the impulsivity domains as well as with regard to attention deficits, mood fluctuations, and overall functioning. Endoxifen is thus potential promising in terms of the management of BPD, but needs more extensive study to fully substantiate its clinical benefits.
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Affiliation(s)
| | - Rajashree Ray
- Gauri Devi Institute of Medical Sciences and Hospital
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16
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Muriel NS, López Resa P, Moraleda Sepúlveda E. Linguistic characteristics in bipolar disorder versus borderline personality disorder. Sci Rep 2023; 13:21715. [PMID: 38065986 PMCID: PMC10709396 DOI: 10.1038/s41598-023-46038-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Scientific evidence has documented throughout the research carried out in recent years, the neuropsychological, behavioral and adaptive difficulties presented by people with Bipolar Disorder and Borderline Personality Disorder at different stages of their development. However, little importance has been given to other factors such as communication, especially in the adult population. The objective of this research was to know the language characteristics presented by people from both groups and the differences in linguistic development. The sample consisted of 60 participants between the ages of 17 and 42:31 of them with a diagnosis of Borderline Personality Disorder and the remaining 29 with a diagnosis of Bipolar Disorder. The standardized evaluation instruments were: the Social Skills Scale and the Pragmatic Competence Questionnaire completed by three different informants (families, professionals and the own person). The results obtained show that both populations manifest linguistic difficulties in adulthood and that there are differences depending on the perception of the agent involved in the language assessment. These results are highly relevant since they provide up-to-date information about language level, support the need for language intervention in adulthood, and reflect a different communicative profile in Bipolar Disorder and Borderline Personality Disorder.
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Affiliation(s)
- Noelia Santos Muriel
- Department of Psychology, Faculty of Health Sciences, University of Castilla-La-Mancha, Avda Real Fábrica de la Seda s/n, 45600, Talavera de la Reina, Spain
| | - Patricia López Resa
- Department of Psychology, Faculty of Health Sciences, University of Castilla-La-Mancha, Avda Real Fábrica de la Seda s/n, 45600, Talavera de la Reina, Spain
| | - Esther Moraleda Sepúlveda
- Department of Psychology, Faculty of Pychology, University Complutense, Campus de Somosaguas, 28223, Pozuelo de Alarcón, Madrid, Spain.
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17
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Esposito CM, Auxilia AM, Ceresa A, Zanvit FG, Zanelli Quarantini F, Capuzzi E, Caldiroli A, Clerici M, Buoli M. Which factors are associated with duration of untreated illness in borderline personality disorder? Early Interv Psychiatry 2023; 17:1216-1221. [PMID: 37046384 DOI: 10.1111/eip.13429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/02/2023] [Accepted: 03/28/2023] [Indexed: 04/14/2023]
Abstract
AIM Borderline personality disorder (BPD) is a prevalent condition associated with high rates of hospitalizations. The purpose of this manuscript was to detect the factors associated with duration of untreated illness (DUI) in BPD. METHODS Through chart review, we identified 152 patients followed up by community psychiatry services in Milan and Monza, Italy. The association between DUI and socioeconomic and clinical variables was examined using Pearson correlation and analyses of variances. The statistically significant variables from univariate analyses were then inserted in regression models. RESULTS A longer DUI was associated with several variables (substance misuse after the onset of BPD, older age, earlier age at onset, longer duration of illness), but these results were not maintained in the regression analyses. CONCLUSIONS In conclusion, DUI does not seem to be significantly associated with specific clinical aspects of BPD, or significantly modify the course and outcome of the disorder. Studies with larger samples have to confirm these preliminary findings.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anna Maria Auxilia
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Alessandro Ceresa
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Francesco Zanelli Quarantini
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Enrico Capuzzi
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Alice Caldiroli
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
- Psychiatric Department, Azienda Socio Sanitaria Territoriale Monza, Monza, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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18
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Ruiz-Guerrero F, Gomez Del Barrio A, de la Torre-Luque A, Ayad-Ahmed W, Beato-Fernandez L, Polo Montes F, Leon Velasco M, MacDowell KS, Leza JC, Carrasco JL, Díaz-Marsá M. Oxidative stress and inflammatory pathways in female eating disorders and borderline personality disorders with emotional dysregulation as linking factors with impulsivity and trauma. Psychoneuroendocrinology 2023; 158:106383. [PMID: 37714047 DOI: 10.1016/j.psyneuen.2023.106383] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 07/02/2023] [Accepted: 09/05/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Borderline personality disorder (BPD) and eating disorders (ED) are both disorders with emotional dysregulation that may share some similar biological underpinnings, leading to oxidative/inflammatory alterations. Unfortunately, to date, no studies have assessed the relationship between clinical features, inflammatory alterations and childhood trauma across these disorders. Our aim was to identify the potential common and disorder-specific inflammatory pathways and examine possible associations between these dysregulated pathways and the clinical features. METHODS We studied a sample of 108 women (m = 27.17 years; sd = 7.64), divided into four groups: 23 patients with a restrictive ED (ED-R), 23 patients with a bingeeating/ purging ED (ED-P) and 26 patients with BPD; whereas the control group included 23 healthy subjects. Several inflammatory/oxidative parameters: tumor necrosis factor alpha (TNFα), Thiobarbituric Acid Reactive Substances (TBARS), inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX2), p38 mitogenactivated protein kinases, ERK mitogen-activated protein kinases and c-Jun NH2- terminal kinase (JNK), and some antiinflammatory antioxidant elements: glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), Kelch-like ECHassociated protein (Keap1) were determined in plasma or peripheral blood mononuclear cells. Furthermore, clinical, impulsivity, trauma and eating behavior questionnaires were administered. RESULTS Three main inflammatory/oxidative components were extracted using principal component analysis (59.19 % of biomarker variance explained). Disorder-specific dysfunction in the inflammatory and oxidative pathways in patients with BPD and ED were revealed by means of relationships with specific principal components (p < .01). BPD patients showed higher levels of a component featured by elevated levels of JNK and lower of GPx and SOD. ED-R and impulsivity were associated with a component featured by the activation of ERK and negative influence of Keap1. The component featured by the suppression of catalase and COX2 was associated with both ED subtypes and trauma exposure. CONCLUSION Several risk factors such as trauma, impulsivity and eating disorder symptoms were transdiagnostically associated with some inflammatory alterations regardless of diagnosis. These findings suggest that the clinical profile comprising trauma exposure and an emotional dysregulation disorder might constitute a specific endophenotype highly linked with inflammatory alterations.
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Affiliation(s)
- Francisco Ruiz-Guerrero
- Marqués de Valdecilla University Hospital, Eating Disorders Unit, Department of Psychiatry, Santander, Spain; Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain
| | - Andrés Gomez Del Barrio
- Marqués de Valdecilla University Hospital, Eating Disorders Unit, Department of Psychiatry, Santander, Spain; Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Valdecilla Biomedical Research Institute (IDIVAL), Santander, Spain.
| | - Alejandro de la Torre-Luque
- Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Spain
| | | | | | | | | | - Karina S MacDowell
- Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain; IIS Hospital 12 de Octubre, IUIN-UCM, Madrid, Spain
| | - Juan C Leza
- Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Pharmacology and Toxicology, School of Medicine, UCM, Madrid, Spain; IIS Hospital 12 de Octubre, IUIN-UCM, Madrid, Spain
| | - José Luis Carrasco
- Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Spain; IIS Hospital Clínico San Carlos, Madrid, Spain
| | - Marina Díaz-Marsá
- Center for Biomedical Research in Mental Health (CIBERSAM), Spain; Department of Legal Medicine, Psychiatry, and Pathology, School of Medicine, Universidad Complutense de Madrid (UCM), Spain; IIS Hospital Clínico San Carlos, Madrid, Spain.
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19
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Felix CB, Sand P. Feasibility and Efficacy of Intensive Dialectical Behavior Therapy Skills Training in An Outpatient Setting for A Group of Patients with Extensive Care Needs - A Transdiagnostic Approach. Psychiatr Q 2023; 94:691-704. [PMID: 37792150 PMCID: PMC10638174 DOI: 10.1007/s11126-023-10052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE Dialectical behavior therapy (DBT) is a treatment originally developed för chronically suicidal adults. It is common to adapt it by using one specific component, the DBT skills training (DBT-ST) and apply it in a group therapy setting for a variety of mental disorders. The primary aim of the study was to explore whether patients with extended care needs would report improved mental health after participating in an intensive form of DBT-ST. The secondary aim was to explore whether the use of psychiatric inpatient care for the group would decrease. METHODS Thirty-seven participants completed the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), and visual analogue scale (VAS) at three time points: pre-intervention, post-intervention and at 6-month follow-up after intensive DBT-ST. RESULTS One-way ANOVA showed a significant effect for time on the CORE-OM: F (2,35) = 7.93, p = .001, η2 = 0.312 (large effect size). Post hoc tests indicated a significant difference between pre-intervention and post-intervention (p = .001) and between pre-intervention and follow-up (p = .01). A Friedman test indicated a statistically significant difference in the VAS scale scores across the three time points, with p-values between 0.00 and 0.05. There was no difference in psychiatric healthcare consumption. CONCLUSION These study results confirm to some extent the feasibility and effectiveness of the intensive DBT-ST in a transdiagnostic clinical setting. The participants had a positive outcome from the skills training program, but psychiatric healthcare consumption did not decrease.
