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Jørgensen MS, Møller L, Bo S, Kongerslev M, Hastrup LH, Chanen A, Storebø OJ, Poulsen S, Beck E, Simonsen E. The course of borderline personality disorder from adolescence to early adulthood: A 5-year follow-up study. Compr Psychiatry 2024; 132:152478. [PMID: 38522259 DOI: 10.1016/j.comppsych.2024.152478] [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: 12/05/2023] [Revised: 02/07/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024] Open
Abstract
BACKGROUND Studies of the medium- to long-term clinical and functional course for treatment-seeking adolescents with borderline personality disorder (BPD) are lacking. This study aims to outline the psychopathological and functional status of participants, five years after being diagnosed with BPD during adolescence. METHODS Participants were originally enrolled in a randomized clinical trial that compared mentalization-based group treatment with treatment as usual for adolescents with BPD. Semi-structured interview assessments at five-year follow-up included the Schedules for Clinical Assessment in Neuropsychiatry and the Structured Clinical Interview for DSM-5 Personality Disorders. Attention deficit hyperactivity disorder (ADHD), alcohol, substance and tobacco use, posttraumatic stress disorder (PTSD), complex PTSD, and general functioning were assessed using self-report instruments. RESULTS 97 of the original sample of 111 participants (87%) participated. They were aged 19-23 years. The most prevalent disorders were ADHD (59%), any personality disorder (47%) of which half continued to meet criteria for BPD (24%), anxiety disorders (37%), depressive disorders (32%), PTSD or complex PTSD (20%), schizophrenia (16%), and eating disorders (13%). Only 16% did not meet criteria for any mental disorder. Approximately half of the sample were in psychological and/or psychopharmacological treatment at the time of follow-up. Their general functioning remained impaired, with 36% not engaged in education, employment or training (NEET), which is nearly four times the rate of NEET in the same age group in the general population. CONCLUSIONS Although stability of the categorical BPD diagnosis is modest, adolescents meeting diagnostic criteria for BPD show a broad range of poor outcomes at five-year follow-up. BPD appears to be a marker of general maladjustment during adolescence and a harbinger of severe problems during the transition to young adulthood. Early intervention programs for adolescents diagnosed with BPD should focus upon a broad range of functional and psychopathological outcomes, especially social and vocational support, rather than the narrow BPD diagnosis.
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Affiliation(s)
- Mie Sedoc Jørgensen
- Psychiatric Research Unit, Mental Health Services, Region Zealand, 4200 Slagelse, Denmark.
| | - Lise Møller
- Psychiatric Research Unit, Mental Health Services, Region Zealand, 4200 Slagelse, Denmark.
| | - Sune Bo
- Psychiatric Research Unit, Mental Health Services, Region Zealand, 4200 Slagelse, Denmark; Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark.
| | - Mickey Kongerslev
- Mental Health Services, Region Zealand East, 4000 Roskilde, Denmark; Department of Psychology, University of Southern Denmark, Denmark.
| | - Lene Halling Hastrup
- Psychiatric Research Unit, Mental Health Services, Region Zealand, 4200 Slagelse, Denmark; Danish Centre for Health Economics (DaCHE), University of Southern Denmark, Odense, Denmark.
| | - Andrew Chanen
- Orygen, Melbourne, Australia, and Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.
| | - Ole Jakob Storebø
- Psychiatric Research Unit, Mental Health Services, Region Zealand, 4200 Slagelse, Denmark; Department of Psychology, University of Southern Denmark, Denmark.
| | - Stig Poulsen
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen, Denmark.
| | | | - Erik Simonsen
- Mental Health Services, Region Zealand East, 4000 Roskilde, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
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Gammino L, Pelizza L, Emiliani R, D'Adda F, Lupoli P, Pellegrini L, Berardi D, Menchetti M. Cognitive disturbances basic symptoms in help-seeking patients with borderline personality disorder: Characteristics and association with schizotypy. Early Interv Psychiatry 2024. [PMID: 38778517 DOI: 10.1111/eip.13557] [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: 07/13/2023] [Revised: 02/04/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024]
Abstract
AIM Although the presence of psychotic symptoms has been widely recognized in Borderline Personality Disorder (BPD), no study previously investigated cognitive Basic Symptoms (BS) and their clinical implications in patients with BPD. METHODS This cross-sectional study specifically examined the prevalence of COGDIS (cognitive disturbances) BS criteria in 93 help-seeking outpatients with BPD by using the Schizophrenia Proneness Instrument-Adult Version (SPI-A). We then explored associations of COGDIS with personality traits, functioning and core psychopathological features of BPD. RESULTS The prevalence rates of COGDIS criterion were 62.4%. BPD patients meeting COGDIS criteria reported higher levels of schizotypal personality traits, dissociative experiences and work/social functional impairment compared to individuals without COGDIS criteria. Furthermore, the number of cognitive BSs showed a positive correlation with severity levels of schizotypy. CONCLUSIONS Cognitive BS are common in BPD. Cognitive disturbances are associated with schizotypal personality traits and specific clinical features. The presence of cognitive BSs may identify a more severe subgroup of patients with BPD, potentially vulnerable to psychotic symptoms and reliably identifiable through assessment of schizotypal traits.