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Affiliation(s)
- Christina Bertholds Felix
- Department of Psychiatry for Affective Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Sand
- Department of Psychiatry for Affective Disorders, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
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20
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De Prisco M, Oliva V, Fico G, Radua J, Grande I, Roberto N, Anmella G, Hidalgo-Mazzei D, Fornaro M, de Bartolomeis A, Serretti A, Vieta E, Murru A. Emotion dysregulation in bipolar disorder compared to other mental illnesses: a systematic review and meta-analysis. Psychol Med 2023; 53:7484-7503. [PMID: 37842774 PMCID: PMC10951413 DOI: 10.1017/s003329172300243x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/24/2023] [Accepted: 07/27/2023] [Indexed: 10/17/2023]
Abstract
People with bipolar disorder (BD) often present emotion dysregulation (ED), a pattern of emotional expression interfering with goal-directed behavior. ED is a transdiagnostic construct, and it is unclear whether it manifests itself similarly in other conditions, such as major depressive disorder (MDD) or borderline personality disorder (BPD), or has specific features in BD. The present systematic review and meta-analysis explored ED and adopted emotion regulation (ER) strategies in BD compared with other psychiatric conditions. PubMed/MEDLINE, EMBASE, Scopus, and PsycINFO databases were systematically searched from inception to April 28th, 2022. Studies implementing validated instruments assessing ED or ER strategies in BD and other psychiatric disorders were reviewed, and meta-analyses were conducted. Twenty-nine studies yielding multiple comparisons were included. BD was compared to MDD in 20 studies (n = 2451), to BPD in six studies (n = 1001), to attention deficit hyperactivity disorder in three studies (n = 232), to anxiety disorders in two studies (n = 320), to schizophrenia in one study (n = 223), and to post-traumatic stress disorder in one study (n = 31). BD patients did not differ from MDD patients in adopting most adaptive and maladaptive ER strategies. However, small-to-moderate differences in positive rumination and risk-taking behaviors were observed. In contrast, patients with BPD presented an overall higher degree of ED and more maladaptive ER strategies. There were insufficient data for a meta-analytic comparison with other psychiatric disorders. The present report further supports the idea that ED is a transdiagnostic construct spanning a continuum across different psychiatric disorders, outlining specific clinical features that could represent potential therapeutic targets.
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Affiliation(s)
- Michele De Prisco
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology Federico II University of Naples, Naples, Italy
| | - Vincenzo Oliva
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Giovanna Fico
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Joaquim Radua
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Imaging of Mood- and Anxiety-Related Disorders (IMARD) Group, IDIBAPS, Barcelona, Spain
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Iria Grande
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Natalia Roberto
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Gerard Anmella
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Diego Hidalgo-Mazzei
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology Federico II University of Naples, Naples, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology Federico II University of Naples, Naples, Italy
| | - Alessandro Serretti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Eduard Vieta
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Andrea Murru
- Departament de Medicina, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), c. Casanova, 143, 08036 Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Hospìtal Clinic de Barcelona. c. Villarroel, 170, 08036 Barcelona, Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), c. Villarroel, 170, 08036 Barcelona, Spain
- Institute of Neurosciences (UBNeuro), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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21
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Haapalahti E, Hakko H, Leppänen V, Räsänen S. One-year prevalence and psychiatric comorbidity of borderline personality disorder in a medical certificate population: a registry study of psychiatric outpatients in community mental health care in the city of Oulu. Nord J Psychiatry 2023; 77:811-817. [PMID: 37818619 DOI: 10.1080/08039488.2023.2267032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/24/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVE Borderline personality disorder (BPD) is a common disorder in healthcare settings but estimates of BPD prevalence vary greatly. This study aimed to estimate the one-year prevalence of BPD in psychiatric outpatients and analyze the psychiatric comorbidity presented with BPD. METHOD The data comprised 18-60-year-old patients who had a BPD diagnosis recorded in their medical certificate B (mcB) and were treated in specialized psychiatric outpatient services in the city of Oulu, northern Finland, in 2014. An mcB is a comprehensive summary of a patient's medical history written by a doctor, and patients need it in the Finnish healthcare system when applying for social benefits and rehabilitation measures. RESULTS The prevalence of BPD was 12.8% among patients with an mcB treated in the psychiatric outpatient services. BPD was 3.0 times more common in female than male psychiatric outpatients with an mcB. The most common comorbid psychiatric disorders written in mcBs of BPD patients were mood (81.0%) and anxiety (39.2%) disorders. The only statistically significant gender difference was found in behavioral and emotional disorders (16.7% in men, 1.6% in women). CONCLUSIONS The mcB-based BPD prevalence estimate and psychiatric comorbidity was consistent with previous studies researching psychiatric outpatients with BPD. McBs appear to be a reliable and comprehensive data source for diagnostic information in research.
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Affiliation(s)
- Ellen Haapalahti
- Research Unit of Clinical Medicine, Psychiatry, University of Oulu, Oulu, Finland
| | - Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Virpi Leppänen
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Sami Räsänen
- Research Unit of Clinical Medicine, Psychiatry, University of Oulu, Oulu, Finland
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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22
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Gilbey D, Brealey G, Mateo-Arriero I, Waters Z, Ansell M, Janse van Rensburg E, De Gouveia Belinelo P, Milroy H, Pace G, Runions K, Salmin I, Woolard A. The effectiveness of a day hospital mentalization-based therapy programme for adolescents with borderline personality traits: Findings from Touchstone-Child and Adolescent Mental Health Service. Clin Psychol Psychother 2023; 30:1303-1312. [PMID: 37078825 DOI: 10.1002/cpp.2854] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 04/04/2023] [Accepted: 04/04/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Individuals with borderline personality disorder (BPD) are at a substantial risk of harm to themselves and others, experience high levels of functional impairment and typically are high users of tertiary healthcare to address their mental health concerns. As indicators for BPD typically emerge in adolescence, a day therapy service in Bentley, Western Australia, Touchstone Child and Adolescent Mental Health Service (CAMHS), was developed as an intensive intervention for adolescents with indicators for BPD and its associated symptomology. Touchstone utilizes mentalization-based therapy (MBT) in a therapeutic community setting, where the current study sought to document the anecdotal outcomes using the data provided at Touchstone, to enable a greater understanding of this treatment approach for adolescents with indicators for BPD. METHOD Forty-six participants attended the Touchstone programme between 2015 and 2020. The programme involved 6 months of MBT (group and individual), occupational therapy, education and creative therapies. Measures of self-injury, mood and emergency department presentations were collected pre- and post-programme. RESULTS Results indicate that participants show a reduction in non-suicidal acts and thoughts, as well as a reduction in negative moods and feelings from pre-Touchstone to post-Touchstone. There is also a decrease in participant presentation to tertiary emergency departments for mental health concerns. CONCLUSIONS The current study shows evidence for the efficacy of Touchstone as an MBT therapeutic community intervention to reduce symptoms of emerging BPD and effectively reduce presentations to emergency departments for mental health presentations, alleviating pressure on tertiary hospitals and reducing economic impact of adolescents within this demographic.
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Affiliation(s)
- Dylan Gilbey
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Georgia Brealey
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Irene Mateo-Arriero
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Zoe Waters
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Megan Ansell
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Elmie Janse van Rensburg
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | | | - Helen Milroy
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Giulia Pace
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Kevin Runions
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
| | - Ivan Salmin
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Alix Woolard
- Telethon Kids Institute, Nedlands, Western Australia, Australia
- The University of Western Australia, Perth, Western Australia, Australia
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23
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Pape VR, Braun S, Peters S, Stingl M, Tucha O, Sammer G. The riddle of deliberate self-harm: Physiological and subjective effects of self-cutting cues in patients with borderline personality disorder and healthy controls. Personal Ment Health 2023; 17:328-351. [PMID: 37042027 DOI: 10.1002/pmh.1583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 04/13/2023]
Abstract
Self-harming behavior is a core symptom of borderline personality disorder. Self-report studies show a correlation between a lack of self-reported negative feelings toward self-cutting cues and the likelihood of future self-destructive behavior. Despite these findings, there has so far been insufficient investigation into the implicit emotional processes evoked by this stimulus type. Forty patients with borderline personality disorder and 35 healthy controls between 20 and 50 years of age were confronted with pictures of self-cutting cues and affective reference pictures. A startle reflex paradigm was used for measuring implicit emotional responses, and the Self-Assessment Manikin was used for subjective responses. In line with previous studies, the patients rated the self-cutting pictures significantly less negatively than healthy individuals. On the physiological level, a significant startle inhibition was observed, indicating an activation of the behavioral approach system. A more detailed analysis showed that this startle inhibition effect was specific to scary pictures, whereas no such effect was observed for bloody wounds and self-cutting instruments. For pleasant standard pictures, in contrast, no startle reflex inhibition and no increase in emotional arousal parameters were found. The data replicate the findings of previous studies, demonstrating a generally diminished emotional reactivity to pleasant stimuli in patients with borderline personality disorder. In addition, a physiological approach reaction to self-cutting pictures was found, especially for the scary pictures. These results might indicate a positive identification with the long-lasting consequences of self-cutting behavior in the patients. Implications for therapy are discussed.
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Affiliation(s)
- Valeska Reichel Pape
- Institute of Psychiatry and Psychotherapy, University Medicine Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Silke Braun
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Svenja Peters
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Markus Stingl
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
| | - Oliver Tucha
- Institute of Psychiatry and Psychotherapy, University Medicine Rostock, Gehlsheimer Straße 20, 18147, Rostock, Germany
| | - Gebhard Sammer
- Institute of Psychiatry and Psychotherapy, University Medicine Giessen, Klinikstraße 36, 35392, Giessen, Germany
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Robinson Lake J, Bear N, Fletcher C, Pace G, Salmin I, Brealey G. The impact of a combined mentalisation-based therapy and therapeutic community programme for adolescents with borderline personality disorder traits on service utilisation in Western Australia. Personal Ment Health 2023; 17:300-312. [PMID: 36960575 DOI: 10.1002/pmh.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/15/2023] [Accepted: 01/30/2023] [Indexed: 03/25/2023]
Abstract
This study assessed the effect of a mentalisation-based therapy (MBT) treatment programme on the utilisation of Western Australian public hospitals for mental health presentations over an 18-month period. Hospital data included the number of visits to the emergency department (ED), the number of inpatient admissions to hospital and length of stay of the admissions. Participants included 76 adolescents aged 13-17 years old, who presented with borderline personality disorder (BPD) traits. The Touchstone treatment programme is a time-limited intensive programme that utilises MBT in the context of a therapeutic community. Hospital data for the participants were collected and analysed from three time points; 6 months prior to attending the programme, during the 6-month programme (active treatment) and 6 months after the programme. Results found a statistically significant decrease in hospital utilisation from pre to post programme, with a decline in ED visits, inpatient admissions and admission length of stay. This study presents promising preliminary evidence for the effectiveness of an intensive MBT programme as an intervention for adolescents with BPD features and has significant implications for the public health system in terms of providing effective community-based treatment for this difficult to treat population as well as reducing pressure on tertiary care.
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Affiliation(s)
- Jemima Robinson Lake
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Natasha Bear
- Child and Adolescent Health Service, Bentley, Western Australia, Australia
| | - Carl Fletcher
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Giulia Pace
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Ivan Salmin
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
| | - Georgia Brealey
- Touchstone, Child and Adolescent Mental Health Service, Bentley, Western Australia, Australia
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25
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Tennant M, Frampton C, Mulder R, Beaglehole B. Polypharmacy in the treatment of people diagnosed with borderline personality disorder: repeated cross-sectional study using New Zealand's national databases. BJPsych Open 2023; 9:e200. [PMID: 37881020 PMCID: PMC10753949 DOI: 10.1192/bjo.2023.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/14/2023] [Accepted: 09/22/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND There is insufficient evidence to support the pharmacological treatment of borderline personality disorder. However, previous out-patient cohorts have described high rates of polypharmacy in this group. So far, there have been no national studies that have considered polypharmacy in borderline personality disorder. AIMS To describe psychotropic polypharmacy in people with borderline personality disorder in New Zealand. METHOD New Zealand's national databases have been used to link psychotropic medication dispensing data and diagnostic data for borderline personality disorder. Annual dispensing data for 2014 and 2019 have been compared. RESULTS Fifty percent of people with borderline personality disorder who were dispensed medications had three or more psychotropic medications in 2014. This increased to 55.9% in 2019 (P < 0.001). Those on seven or more psychotropics increased from 8.4 to 10.7% (P < 0.023). Quetiapine was the most dispensed psychotropic medication, being given to 53.8% of people dispensed medication with borderline personality disorder in 2019. Lorazepam dispensing showed the largest increase, going from 15.5 to 26.7% between 2014 and 2019 (P < 0.001). CONCLUSIONS There is a large burden of psychotropic polypharmacy in people with borderline personality disorder. This is concerning because of the lack of evidence regarding the efficacy of these medications in this group.
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Affiliation(s)
- Matthew Tennant
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Chris Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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26
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DiBenedetti D, Kosa K, Waters HC, Oberdhan D. Understanding Patients' Experiences with Borderline Personality Disorder: Qualitative Interviews. Neuropsychiatr Dis Treat 2023; 19:2115-2125. [PMID: 37840625 PMCID: PMC10575031 DOI: 10.2147/ndt.s423882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/09/2023] [Indexed: 10/17/2023] Open
Abstract
Background Patient perspectives of living with borderline personality disorder (BPD) are not traditionally captured in the literature. To overcome this gap, we explored participants' experiences with BPD to gain a better understanding of symptoms and impacts related to the condition. Methods Two experienced researchers conducted semistructured interviews with a subset of participants from a randomized controlled trial evaluating a BPD treatment. The interview study was independent from the trial. Interviews focused on participants' experiences with BPD prior to the trial, including the symptoms and impacts of BPD. Interview transcripts were analyzed to identify dominant trends and generate patterns in the way participants described their experiences with BPD. Results A total of 50 adults with BPD participated in the interview study. The mean age of the participants was 28.5 years (range, 18-53 years) and 72.0% were female. All participants described having difficulties with extreme emotional responses and interpersonal relationships, and most participants reported experiencing issues with self-image, impulsivity, suspiciousness/distrust, feelings of emptiness, and anger. The symptoms that were most bothersome to participants were extreme moods or emotional responses and a pattern of unstable personal relationships. All participants remarked that their BPD-related symptoms negatively impacted their interpersonal relationships, and nearly two-thirds of the sample reported that the impact of BPD on their relationships was the most bothersome. Additionally, more than half of the participants discussed impacts on work or school, memory or thinking, self-care, and financial and legal issues. Conclusion Participants reported that the most bothersome symptoms of BPD were those related to extreme moods or emotional responses and interpersonal relationships. Participants similarly described the impact of BPD on their interpersonal relationships as the most bothersome. Overall, participant perspectives from this study indicate that the burden of BPD is significant and new treatments tailored to patients' real-world needs are warranted.
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Affiliation(s)
- Dana DiBenedetti
- Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Katherine Kosa
- Patient-Centered Outcomes Assessment, RTI Health Solutions, Research Triangle Park, NC, USA
| | - Heidi C Waters
- Global Value & Real-World Evidence, Otsuka Pharmaceutical Development & Commercialization, Inc, Rockville, MD, USA
| | - Dorothee Oberdhan
- Global Value & Real-World Evidence, Otsuka Pharmaceutical Development & Commercialization, Inc, Rockville, MD, USA
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27
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Lu Z, Chen M, Yan S, Deng W, Wu T, Liu L, Zhou Y. The relationship between depressive mood and non-suicidal self-injury among secondary vocational school students: the moderating role of borderline personality disorder tendencies. Front Psychiatry 2023; 14:1187800. [PMID: 37867773 PMCID: PMC10585263 DOI: 10.3389/fpsyt.2023.1187800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/19/2023] [Indexed: 10/24/2023] Open
Abstract
Background Non-suicidal self-injury (NSSI) has become an important public health issue of global concern, often occurring in adolescents, and depressive mood is closely related to NSSI. In addition, NSSI is considered a symptom of borderline personality disorder. It has been found that adolescents in secondary vocational schools are more vulnerable to behavior and emotional disorders than those in general high schools. This study investigated the risk factors associated with NSSI affecting secondary vocational school students and analyzed the role of borderline personality disorder tendencies in promoting the occurrence of NSSI among students with depressive moods. Methods A total of 1,848 Chinese secondary vocational students completed a self-report questionnaire. The homemade NSSI behavior questionnaire, Patient Health Questionnaire-9 and Personality Diagnostic Questionnaire-4 were used in this survey. Binary logistic regression and PROCESS software analysis were used to explore the influencing factors associated with NSSI and to test for moderating effects. Results Female (OR = 3.412, 95% CI 2.301-5.060), drinking history (OR = 2.007, 95% CI 1.383-2.911), history of suicidal death exposure (OR = 3.161, 95% CI 1.999-4.999), depressive mood (OR = 2.436, 95% CI 1.668-3.558) and borderline personality disorder tendencies (OR = 2.558, 95% CI = 1.764-3.711) were independent risk factors for NSSI. Borderline personality disorder tendencies (B = 0.047, p = 0.000) moderated the relationship between depressive mood and NSSI. The stronger the borderline personality tendencies, the more NSSI behavior occurred when they were depressive. Conclusions Borderline personality disorder tendencies in secondary vocational school adolescents significantly enhance the association of depressive mood with NSSI. There is a moderating role for borderline personality disorder tendencies in depressive mood and NSSI.
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Affiliation(s)
- Zhaoyuan Lu
- School of Medicine, Jianghan University, Wuhan, China
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Affiliated Wuhan Mental Health Center, Jianghan University, Wuhan, China
| | - Mo Chen
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | - Shu Yan
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
| | - Weixi Deng
- Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Taimin Wu
- Institute of Education, China University of Geosciences (Wuhan), Wuhan, China
| | - Lianzhong Liu
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
- Affiliated Wuhan Mental Health Center, Jianghan University, Wuhan, China
- Affiliated Wuhan Mental Health Center, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Yang Zhou
- Department of Psychiatry, Wuhan Mental Health Center, Wuhan, China
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28
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Wang Q, Li P, Qi S, Yuan J, Ding Z. Borderline personality disorder and thyroid diseases: a Mendelian randomization study. Front Endocrinol (Lausanne) 2023; 14:1259520. [PMID: 37854187 PMCID: PMC10579900 DOI: 10.3389/fendo.2023.1259520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/18/2023] [Indexed: 10/20/2023] Open
Abstract
Background Previous studies have shown that there is a correlation between diseases of the thyroid gland and mental illnesses; however, any causal relationship between them remains unclear. This study aimed to evaluate the causal relationship between borderline personality disorder and four thyroid diseases. Methods The causal relationship was inferred using double-sample Mendelian randomization analysis of appropriate instrumental variables from genome-wide association studies. We calculated the estimated value of the effect using various statistical methods. Results Borderline personality disorder was a risk factor for non-toxic single thyroid nodules with each increase in standard deviation increasing the risk of a non-toxic single thyroid nodule by 1.13 times (odds ratio = 1.131; 95% confidence interval, 1.006-1.270; P=0.039). There was no evidence of a correlation between borderline personality disorder and hyperthyroidism/thyrotoxicosis, hypothyroidism, and autoimmune thyroiditis. Conclusion This study showed that there is a positive causal correlation between borderline personality disorder and non-toxic single thyroid nodules but not with other thyroid diseases. This means that thyroid status should be monitored in patients with borderline personality disorder. However, the possibility of a causal relationship between other mental illnesses and thyroid diseases requires further research.