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Affiliation(s)
- Lorenzo Gammino
- Department of Mental Health and Addiction DSM-DP, Azienda USL di Bologna, Bologna, Italy
| | - Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, Bologna, Italy
| | - Roberta Emiliani
- Department of Mental Health and Addiction DSM-DP, Azienda USL di Imola, Imola, Italy
| | - Francesca D'Adda
- Department of Mental Health and Addiction DSM-DP, Azienda USL di Bologna, Bologna, Italy
| | - Pasqualino Lupoli
- Department of Mental Health and Addiction DSM-DP, Azienda USL di Bologna, Bologna, Italy
| | - Luca Pellegrini
- Hertfordshire Partnership NHS University Foundation Trust, Welwyn Garden City, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- Centre for Psychedelic Research, Imperial College London, London, UK
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, Bologna, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences DIBINEM, University of Bologna, Bologna, Italy
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Chanen AM, Kerslake R, Berubé FA, Nicol K, Jovev M, Yuen HP, Betts JK, McDougall E, Nguyen AL, Cavelti M, Kaess M. Psychopathology and psychosocial functioning among young people with first-episode psychosis and/or first-presentation borderline personality disorder. Schizophr Res 2024; 266:12-18. [PMID: 38359514 DOI: 10.1016/j.schres.2024.02.010] [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: 12/09/2022] [Revised: 02/01/2024] [Accepted: 02/11/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND One in five young people with first-episode psychosis (FEP) also presents with borderline personality disorder (BPD) features. Among people diagnosed with BPD, auditory verbal hallucinations occur in 29-50 % and delusions in 10-100 %. Co-occurrence of psychotic symptoms and BPD is associated with greater clinical severity and greater difficulty accessing evidence based FEP care. This study aimed to investigate psychotic symptoms and psychosocial functioning among young people presenting to an early intervention mental health service. METHOD According to the presence or absence of either FEP or BPD, 141 participants, aged 15-25 years, were assigned to one of four groups: FEP, BPD, combined FEP + BPD, or clinical comparison (CC) participants with neither FEP nor BPD. Participants completed semi-structured diagnostic interviews and interviewer and self-report measures of psychopathology and psychosocial functioning. RESULTS The FEP + BPD group had significantly more severe psychopathology and poorer psychosocial functioning than the FEP group on every measure, apart from intensity of hallucinations. Comparing the FEP or BPD groups, the BPD group had greater psychopathology, apart from intensity of psychotic symptoms, which was significantly greater in the FEP group. These two groups did not significantly differ in their overall psychosocial functioning. Compared with CC young people, both the FEP + BPD and BPD groups differed significantly on every measure, with medium to large effect sizes. CONCLUSIONS Young people with co-occurring FEP and BPD experience more severe difficulties than young people with either diagnosis alone. This combination of psychosis and severe personality pathology has been longitudinally associated with poorer outcomes among adults and requires specific clinical attention.
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Affiliation(s)
- Andrew M Chanen
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Richard Kerslake
- Sussex Partnership NHS Foundation Trust, Sussex, United Kingdom.
| | - Felix-Antoine Berubé
- Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Montreal, Canada.
| | - Katie Nicol
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Martina Jovev
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Hok Pan Yuen
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Jennifer K Betts
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Emma McDougall
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
| | - Ai-Lan Nguyen
- Department of Medicine, The University of Melbourne, Parkville, VIC, Australia.