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Affiliation(s)
- Qian Wang
- Department of Thyropathy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Department of Thyropathy, Sunsimiao Hospital, Beijing University of Chinese Medicine, Tongchuan, Shanxi, China
| | - Peijin Li
- Department of Oncology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shuo Qi
- Department of Thyropathy, Sunsimiao Hospital, Beijing University of Chinese Medicine, Tongchuan, Shanxi, China
| | - Jiaojiao Yuan
- Department of Thyropathy, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhiguo Ding
- Department of Thyropathy, Sunsimiao Hospital, Beijing University of Chinese Medicine, Tongchuan, Shanxi, China
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29
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Culina I, Maillard P, Loosli J, Martin-Soelch C, Berney S, Kolly S, Kramer U. Validation of the French version of the Revised Diagnostic Interview for Borderlines (DIB-R) for assessing the psychopathology of borderline personality disorder. Borderline Personal Disord Emot Dysregul 2023; 10:27. [PMID: 37718410 PMCID: PMC10506241 DOI: 10.1186/s40479-023-00233-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/26/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is frequently subject to misdiagnosis or underdiagnosis. As a matter of fact, its evaluation poses several challenges, highlighting the importance of having validated evaluation instruments. The Revised Diagnostic Interview for Borderlines (DIB-R) is widely used and recognized for its validity when it comes to assessing the psychopathology of BPD, but, as for now, no French version of the interview exists. The aim of the current work is to validate a French version of the DIB-R. METHODS The sample consists of N = 65 patients with borderline personality disorder (BPD) and N = 57 treatment seeking patients (non-BPD comparison group). For inter-rater reliability, a subsample of N = 84 interviews will be assessed by two raters, n = 47 for the BPD group and n = 37 for the non-BPD comparison group. RESULTS To assess reliability, we conducted analyses of internal consistency and inter-rater reliability. The results were good for the overall interview as well as for the four domains of the DIB-R. To assess validity, we calculated the receiver operating characteristic (ROC) curve, sensitivity, specificity, predictive values, convergent and discriminative validity. The optimal cutoff was found to be 7. Regarding convergent validity, we found strong convergence between the Borderline Symptom List (BSL-23) and the DIB-R total score. Additionally, the two groups statistically differed on all the DIB-R scores, which indicates that the interview discriminates between the two groups. CONCLUSIONS Our results indicate good psychometric properties of the French version of the DIB-R. This has important implications as the interview is useful both in clinical settings and for research purposes. Additionally, the present paper aims to contribute to the more general effort of demonstrating generalizability and transportability of the scale.
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Affiliation(s)
- Ines Culina
- Department of Psychiatry, General Psychiatry Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
- Department of Psychology, Unit of Clinical and Health Psychology, University Fribourg, Fribourg, Switzerland.
| | | | - Janice Loosli
- Institute of Psychotherapy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Chantal Martin-Soelch
- Department of Psychology, Unit of Clinical and Health Psychology, University Fribourg, Fribourg, Switzerland
| | - Sylvie Berney
- Department of Psychiatry, General Psychiatry Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Kolly
- Department of Psychiatry, General Psychiatry Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | - Ueli Kramer
- Department of Psychiatry, General Psychiatry Service, University Hospital Center and University of Lausanne, Lausanne, Switzerland
- Institute of Psychotherapy, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Windsor, Windsor, Canada
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30
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Tsyngauz E, Chiu AK, Faruqui Z. Importance of Longitudinal Assessments in a Case of Comorbid Polysubstance Use Disorder and Borderline Personality Disorder Misdiagnosed As Bipolar I Disorder. Cureus 2023; 15:e45253. [PMID: 37842374 PMCID: PMC10576620 DOI: 10.7759/cureus.45253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Differentiating between borderline personality disorder (BPD) and bipolar disorder (BD) can be difficult. Both may present with altered mood states, deliberate self-harm, suicidality, impulsivity, unstable relationships, and risky behaviors. A manic episode is characterized by at least one week of elevated or irritated mood and at least three of the following: distractibility, impulsivity, grandiosity, flight of ideas, psychomotor activity, decreased need for sleep, and pressured speech. Borderline personality disorder is characterized by unstable mood and relationships, fear of abandonment, impulsivity, self-mutilation, suicidality, and a feeling of emptiness. In combination with polysubstance use, borderline personality disorder can present similarly to a manic episode and lead to an incorrect diagnosis of bipolar I disorder. In this study, we present a 44-year-old female whose psychiatric history highlights the importance of long-term patient observation in making an accurate diagnosis. Over the course of several years, she was given incorrect psychiatric diagnoses, including attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder, and bipolar I disorder. As a result, her interpersonal relationships remained unstable and significantly affected her quality of life. Over the course of consistent, long-term psychiatric appointments, conversations with family members, and notes from previous psychiatrists, it became evident that substance use had also complicated her psychiatric history, leading to the aforementioned diagnoses. Once this was established, she was diagnosed with borderline personality disorder; subsequent correct medical intervention has been integral in helping her maintain a steady job and improve her interpersonal relationships and quality of life.
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Affiliation(s)
- Esther Tsyngauz
- Psychiatry and Behavioral Sciences, Drexel University College of Medicine, Philadelphia, USA
| | - Andrew K Chiu
- Psychiatry, Drexel University College of Medicine, Philadelphia, USA
| | - Zeeshan Faruqui
- Interventional Psychiatry, Keystone Health, Chambersburg, USA
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31
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Zou M, Broadbear JH, Rao S. Exploring the Utility of Neurostimulation Therapies in the Treatment of Borderline Personality Disorder: A Systematic Literature Review. J ECT 2023; 39:151-157. [PMID: 36988515 DOI: 10.1097/yct.0000000000000916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
ABSTRACT The use of electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS) in the treatment of people diagnosed with borderline personality disorder (BPD) highlights the need for systematic review of the evidence supporting this practice. A comprehensive literature search identified seven original clinical research studies investigating the use of brain stimulation therapies in people diagnosed with BPD. The lack of consistent study design, diagnostic methodology, treatment parameters, and outcome measures precluded analysis of aggregated study results. There were no ECT studies evaluating BPD symptom outcomes; however, studies of ECT in patients with comorbid BPD and depression suggested that depressive symptoms were less responsive to ECT compared with depression-only patients. The few studies available suggest that TMS may lead to clinically and statistically significant improvements in BPD symptoms and depressive symptoms. Similar overall improvements were reported despite the use of heterogeneous TMS treatment protocols, highlighting the importance of including a sham condition to investigate the contribution of the placebo effect to overall improvement. There is still no clear evidence supporting the use of ECT for treating people with BPD (with or without depression); therefore, the use of ECT in this population should be approached with caution. Although TMS shows early promise, the low numbers of participants in the few available studies suggest the urgent need for larger randomized controlled trials to provide an evidence base for this increasingly popular treatment.
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Affiliation(s)
- Michael Zou
- From the Spectrum Personality Disorder and Complex Trauma Service
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Lin D, Zona L, Seery E. Navigating Countertransference in Inpatient Settings: Optimizing Interventions for Patients with Borderline Personality Disorder and Repeated Acute Hospitalizations. Psychodyn Psychiatry 2023; 51:330-349. [PMID: 37712661 DOI: 10.1521/pdps.2023.51.3.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Over the years, the psychiatric inpatient treatment paradigm has shifted to more brief stays focused on acute stabilization and psychopharmacologic-focused interventions, rather than individual psychotherapeutic engagement. Unfortunately, this has allowed patients with complex interpersonal dynamics, particularly borderline personality disorder, to slip through the cracks of effective treatment. This can contribute to repeated inpatient admissions, where both patients and clinicians feel trapped in a maladaptive, unhelpful cycle. In this article, we examine the evolution of inpatient treatment with de-emphasized psychotherapy practices, review the particular dynamics that patients with borderline personality disorder may evoke within an interdisciplinary treatment team, and provide a framework of clinically based vignettes for scenarios that may arise within inpatient treatment of this patient population. With attention to countertransference patterns and common pitfalls of communication, we offer alternative approaches and conversations with the hopes of improving outcomes and alliances in a new landscape of psychiatric practice.
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Affiliation(s)
- Deborah Lin
- Psychiatry Resident Physician PGY-3, Medical University of South Carolina
| | - Luke Zona
- Psychiatry Resident Physician PGY-2, Medical University of South Carolina
| | - Erin Seery
- Associate Program Director and Assistant Professor, Medical University of South Carolina
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Weijers JG, van Kaam F, Selten JP, de Winter RFP, ten Kate C. Diverging effects of mentalization based treatment for patients with borderline personality disorder and schizophrenia: an explorative comparison. Front Psychiatry 2023; 14:1226507. [PMID: 37692309 PMCID: PMC10485774 DOI: 10.3389/fpsyt.2023.1226507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 08/01/2023] [Indexed: 09/12/2023] Open
Abstract
Introduction There is robust evidence that both patients with schizophrenia (SCZ) and borderline personality disorder (BPD) display mentalizing difficulties. Less is known however about differences in the way mentalization based treatment (MBT) impacts mentalizing capacity in SCZ and BPD patients. This study compares the impact of MBT on mentalizing capacity in individuals with SCZ and BPD. Method The thematic apperception test was used to measure mentalizing capacity. It was administered at the beginning and end of treatment to 26 patients with SCZ and 28 patients with BPD who enrolled in an 18-month long MBT program. For comparison a sample of 28 SCZ patients who did not receive MBT was also included. Using the social cognition and object-relations system, these narratives were analyzed and scored. Missing data was imputed and analyzed using intention-to-treat ANCOVAs with post-treatment measures of mentalizing capacity as dependent variables, group type as independent variable and baseline mentalizing capacities as covariates. Results Results showed that patients with BPD showed significantly more improvement on several measures of mentalizing, including complexity of representation (ηp2 = 0.50, ppooled < 0.001), understanding of social causality (ηp2 = 0.41, ppooled < 0.001) and emotional investment in relationships (ηp2 = 0.41, ppooled < 0.001) compared to patients with SCZ who received MBT. No differences were found regarding affect-tone of relationships (ηp2 = 0.04, ppooled = 0.36). SCZ patients who received MBT showed greater performance on understanding of social causality (ηp2 = 0.12, ppooled = 0.01) compared to SCZ patients who did not receive MBT, but no differences were observed on complexity of representations, capacity for emotional investment or affect-tone of relationships. Discussion Patients with BPD performed better after receiving MBT on three dimensions of mentalizing capacity than SCZ patients who received MBT. Remarkably, SCZ patients who received MBT performed better on one dimension of mentalizing capacity compared to SCZ patients who did not receive MBT. Whereas MBT for BPD clearly involves improvement on most aspects of mentalizing, MBT for SCZ seems to thwart a further decline of other-oriented, cognitive mentalizing. Treatment goals should be adapted toward these disorder-specific characteristics.
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Affiliation(s)
- Jonas G. Weijers
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
| | - Fleur van Kaam
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
| | - Jean-Paul Selten
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Remco F. P. de Winter
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
- MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Coriene ten Kate
- GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands
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Jiménez S, Arango de Montis I, Garza-Villarreal EA. Modeling vulnerability and intervention targets in the Borderline Personality Disorder system: A network analysis of in silico and in vivo interventions. PLoS One 2023; 18:e0289101. [PMID: 37523373 PMCID: PMC10389718 DOI: 10.1371/journal.pone.0289101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023] Open
Abstract
Modeling psychopathology as a complex dynamic system represents Borderline Personality Disorder (BPD) as a constellation of symptoms (e.g., nodes) that feedback and self-sustain each other shaping a network structure. Through in silico interventions, we simulated the evolution of the BPD system by manipulating: 1) the connectivity strength between nodes (i.e., vulnerability), 2) the external disturbances (i.e., stress) and 3) the predisposition of symptoms to manifest. Similarly, using network analysis we evaluated the effect of an in vivo group psychotherapy to detect the symptoms modified by the intervention. We found that a network with greater connectivity strength between nodes (more vulnerable) showed a higher number of activated symptoms than networks with less strength connectivity. We also found that increases in stress affected more vulnerable networks compared to less vulnerable ones, while decreases in stress revealed a hysteresis effect in the most strongly connected networks. The in silico intervention to symptom alleviation revealed the relevance of nodes related to difficulty in anger regulation, nodes which were also detected as impacted by the in vivo intervention. The complex systems methodology is an alternative to the common cause model with which research has approached the BPD phenomenon.
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Affiliation(s)
- Said Jiménez
- Departamento de Psicología, Tecnológico de Monterrey, Ciudad de México, México
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Iván Arango de Montis
- Clínica de Trastorno Límite de Personalidad, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
| | - Eduardo A Garza-Villarreal
- Instituto de Neurobiología, Universidad Nacional Autónoma de México Campus Juriquilla, Querétaro, México
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Xu YE, Barron DA, Sudol K, Zisook S, Oquendo MA. Suicidal behavior across a broad range of psychiatric disorders. Mol Psychiatry 2023; 28:2764-2810. [PMID: 36653675 PMCID: PMC10354222 DOI: 10.1038/s41380-022-01935-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 12/12/2022] [Accepted: 12/16/2022] [Indexed: 01/20/2023]
Abstract
Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.
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Affiliation(s)
- Yingcheng E Xu
- Department of Psychiatry and Behavioral Health, Cooper Medical School of Rowan University and Cooper University Health Care, Camden, NJ, 08103, US
| | - Daniel A Barron
- Corporal Michael J. Crescenz Department of Veterans Affairs Medical Center, Philadelphia, PA, 19104, USA
| | - Katherin Sudol
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, 37212, USA
| | - Sidney Zisook
- Department of Psychiatry, University of California San Diego School of Medicine, San Diego, CA, 92103, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
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Flechsig A, Bernheim D, Buchheim A, Domin M, Mentel R, Lotze M. One Year of Outpatient Dialectical Behavioral Therapy and Its Impact on Neuronal Correlates of Attachment Representation in Patients with Borderline Personality Disorder Using a Personalized fMRI Task. Brain Sci 2023; 13:1001. [PMID: 37508932 PMCID: PMC10377139 DOI: 10.3390/brainsci13071001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/22/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
(1) Background: BPD is characterized by affect dysregulation, interpersonal problems, and disturbances in attachment, but neuroimaging studies investigating attachment representations in BPD are rare. No study has examined longitudinal neural changes associated with interventions targeting these impairments. (2) Methods: We aimed to address this gap by performing a longitudinal neuroimaging study on n = 26 patients with BPD treated with Dialectic Behavioral Therapy (DBT) and n = 26 matched healthy controls (HCs; post intervention point: n = 18 BPD and n = 23 HCs). For functional imaging, we applied an attachment paradigm presenting attachment related scenes represented in drawings paired with related neutral or personalized sentences from one's own attachment narratives. In a prior cross-sectional investigation, we identified increased fMRI-activation in the human attachment network, in areas related to fear response and the conflict monitoring network in BPD patients. These were especially evident for scenes from the context of loneliness (monadic pictures paired with individual narrative sentences). Here, we tested whether these correlates of attachment representation show a near-to-normal development over one year of DBT intervention. In addition, we were interested in possible associations between fMRI-activation in these regions-of-interest (ROI) and clinical scores. (3) Results: Patients improved clinically, showing decreased symptoms of borderline personality organization (BPI) and increased self-directedness (Temperament and Character Inventory, TCI) over treatment. fMRI-activation was increased in the anterior medial cingulate cortex (aMCC) and left amygdala in BPD patients at baseline which was absent after intervention. When investigating associations between scores (BPI, TCI) and functional activation, we found significant effects in the bilateral amygdala. In contrast, aMCC activation at baseline was negatively associated with treatment outcome, indicating less effective treatment effects for those with higher aMCC activation at baseline. (4) Conclusions: Monadic attachment scenes with personalized sentences presented in an fMRI setup are capable of identifying increased activation magnitude in BPD. After successful DBT treatment, these increased activations tend to normalize which could be interpreted as signs of a better capability to regulate intensive emotions in the context of "social pain" towards a more organized/secure attachment representation. Amygdala activation, however, indicates high correlations with pre-treatment scores; activation in the aMCC is predictive for treatment gain. Functional activation of the amygdala and the aMCC as a response to attachment scenes representing loneness at baseline might be relevant influencing factors for DBT-intervention outcomes.
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Affiliation(s)
- Ariane Flechsig
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University of Greifswald, 17475 Greifswald, Germany
| | - Dorothee Bernheim
- Department of Psychiatry and Psychotherapy, University Hospital of Greifswald, 17475 Greifswald, Germany
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, 89075 Ulm, Germany
| | - Anna Buchheim
- Department of Psychology, University of Innsbruck, 6020 Innsbruck, Austria
| | - Martin Domin
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University of Greifswald, 17475 Greifswald, Germany
| | - Renate Mentel
- Department of Psychiatry and Psychotherapy, University Hospital of Greifswald, 17475 Greifswald, Germany
| | - Martin Lotze
- Functional Imaging Unit, Department of Diagnostic Radiology and Neuroradiology, University of Greifswald, 17475 Greifswald, Germany
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Calancie OG, Parr AC, Brien DC, Huang J, Pitigoi IC, Coe BC, Booij L, Khalid-Khan S, Munoz DP. Motor synchronization and impulsivity in pediatric borderline personality disorder with and without attention-deficit hyperactivity disorder: an eye-tracking study of saccade, blink and pupil behavior. Front Neurosci 2023; 17:1179765. [PMID: 37425020 PMCID: PMC10323365 DOI: 10.3389/fnins.2023.1179765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
Shifting motor actions from reflexively reacting to an environmental stimulus to predicting it allows for smooth synchronization of behavior with the outside world. This shift relies on the identification of patterns within the stimulus - knowing when a stimulus is predictable and when it is not - and launching motor actions accordingly. Failure to identify predictable stimuli results in movement delays whereas failure to recognize unpredictable stimuli results in early movements with incomplete information that can result in errors. Here we used a metronome task, combined with video-based eye-tracking, to quantify temporal predictive learning and performance to regularly paced visual targets at 5 different interstimulus intervals (ISIs). We compared these results to the random task where the timing of the target was randomized at each target step. We completed these tasks in female pediatric psychiatry patients (age range: 11-18 years) with borderline personality disorder (BPD) symptoms, with (n = 22) and without (n = 23) a comorbid attention-deficit hyperactivity disorder (ADHD) diagnosis, against controls (n = 35). Compared to controls, BPD and ADHD/BPD cohorts showed no differences in their predictive saccade performance to metronome targets, however, when targets were random ADHD/BPD participants made significantly more anticipatory saccades (i.e., guesses of target arrival). The ADHD/BPD group also significantly increased their blink rate and pupil size when initiating movements to predictable versus unpredictable targets, likely a reflection of increased neural effort for motor synchronization. BPD and ADHD/BPD groups showed increased sympathetic tone evidenced by larger pupil sizes than controls. Together, these results support normal temporal motor prediction in BPD with and without ADHD, reduced response inhibition in BPD with comorbid ADHD, and increased pupil sizes in BPD patients. Further these results emphasize the importance of controlling for comorbid ADHD when querying BPD pathology.