| | - Marialuisa Cavelti
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland; Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
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Pelizza L, Leuci E, Quattrone E, Azzali S, Paulillo G, Pupo S, Pellegrini P, Gammino L, Biancalani A, Menchetti M. Borderline personality disorder vs. schizophrenia spectrum disorders in young people recruited within an "Early Intervention in Psychosis" service: clinical and outcome comparisons. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01772-5. [PMID: 38472469 DOI: 10.1007/s00406-024-01772-5] [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: 07/11/2023] [Accepted: 01/28/2024] [Indexed: 03/14/2024]
Abstract
Borderline Personality Disorder (BPD) is under-recognized in First-Episode Psychosis (FEP) and its psychotic manifestations are difficult to differentiate from Schizophrenia Spectrum Disorders (SSD). The aim of this investigation was to compare clinical, sociodemographic, and outcome characteristics between FEP patients with BPD vs. FEP subjects with SSD both at baseline and across a 2-year follow-up period. Participants completed the Health of the Nation Outcome Scale (HoNOS), the Positive And Negative Syndrome Scale (PANSS), and the Global Assessment of Functioning (GAF) scale both at entry and every 12 months during the follow-up. A mixed-design ANOVA model was conducted to investigate the temporal stability of clinical scores within and between the two subgroups. Among 356 FEP participants, 49 had a BPD diagnosis. Compared to FEP/SSD (n = 307), FEP/BPD patients showed higher prevalence of employment, current substance use, and past attempted suicide. They had a lower equivalent dose of antipsychotic medication at entry and lower levels of negative symptoms. Finally, they had a higher 2-year drop-out rate and a significant improvement in psychopathological scores limited to the first year of treatment. BPD as categorical entity represents a FEP subgroup with specific clinical challenges. Appropriate treatment guidelines for this FEP subgroup are thus needed.
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Affiliation(s)
- Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Psychiatry Institute, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy.
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy.
| | - Emanuela Leuci
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Emanuela Quattrone
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Silvia Azzali
- Department of Mental Health and Pathological Addictions, Azienda USL-IRCCS di Reggio Emilia, Via Amendola 2, 43100, Reggio Emilia, Italy
| | - Giuseppina Paulillo
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Simona Pupo
- Division of Pain Medicine, Department of Medicine and Surgery, Azienda Ospedaliero-Universitaria di Parma, Via Gramsci 14, 43100, Parma, Italy
| | - Pietro Pellegrini
- Department of Mental Health and Pathological Addictions, Azienda USL di Parma, Largo Palli 1/a, 43100, Parma, Italy
| | - Lorenzo Gammino
- Department of Mental Health and Pathological Addictions, Azienda USL di Bologna, Via Castiglione 29, 40124, Bologna, Italy
| | - Arianna Biancalani
- Department of Biomedical and Neuromotor Sciences, Psychiatry Institute, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Psychiatry Institute, "Alma Mater Studiorum" Università degli Studi di Bologna, Via Pepoli 5, 40123, Bologna, BO, Italy
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Biancalani A, Pelizza L, Menchetti M. Borderline personality disorder and early psychosis: a narrative review. Ann Gen Psychiatry 2023; 22:44. [PMID: 37919718 PMCID: PMC10623785 DOI: 10.1186/s12991-023-00475-w] [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: 07/14/2023] [Accepted: 10/22/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND The purpose of the present review was to summarize the main literature contribution on the relationship between borderline personality disorder (BPD) and early psychosis. While retracing the historical path of the term "borderline", specific attention was paid to psychotic and psychotic-like symptoms in BPD. Its relationship with At Risk Mental State was evaluated, as well. METHODS This search was conducted on PUBMED/MEDLINE and PsycInfo, looking for "Borderline personality disorder, First Episode Psychosis, Early Psychosis, Ultra-High Risk AND/OR Clinical High Risk" for psychosis. RESULTS Eight pertinent papers were identified on this topic. Their main findings were then discussed. The term "borderline" has undergone different changes in meaning and use, despite always referring to states considered on the fence between neurosis and psychosis. However, considering the history of psychopathology and its relationship with diagnostic manuals, little attention has been given to its psychotic features. Being those symptoms highly burdensome, this neglect has often led to misdiagnosis and under-treatment. CONCLUSIONS Psychotic symptoms in BPD can be severe and distressing. Nonetheless they can be easily neglected, and when found they challenge clinicians in defining a differential diagnosis to distinguish between BPD and Psychosis Spectrum Disorders. Given specific needs and interventions for these different conditions, a dimensional, rather than categorical, approach should be considered, as well as specific care pathways and monitoring should be advised.
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Affiliation(s)
- Arianna Biancalani
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, Università Di Bologna, Via Zamboni 33, 40106, Bologna, BO, Italy
| | - Lorenzo Pelizza
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, Università Di Bologna, Via Zamboni 33, 40106, Bologna, BO, Italy.