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Affiliation(s)
- Olivia G. Calancie
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Ashley C. Parr
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Don C. Brien
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Jeff Huang
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Isabell C. Pitigoi
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Brian C. Coe
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Linda Booij
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Research Centre and Eating Disorders Continuum, Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Sarosh Khalid-Khan
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- Divison of Child and Youth Psychiatry, Department of Psychiatry, School of Medicine, Queen’s University, Kingston, ON, Canada
| | - Douglas P. Munoz
- Queen’s Eye Movement Lab, Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
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Setkowski K, Palantza C, van Ballegooijen W, Gilissen R, Oud M, Cristea IA, Noma H, Furukawa TA, Arntz A, van Balkom AJLM, Cuijpers P. Which psychotherapy is most effective and acceptable in the treatment of adults with a (sub)clinical borderline personality disorder? A systematic review and network meta-analysis. Psychol Med 2023; 53:3261-3280. [PMID: 37203447 PMCID: PMC10277776 DOI: 10.1017/s0033291723000685] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 02/11/2023] [Accepted: 02/27/2023] [Indexed: 05/20/2023]
Abstract
A broad range of psychotherapies have been proposed and evaluated in the treatment of borderline personality disorder (BPD), but the question which specific type of psychotherapy is most effective remains unanswered. In this study, two network meta-analyses (NMAs) were conducted investigating the comparative effectiveness of psychotherapies on (1) BPD severity and (2) suicidal behaviour (combined rate). Study drop-out was included as a secondary outcome. Six databases were searched until 21 January 2022, including RCTs on the efficacy of any psychotherapy in adults (⩾18 years) with a diagnosis of (sub)clinical BPD. Data were extracted using a predefined table format. PROSPERO ID:CRD42020175411. In our study, a total of 43 studies (N = 3273) were included. We found significant differences between several active comparisons in the treatment of (sub)clinical BPD, however, these findings were based on very few trials and should therefore be interpreted with caution. Some therapies were more efficacious compared to GT or TAU. Furthermore, some treatments more than halved the risk of attempted suicide and committed suicide (combined rate), reporting RRs around 0.5 or lower, however, these RRs were not statistically significantly better compared to other therapies or to TAU. Study drop-out significantly differed between some treatments. In conclusion, no single treatment seems to be the best choice to treat people with BPD compared to other treatments. Nevertheless, psychotherapies for BPD are perceived as first-line treatments, and should therefore be investigated further on their long-term effectiveness, preferably in head-to-head trials. DBT was the best connected treatment, providing solid evidence of its effectiveness.
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Affiliation(s)
- Kim Setkowski
- Research Department, 113 Suicide Prevention, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Christina Palantza
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Wouter van Ballegooijen
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Renske Gilissen
- Research Department, 113 Suicide Prevention, Amsterdam, the Netherlands
| | - Matthijs Oud
- Department of Treatment, Care and Reintegration, Trimbos Institute, Utrecht, the Netherlands
| | - Ioana A. Cristea
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- IRCCS Mondino Foundation, Pavia, Italy
| | - Hisashi Noma
- Department of Data Science, The Institute of Statistical Mathematics, Tokyo, Japan
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Arnoud Arntz
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
| | - Anton J. L. M. van Balkom
- Department of Psychiatry, Amsterdam UMC, VU University, Amsterdam Public Health research institute, and GGZinGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, the Netherlands
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Senberg A, Schmucker M, Oster A, Zumbach J. Parental personality disorder and child maltreatment: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2023; 140:106148. [PMID: 37060689 DOI: 10.1016/j.chiabu.2023.106148] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 02/20/2023] [Accepted: 03/15/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Parental pathology may affect parenting capacity and is deemed a risk factor for child maltreatment. Especially parental personality disorder (PD) can significantly burden the relationship and interaction between parents and their children. OBJECTIVE This meta-analytic review aims to summarize and quantify the influence of parental PD on the occurrence / the risk of child maltreatment. PARTICIPANTS AND SETTING Studies had to meet the following inclusion criteria: They had to analyze a sample of parents with a diagnosed PD and the occurrence / risk of maltreating their children. To be included in the narrative synthesis and/or meta-analysis, they had to be case-control, cross-sectional, or longitudinal studies. Literature research was conducted in the databases Web of Science, Psychinfo, and Google Scholar up to January 2023. METHODS First, studies were analyzed on a narrative level, and eligible studies for the meta-analysis were identified. Studies were grouped according to the diagnosed PDs. Five different groups were included: borderline PD, antisocial PD, narcissistic PD, nondifferentiated PDs, and Cluster B PDs. Three different random-effects meta-analyses were computed (borderline PD, antisocial PD, Cluster B PDs). Meta-analyses were controlled for publication bias and different covariates (e.g., study quality, sample size). RESULTS After screening 41 full texts, 17 studies were included in the narrative synthesis, out of which 14 samples from 11 studies were included in the meta-analysis. Analysis of borderline PD showed an association with the occurrence / risk of child maltreatment (OR = 8.08; 95 % CI [2.51, 25.93]). However, after taking into account possible publication bias, this association was no longer significant. We found a significant and stable association between antisocial PD and the occurrence of / risk of child maltreatment (OR = 4.92; 95 % CI [3.26, 7.43]). Analysis of Cluster B PDs (antisocial, borderline, histrionic, narcissistic) revealed a significant overall association (OR = 4.23; 95 % CI [2.75, 6.5]), indicating that the presence of Cluster B PDs in parents significantly increases the occurrence of / the risk of child maltreatment. CONCLUSIONS Analyses indicated a significant association between of Cluster B PDs, and specifically between antisocial and borderline PD, with the occurrence of / the risk of child maltreatment. However, methodological limitations have to be taken into account, because results for borderline PD were no longer significant after controlling for possible publication bias. Moreover, the number of studies included was rather small, and results showed a substantial amount of heterogeneity. OTHER This work was not supported by any funding.
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Affiliation(s)
- Asne Senberg
- Department of Forensic Psychology, Psychologische Hochschule Berlin, Am Koellnischen Park 2, 10179 Berlin, Germany.
| | - Martin Schmucker
- Institute of Psychology, Friedrich-Alexander University Erlangen-Nürnberg, Nägelsbachstraße 49b, 91052 Erlangen, Germany.
| | - Anna Oster
- Department of Forensic Psychology, Psychologische Hochschule Berlin, Am Koellnischen Park 2, 10179 Berlin, Germany.
| | - Jelena Zumbach
- Department of Forensic Psychology, Psychologische Hochschule Berlin, Am Koellnischen Park 2, 10179 Berlin, Germany.
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Nasello JA, Dardenne B, Hansenne M, Blavier A, Triffaux JM. Moral Decision-Making in Trolley Problems and Variants: How Do Participants' Perspectives, Borderline Personality Traits, and Empathy Predict Choices? THE JOURNAL OF PSYCHOLOGY 2023:1-21. [PMID: 37205791 DOI: 10.1080/00223980.2023.2206604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 03/07/2023] [Accepted: 04/18/2023] [Indexed: 05/21/2023] Open
Abstract
The aim of the present study was to demonstrate and extend the causal effect of participants' perspectives on moral decision-making using trolley problems and variants. Additionally, we investigated whether empathy and borderline (BDL) personality traits predicted participants' choices in these scenarios. We used both a classical trolley problem (a causing harm scenario) and an everyday trolley-like problem (a causing inconvenience scenario). Participants (N = 427, women: 54%) completed BDL traits and empathy questionnaires and, randomly, the two types of trolley problems, presenting both three different perspectives. Our study provided strong evidence that the perspective from which participants were enrolled in the trolley problem caused significant changes in their moral decision-making. Furthermore, we found that affective empathy and BDL traits significantly predicted participants' decisions in the causing inconvenience scenario, while only BDL traits predicted choices in the causing harm scenario. This study was original in providing new experimental materials, causal results, and highlighting the significant influence of BDL traits and affective empathy on moral decision-making. These findings raised fundamental questions, which are further developed in the discussion section.
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Dell’Osso L, Nardi B, Bonelli C, Gravina D, Benedetti F, Amatori G, Battaglini S, Massimetti G, Luciano M, Berardelli I, Brondino N, De Gregorio M, Deste G, Nola M, Reitano A, Muscatello MRA, Pompili M, Politi P, Vita A, Carmassi C, Cremone IM, Carpita B, Maj M. Investigating suicidality across the autistic-catatonic continuum in a clinical sample of subjects with major depressive disorder and borderline personality disorder. Front Psychiatry 2023; 14:1124241. [PMID: 37275986 PMCID: PMC10234210 DOI: 10.3389/fpsyt.2023.1124241] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/04/2023] [Indexed: 06/07/2023] Open
Abstract
Background Recent literature has highlighted that catatonia may be more prevalent among psychiatric patients than previously thought, beginning from autism spectrum disorders (ASD), for which it has been suggested to represent a severe late consequence, but also among individuals with mood disorders and borderline personality disorder (BPD). Interestingly, one critical point shared by these conditions is the increased risk of suicidality. The aim of this study was to evaluate how the presence and the prevalence of catatonic symptoms may shape and correlate with suicidal risk in a sample of individuals with major depressive disorder (MDD) or BPD. Methods We recruited two clinical samples of subjects (BPD and MDD) and a control group without a diagnosis according to DSM-5 (CTL). Subjects were assessed with the catatonia spectrum (CS) and the MOODS-SR for evaluating suicidality. Results In the total sample, suicidality score was significantly and positively correlated with all CS domains and CS total score. Correlation and regression analyses highlighted specific patterns of association among Catatonia spectrum domains and suicidality in the MDD and BPD group and in the total sample. Conclusion In both disorders, higher catatonic traits are linked to higher suicidal tendencies, confirming the high risk of suicide for this population. However, different patterns of association between catatonic symptoms and suicidality were highlighted in the two disorders.