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, Università Di Bologna, Via Zamboni 33, 40106, Bologna, BO, Italy
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Chanen AM. Bringing personality disorder in from the cold: Why personality disorder is a fundamental concern for youth mental health. Australas Psychiatry 2023; 31:267-269. [PMID: 36864605 DOI: 10.1177/10398562231159511] [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] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Personality disorder (PD) has its peak incidence between puberty and young adulthood. By any measure, it is among the most severe mental health problems occurring in young people, uniquely predicting debilitating current problems and acting as a 'gateway' to diverse and serious future problems. Yet, PD still struggles for legitimacy and parity of access to services, including early intervention. CONCLUSION Addressing PD is fundamental to youth mental health, and early intervention for PD has reached 'proof of concept'. Yet, reform is hindered by bigotry and sectarianism. Successful early intervention calls for a shift in the culture of services, countering damaging myths, addressing bigotry, and fostering hope. Such reforms are well within the reach of youth mental health.
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Affiliation(s)
- Andrew M Chanen
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
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Chanen AM, Sharp C, Nicol K, Kaess M. Early Intervention for Personality Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:402-408. [PMID: 37200874 PMCID: PMC10187393 DOI: 10.1176/appi.focus.20220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Both the DSM-5 Section III Alternative Model for Personality Disorders and the ICD-11 have introduced a genuinely developmental approach to personality disorder. Among young people with personality disorder, compelling evidence demonstrates a high burden of disease, substantial morbidity, and premature mortality, as well as response to treatment. Yet, early diagnosis and treatment for the disorder have struggled to emerge from its identity as a controversial diagnosis to a mainstream focus for mental health services. Key reasons for this include stigma and discrimination, lack of knowledge about and failure to identify personality disorder among young people, along with the belief that personality disorder must always be addressed through lengthy and specialized individual psychotherapy programs. In fact, evidence suggests that early intervention for personality disorder should be a focus for all mental health clinicians who see young people and is feasible by using widely available clinical skills.
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Affiliation(s)
- Andrew M Chanen
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Carla Sharp
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Katie Nicol
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Michael Kaess
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
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Archer M, Shnyien A, Mansfield S, Draycott S. Mentalizing in first-episode psychosis: Correlates with symptomatology and traits of borderline personality disorder. Early Interv Psychiatry 2022. [PMID: 36181363 DOI: 10.1111/eip.13356] [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: 03/21/2022] [Revised: 07/13/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022]
Abstract
AIM To explore the associations between mentalizing, positive and negative symptoms of psychosis, and traits of borderline personality disorder, in a sample of patients with first-episode psychosis, and in a non-clinical sample. METHODS A quantitative cross-sectional design was employed. Thirty-two adults with first-episode psychosis and 148 non-clinical participants were assessed using the reflective functioning questionnaire. The questionnaire measures two dimensions of mentalizing, certainty and uncertainty about mental states. Traits of borderline personality disorder and symptoms of psychosis were measured using the self-report version of the Zanarini rating scale, the Community Assessment of Psychotic Experiences, and the Green et al., paranoid thought scale. RESULTS Patients with first-episode psychosis reported increased mentalizing impairments, characterized as hypomentalizing tendencies, compared to the non-clinical group. Regression analysis showed significant associations between higher scores on the uncertainty about mental states scale and negative symptoms of psychosis in both groups. No associations were found between mentalizing impairments and traits of borderline personality disorder in the clinical sample, although associations were found in the non-clinical sample. CONCLUSIONS The present findings suggests that impairments in mentalizing may be associated with negative symptoms of psychosis across both clinical and non-clinical samples. Mentalizing impairments was found to be associated with traits of borderline personality disorder, but this finding was only confirmed in the non-clinical sample. Mentalizing should therefore be considered in the early assessment and treatment of patients experiencing difficulties with negative symptoms of psychosis.
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Affiliation(s)
| | - Ali Shnyien
- University of Surrey, Guildford, England, UK
| | - Sarah Mansfield
- South West London and St George's Mental Health Trust, London, England, UK
| | - Simon Draycott
- University of Surrey, Guildford, England, UK.,West London NHS Trust, London, England, UK
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Schandrin A, Francey S, Nguyen L, Whitty D, McGorry P, Chanen AM, O'Donoghue B. Co-occurring first-episode psychosis and borderline personality pathology in an early intervention for psychosis cohort. Early Interv Psychiatry 2022. [PMID: 36163652 DOI: 10.1111/eip.13352] [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: 05/09/2022] [Revised: 08/11/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is common among people diagnosed with first episode of psychosis (FEP), but is often under-recognized and under-researched. This study aimed to determine: (i) the prevalence of borderline personality pathology (subthreshold features and categorical disorder) in a FEP cohort (termed FEP + BPP); (ii) demographic and clinical factors associated with FEP + BPP; (iii) the symptomatic and functional outcomes. METHODS This study was conducted within the Early Psychosis Prevention and Intervention Centre (EPPIC) at Orygen over the 30-month period between 2014 and 2016. BPP was evaluated by using the Structured Clinical Interview for DSM-IV Axis II Personality Questionnaire BPD criteria. RESULTS In a cohort of 457 young people with a FEP (mean age 19.5 years, 56% male), 18.4% had borderline personality pathology (BPP). Compared with FEP alone, young people with FEP + BPP were more likely to be female, younger, Australian-born. In addition, young people with FEP + BPP were more likely to be diagnosed with Psychosis NOS, present with more severe hallucinations, and have alcohol abuse. Young people with FEP + BPP had more relationship difficulties at presentation and they were more likely to suffer of depression and to engage in self-harm throughout the follow-up. In relation to outcome, FEP + BPP was not associated with different rates of remission or relapse, however they were less likely to be admitted to hospital at presentation or involuntarily during their episode of care. CONCLUSION BPP is a common occurrence in psychotic disorders and is associated with more severe hallucinations and depression with higher risks of self-harm. Specific interventions need to be developed.
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Affiliation(s)
- Aurelie Schandrin
- Department of Adult Psychiatry, University Hospital of Nîmes, Nîmes, France.,Orygen, Parkville, Victoria, Australia
| | - Shona Francey
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | | | | | - Patrick McGorry
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew M Chanen
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Brian O'Donoghue
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.,St Vincents University Hospital Elm Park, Dublin, Ireland
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Belohradova Minarikova K, Prasko J, Holubova M, Vanek J, Kantor K, Slepecky M, Latalova K, Ociskova M. Hallucinations and Other Psychotic Symptoms in Patients with Borderline Personality Disorder. Neuropsychiatr Dis Treat 2022; 18:787-799. [PMID: 35422622 PMCID: PMC9005124 DOI: 10.2147/ndt.s360013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 03/18/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Psychotic symptoms in BPD are not uncommon, and they are diverse and phenomenologically similar to those in schizophrenia spectrum disorders. Despite their prevalence in BPD patients, knowledge about the characteristics and severity of hallucinations is limited, especially in modalities other than auditory. AIM This review summarises the causes, phenomenology, severity, and treatment options of hallucinations and other psychotic symptoms in BPD. METHODS The PubMed database was used with the following key terms: "borderline personality disorder" and 'hallucinations' and "psychotic symptoms". Articles were selected between January 1990 and May 2021. The primary keyword search yielded a total of 545 papers, of which 102 articles met the inclusion criteria and were fully screened. Papers from the primary source reference lists were also screened, assessed for eligibility, and then added to the primary documents where appropriate (n = 143). After the relevance assessment, 102 papers were included in the review. We included adult and adolescent studies to gather more recent reviews on this topic. RESULTS Hallucinations are significantly prevalent in BPD, mainly auditory, similar to schizophrenia spectrum disorders. The relationship between hallucinations and depression, anxiety, suicidality, schizotypy, and loneliness in BPD has been discovered but requires more research. Studies for treatment options for hallucinations in BPD are lacking. CONCLUSION Recognition of psychotic symptoms in patients with BPD as distinguished psychopathological phenomena instead of diminishing and overlooking them is essential in the clinical assessment and can be useful in predicting complications during treatment. More focused research in this area is needed.