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Affiliation(s)
- Liliana Dell’Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Benedetta Nardi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Chiara Bonelli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Davide Gravina
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Francesca Benedetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giulia Amatori
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Simone Battaglini
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Isabella Berardelli
- Department of Neuroscience, Mental Health and Sense Organs, University of Roma “La Sapienza”, Rome, Italy
| | - Natascia Brondino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Marianna De Gregorio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Marta Nola
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Antonino Reitano
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | | | - Maurizio Pompili
- Department of Neuroscience, Mental Health and Sense Organs, University of Roma “La Sapienza”, Rome, Italy
| | - Pierluigi Politi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Ivan Mirko Cremone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Barbara Carpita
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Mario Maj
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Amiri S, Mirfazeli FS, Grafman J, Mohammadsadeghi H, Eftekhar M, Karimzad N, Mohebbi M, Nohesara S. Alternation in functional connectivity within default mode network after psychodynamic psychotherapy in borderline personality disorder. Ann Gen Psychiatry 2023; 22:18. [PMID: 37170093 PMCID: PMC10176869 DOI: 10.1186/s12991-023-00449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is characterized by impairments in emotion regulation, impulse control, and interpersonal and social functioning along with a deficit in emotional awareness and empathy. In this study, we investigated whether functional connectivity (FC) within the default mode network (DMN) is affected by 1-year psychodynamic psychotherapy in patients with BPD. METHODS Nine BPD patients filled out the demography, Interpersonal Reactive Index (IRI), Toronto Alexithymia Scale 20 (TAS 20), the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST), and the Borderline Evaluation Severity over Time (BEST) questionnaire. The BPD group (9F) and the control group (9F) had a mean ± SD age of 28.2 ± 5.3 years and 30.4 ± 6.1 years, respectively. BPD subjects underwent longitudinal resting-state fMRI before psychodynamic psychotherapy and then every 4 months for a year after initiating psychotherapy. FC in DMN was characterized by calculating the nodal degree, a measure of centrality in the graph theory. RESULTS The results indicated that patients with BPD present with aberrant DMN connectivity compared to healthy controls. Over a year of psychotherapy, the patients with BPD showed both FC changes (decreasing nodal degree in the dorsal anterior cingulate cortex and increasing in other cingulate cortex regions) and behavioral improvement in their symptoms and substance use. There was also a significant positive association between the decreased nodal degree in regions of the dorsal cingulate cortex and a decrease in the score of the TAS-20 indicating difficulty in identifying feelings after psychotherapy. CONCLUSION In BPD, there is altered FC within the DMN and disruption in self-processing and emotion regulation. Psychotherapy may modify the DMN connectivity and that modification is associated with positive changes in BPD emotional symptoms.
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Affiliation(s)
- Saba Amiri
- Neuroscience Research Center, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Fatemeh Sadat Mirfazeli
- Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Jordan Grafman
- Department of Physical Medicine & Rehabilitation, Neurology, Cognitive Neurology and Alzheimer's Center, Department of Psychiatry, Feinberg School of Medicine & Department of Psychology, Weinberg College of Arts and Sciences, Northwestern University, Chicago, IL, USA
| | - Homa Mohammadsadeghi
- Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran.
| | - Mehrdad Eftekhar
- Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Nazila Karimzad
- Iran Psychiatric Hospital, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Mohebbi
- Islamic Azad University Science and Research Branch Qazvin, Qazvin, Iran
| | - Shabnam Nohesara
- Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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What users’ musical preference on Twitter reveals about psychological disorders. Inf Process Manag 2023. [DOI: 10.1016/j.ipm.2023.103269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Blay M, Cohen S, Jan M, Perroud N, Speranza M, Charbon P. [Towards a pragmatic cohabitation of theoretical and clinical models: The example of "Good Psychiatric Management" in the treatment of borderline personality disorder]. L'ENCEPHALE 2023:S0013-7006(23)00042-8. [PMID: 37088579 DOI: 10.1016/j.encep.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 04/25/2023]
Abstract
Borderline personality disorder (BPD) is a common disorder in general and clinical populations and is related to potentially severe medical and socio-professional consequences. Treatment of BPD is based on evidence-based psychotherapies (such as Dialectical Behavioral Therapy, Mentalization-Based Therapy, Schema-Focused Therapy or Transference Focused Psychotherapy), which have been shown effective but are poorly available in France. Pharmacological treatments, which are more easily available, are not effective in treating symptoms of the disorder but can be useful in management of comorbidities. In this context, recently called "generalist" models have been developed, which every well-trained psychiatrist can implement in their daily practice, combining practical elements from evidence-based psychotherapies and elements of pharmacological management of symptoms and comorbidities. The purpose of this article is to present one of these models, the Good Psychiatric Management (GPM) and its basic principles and its applications, and to provide one of the first French-speaking resources about this model. In addition, beyond the practical elements proposed by the GPM, we discuss the deeper question that it raises, namely the question of a pragmatic integration of different theoretical and clinical models. Indeed, the treatment of BPD patients is at the junction of different conceptualizations of mental pathology (psychopathological, neurobiological) and different modalities of practice (psychotherapy, biological psychiatry). In a French context, that sometimes separates these two models, and in our opinion GPM constitutes an example of clinical collaboration which shows the interest of the combined role of psychiatrist-psychotherapist.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Centre ambulatoire d'addictologie et de psychiatrie, Groupe santé basque développement, 164, avenue Jean-Jaurès, 69007 Lyon, France; Université Claude-Bernard Lyon 1, Lyon, France.
| | - Satchel Cohen
- Centre hospitalier de Versailles, Service universitaire de psychiatrie de l'enfant et de l'adolescent, Le Chesnay, France
| | - Marlène Jan
- Centre hospitalier de Versailles, Service universitaire de psychiatrie de l'enfant et de l'adolescent, Le Chesnay, France
| | - Nader Perroud
- Service des spécialités psychiatriques, Département de psychiatrie, Hôpitaux universitaires de Genève, Genève, Suisse; Département de psychiatrie, Université de Genève, Genève, Suisse
| | - Mario Speranza
- Centre hospitalier de Versailles, Service universitaire de psychiatrie de l'enfant et de l'adolescent, Le Chesnay, France; Université Paris-Saclay, UVSQ, Inserm, Centre de recherche en épidémiologie et santé des populations Team "DevPsy", 94807 Villejuif, France
| | - Patrick Charbon
- Service des spécialités psychiatriques, Département de psychiatrie, Hôpitaux universitaires de Genève, Genève, Suisse; Cabinet de groupe « D'un Monde à l'Autre », Lausanne, Suisse
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Diamond D, Keefe JR, Hörz-Sagstetter S, Fischer-Kern M, Doering S, Buchheim A. Changes in Attachment Representation and Personality Organization in Transference-Focused Psychotherapy. Am J Psychother 2023; 76:31-38. [PMID: 36695536 DOI: 10.1176/appi.psychotherapy.20220018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this article was to construct an empirical bridge between object relations theory and attachment theory by investigating how researchers in both traditions have contributed to understanding and assessing identity diffusion (a keystone of personality pathology) and object relations in patients with borderline personality disorder during 1 year of transference-focused psychotherapy (TFP). METHODS The Adult Attachment Interview (AAI) and the Structured Interview of Personality Organization (STIPO) were administered to patients (N=104, all women) before and after 1 year of treatment. This study was part of a randomized controlled trial in which 104 patients with borderline personality disorder were randomly assigned to receive either TFP (a manualized, structured psychodynamic treatment approach) or treatment by experienced community psychotherapists. Changes on the AAI in attachment representations, narrative coherence, and reflective function were examined for their associations with changes on the STIPO in identity, object relations, and aggression. RESULTS Patients who shifted from disorganized (unresolved) to organized attachment on the AAI after 1 year of TFP (but not treatment by experienced community psychotherapists) showed hypothesized improvements in domains of personality organization on the STIPO, including identity, object relations, and aggression. Those who did not change from disorganized (unresolved) to organized attachment improved only in the domain of aggression. CONCLUSIONS These findings highlight the centrality of identity diffusion to borderline personality disorder pathology and the importance of targeting it in treatment. Furthermore, the results suggest that identity may be indexed by measures of attachment security, narrative coherence, and personality organization.
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Affiliation(s)
- Diana Diamond
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
| | - John R Keefe
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
| | - Susanne Hörz-Sagstetter
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
| | - Melitta Fischer-Kern
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
| | - Stephan Doering
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
| | - Anna Buchheim
- Department of Psychiatry, Weill Cornell Medical College, New York City (Diamond); Department of Psychology, City University of New York, New York City (Diamond); Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe); Department of Clinical Psychology and Psychotherapy, Psychologische Hochschule Berlin, Berlin (Hörz-Sagstetter); Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna (Fischer-Kern, Doering); Institute of Psychology, University of Innsbruck, Innsbruck, Austria (Buchheim)
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Alberdi-Páramo Í, Díaz-Marsá M, Saiz González MD, Carrasco Perera JL. Antisocial traits and neuroticism as predictors of suicidal behaviour in borderline personality disorder: A retrospective study. REVISTA COLOMBIANA DE PSIQUIATRÍA (ENGLISH ED.) 2023; 52:11-19. [PMID: 36997367 DOI: 10.1016/j.rcpeng.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 02/02/2021] [Indexed: 03/30/2023]
Abstract
INTRODUCTION The spectrum of suicidal behaviour (SB) is nuclear in the clinic and management of borderline personality disorder (BPD). The pathological personality traits of BPD intervene as risk factors for SB in confluence with other clinical and sociodemographic variables associated with BPD. The objective of this work is to evaluate the specific personality traits of BPD that are related to SB. METHODS A cross-sectional, observational and retrospective study was carried out on a sample of 134 patients diagnosed with BPD according to DSM-5 criteria. The Millon-II, Zuckerman-Kuhlman and Barrat questionnaires were used to assess different personality parameters. Variable comparisons were made using the χ2 test and the Student's t-test. The association between variables was analysed using multivariate logistic regression. RESULTS Statistically significant differences were observed between SB and related factors and the neuroticism-anxiety dimension in the Zuckerman-Kuhlman test. It is also significantly related to the phobic and antisocial subscale of the Millon-II. Impulsivity measured with the Zuckerman-Kuhlman and Barrat tests does not appear to be related to SB. CONCLUSIONS The results presented raise the role of phobic, antisocial and neuroticism traits as possible personality traits of BPD related to SB, suggesting an even greater importance within the relationship between BPD and SB than that of impulsivity. Looking to the future, longitudinal studies would increase the scientific evidence for the specified findings.
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Boström ADE, Andersson P, Jamshidi E, Wilczek A, Nilsonne Å, Rask-Andersen M, Åsberg M, Jokinen J. Accelerated epigenetic aging in women with emotionally unstable personality disorder and a history of suicide attempts. Transl Psychiatry 2023; 13:66. [PMID: 36813766 PMCID: PMC9946998 DOI: 10.1038/s41398-023-02369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 02/24/2023] Open
Abstract
Emotional unstable personality disorder (EUPD; previously borderline personality disorder, BPD) is associated with excess natural-cause mortality, comorbid medical conditions, poor health habits and stress related epigenomic alterations. Previous studies demonstrated that GrimAge - a state-of-the-art epigenetic age (EA) estimator - strongly predicts mortality risk and physiological dysregulation. Herein, we utilize the GrimAge algorithm to investigate whether women with EUPD and a history of recent suicide attempts exhibit EA acceleration (EAA) in comparison to healthy controls. Genome-wide methylation patterns were measured using the Illumina Infinum Methylation Epic BeadChip in whole blood from 97 EUPD patients and 32 healthy controls. The control group was significantly older (p < 0.0001) and reported lesser exposure to violent behavior in both youth and adulthood (p < 0.0001). Groups were otherwise comparable regarding gender, BMI, or tobacco usage (p > 0.05). EA estimator DNAmGrimAge exceeded chronological age by 8.8 and 2.3 years in the EUPD and control group, respectively. Similarly, EAA marker AgeAccelGrim was substantially higher in EUPD subjects when compared to controls, in both univariate and multivariate analyzes (p < 0.00001). Tobacco usage conferred substantial within-group effects on the EA-chronological age difference, i.e., 10.74 years (SD = 4.19) compared to 6.00 years (SD = 3.10) in the non-user EUPD group (p < 0.00001). Notably, past alcohol and substance abuse, use of psychotropic medications, global assessment of functioning, self-reported exposure to violent behavior in youth and adulthood, later completed suicide (N = 8) and age at first suicide attempt did not predict EAA in the EUPD group (p > 0.05). These results underscore the importance of addressing medical health conditions along with low-cost preventative interventions aimed at improving somatic health outcomes in EUPD, such as efforts to support cessation of tobacco use. The independency of GrimAge to other EA algorithms in this group of severely impaired EUPD patients, suggest it may have unique characteristics to evaluate risk of adverse health outcomes in context of psychiatric disorders.
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Affiliation(s)
- Adrian Desai E. Boström
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden ,grid.24381.3c0000 0000 9241 5705Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
| | - Peter Andersson
- grid.4714.60000 0004 1937 0626Department of Clinical Neuroscience/Psychology, Karolinska Institute, Stockholm, Sweden ,grid.8993.b0000 0004 1936 9457Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Esmail Jamshidi
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden
| | - Alexander Wilczek
- grid.4714.60000 0004 1937 0626Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Åsa Nilsonne
- grid.4714.60000 0004 1937 0626Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Mathias Rask-Andersen
- grid.8993.b0000 0004 1936 9457Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Marie Åsberg
- grid.4714.60000 0004 1937 0626Department of Clinical Sciences, Karolinska Institutet at Danderyd Hospital, Stockholm, Sweden
| | - Jussi Jokinen
- grid.12650.300000 0001 1034 3451Department of Clinical Sciences/Psychiatry, Umeå University, Umeå, Sweden ,grid.24381.3c0000 0000 9241 5705Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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Xiao Q, Yi X, Fu Y, Jiang F, Zhang Z, Huang Q, Han Z, Chen BT. Altered brain activity and childhood trauma in Chinese adolescents with borderline personality disorder. J Affect Disord 2023; 323:435-443. [PMID: 36493941 DOI: 10.1016/j.jad.2022.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Childhood trauma may cause borderline personality disorder (BPD). The aim of this study was to assess functional alteration and its association with childhood trauma in Chinese adolescents with BPD. METHODS A total of 187 adolescents with BPD aged 12-17 years and 207 age and gender- matched healthy controls (HCs) were enrolled into this study. The sample consisted of 50 adolescents with BPD and 21 HCs underwent brain resting-state functional magnetic resonance imaging (rs-fMRI). The rs-fMRI data was analyzed for both neural activity as indicated by amplitude of low-frequency fluctuation (ALFF) and seed-based functional connectivity (FC). Clinical assessment for childhood trauma, impulsivity, and depression was also performed. Correlative analysis of functional alterations with childhood trauma assessment were performed. RESULTS Adolescents with BPD had significantly higher rate of all assessed childhood trauma than the HC group (P < 0.001). Most adolescents with BPD (61.5 %) had emotional neglect, which was the most commonly seen type of childhood trauma. Compared with HCs, adolescents with BPD showed decreased ALFF in the cortical regions including the left superior frontal gyrus and right middle occipital gyrus, and default mode network (DMN) regions including the left angular gyrus and medial superior frontal gyrus. Adolescents with BPD also showed enhanced ALFF in the limbic system (left hippocampus, insula, thalamus) (P < 0.05, FWE correction, cluster size ≥100). There were significant correlations between the insula ALFF and childhood trauma assessment for emotional neglect, physical abuse and physical neglect (P < 0.01). Moreover, adolescents with BPD showed increased FC between the left insula and right cortical regions (voxel P < 0.001, cluster P < 0.05, FWE correction). LIMITATIONS The sample size was small. This cohort had patients with more severe BPD symptoms and some had comorbidities such as anxiety and obsessive-compulsive disorder. CONCLUSIONS There were alterations of brain activity as indicated by ALFF in the limbic - cortical circuit and DMN regions in adolescents with BPD and the activity in the left insula was correlated with emotional neglect. In addition, the FC between the left insula and the limbic - prefrontal circuit was enhanced. These results implicate that the functional alterations of insula may serve as a potential neuroimaging biomarker for adolescents with BPD who suffered from childhood trauma.
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Affiliation(s)
- Qian Xiao
- Mental Health Center of Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China
| | - Xiaoping Yi
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China; National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Xiangya Hospital, Changsha 410008, Hunan, PR China; Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China; Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China; Department of Dermatology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China.
| | - Yan Fu
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China; Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China
| | - Furong Jiang
- Mental Health Center of Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China
| | - Zhejia Zhang
- Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China
| | - Qinlin Huang
- Department of Clinical Medicine, Xiangya School of Medicine, Central South University, Changsha 410008, Hunan, PR China
| | - Zaide Han
- Department of Radiology, Xiangya Hospital, Central South University, Changsha 410008, Hunan, PR China
| | - Bihong T Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, USA
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Wilson K, Van Doorn G, Dye J. Vulnerable dark traits mediate the association between childhood adversity and suicidal ideation. PERSONALITY AND INDIVIDUAL DIFFERENCES 2023. [DOI: 10.1016/j.paid.2022.111959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Restek-Petrovic B, Grah M, Ivezic E, Handl H, Milovac Z, Bahun I, Mayer N, Vrbek P. Borderline Personality Disorder: Comparison of Two Treatment Modalities. J Nerv Ment Dis 2023; 211:11-16. [PMID: 36596287 DOI: 10.1097/nmd.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
ABSTRACT The aim of this study was to compare the effectiveness of two treatment modalities for patients diagnosed with borderline personality disorder (BPD). A total of 100 psychiatric patients diagnosed with BPD participated in this study. Among them, 50 patients were outpatients who attended the Reason and Emotion (RIO) program, and the remaining 50 were inpatients who were treated on psychotherapeutic ward at the same hospital. All the participants filled out the following battery of tests when entering the program/psychotherapy ward and 3 months later: Rosenberg's Self-Esteem Scale, Tennessee Self-Concept Scale (2nd ed), Barratt Impulsiveness Scale, The COPE Inventory, and the WHOQOL-BREF scale. The results showed significant positive effects of both treatment modalities on patients' self-esteem, different domains of self-concept, impulsivity, and different domains of subjective quality of life. No significant changes were observed in terms of coping strategies. Thus, the results speak in favor of the outpatient RIO program, which is more cost-effective than the inpatient ward treatment.
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