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Affiliation(s)
- Kamila Belohradova Minarikova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic.,Institute for Postgraduate Education in Health Care, Prague, The Czech Republic.,Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, The Slovak Republic.,Jessenia, a.s., Rehabilitation Hospital Beroun, AKESO Holding, Beroun, The Czech Republic
| | - Michaela Holubova
- Department of Psychiatry, Hospital Liberec, Liberec, The Czech Republic.,Department of Pedagogy and Psychology, Faculty of Science, Humanities and education, Technical University, Liberec, The Czech Republic
| | - Jakub Vanek
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Krystof Kantor
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Milos Slepecky
- Department of Psychology Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University, Nitra, The Slovak Republic
| | - Klara Latalova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
| | - Marie Ociskova
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University, University Hospital, Olomouc, The Czech Republic
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Nietola M, Nordström T, Miettunen J, Korkeila J, Jääskeläinen E. Effects of gender and psychiatric comorbidity on the age of illness onset and the outcome of psychotic depression-A birth cohort study. J Affect Disord 2022; 296:587-592. [PMID: 34634319 DOI: 10.1016/j.jad.2021.09.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 08/28/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Psychotic depression (PD) is an under-researched disorder with severe symptoms and course of illness. Little is known about gender differences relating to this condition and possible variation of prognosis based on comorbid pathology. Our aim was to analyze the effects of gender and psychiatric comorbidities on the age of illness onset and on the outcome of psychotic depression. METHODS The study was carried out in the Northern Finland Birth Cohort 1966. We utilized register data to acquire information about lifetime psychiatric diagnoses, hospitalization, age of illness onset, rate of disability pensions and mortality. The PD group (n = 58) was defined based on a lifetime register diagnosis. We compared outcome variables in sub-groups based on gender and comorbid alcohol use or personality disorder. RESULTS The prevalence of comorbid personality disorders was 38% (22/58) and comorbid alcohol use disorders 41% (24/58). PD patients with a personality disorder diagnosis had an earlier onset age (p<0.01) and a higher mortality rate (p = 0.03). Male gender (p = 0.03), comorbid alcohol use disorder (p<0.01) and personality disorder (p < 0.01) were all associated with more psychiatric hospitalization. Comorbid alcohol use disorder was more common among men (males: 61%; females: 29%; p = 0.03). LIMITATIONS National registers were the main source of diagnostic information. CONCLUSIONS Gender and psychiatric comorbidity have significant implications for the course of illness in PD in naturalistic settings, which is an important message for all clinicians. More research into the heterogeneity of PD is needed in order to guide research and clinical practice.
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Affiliation(s)
- Miika Nietola
- Psychiatric department, University of Turku and the Hospital District of Southwest Finland, Kunnallissairaalantie 20, building 9, 3. floor, 20700 Turku, Finland.
| | - Tanja Nordström
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Jyrki Korkeila
- Psychiatric Department, University of Turku and Satakunta Hospital District, Finland
| | - Erika Jääskeläinen
- Center for Life Course Health Research, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland
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12
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Cavelti M, Thompson K, Chanen AM, Kaess M. Psychotic symptoms in borderline personality disorder: developmental aspects. Curr Opin Psychol 2021; 37:26-31. [DOI: 10.1016/j.copsyc.2020.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/02/2020] [Indexed: 12/14/2022]
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13
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Corbeil O, Bérubé FA, Artaud L, Roy MA. Détecter et traiter les troubles comorbides aux premiers épisodes psychotiques : un levier pour le rétablissement. SANTE MENTALE AU QUEBEC 2021. [DOI: 10.7202/1088187ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Chanen AM, Betts J, Jackson H, McGorry P, Nelson B, Cotton SM, Bartholomeusz C, Jovev M, Ratheesh A, Davey C, Pantelis C, McCutcheon L, Francey S, Bhaduri A, Lowe D, Rayner V, Thompson K. Aripiprazole compared with placebo for auditory verbal hallucinations in youth with borderline personality disorder: Protocol for the VERBATIM randomized controlled trial. Early Interv Psychiatry 2019; 13:1373-1381. [PMID: 30689305 DOI: 10.1111/eip.12774] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 06/15/2018] [Accepted: 12/06/2018] [Indexed: 01/11/2023]
Abstract
AIM Up to half of patients with borderline personality disorder report auditory verbal hallucinations that are phenomenologically indistinguishable from those in schizophrenia, occur early in the course of the disorder, and are enduring, distressing and disabling. In clinical practice, this symptom is widely assumed to be unresponsive to treatment with antipsychotic medication and early intervention is rarely offered. The Verbal Experiences Response in Borderline personality disorder to Aripiprazole TrIal Medication (VERBATIM) study aims to be the first controlled trial to investigate the effectiveness of conventional pharmacotherapy for this symptom in this patient group. METHOD VERBATIM is a 12-week, triple-blind, single-centre, parallel groups randomised controlled trial, with a 27-week follow-up period. Participants between the ages of 15 and 25 years receive either aripiprazole or placebo daily, commencing at 2 mg and increasing to 10 mg by day 15. Further dose escalations (up to 30 mg) may occur, as clinically indicated. This trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry ACTRN12616001192471 on 30/08/2016. RESULTS The primary outcome is severity of auditory verbal hallucinations assessed using the Psychotic Symptom Rating Scale. Secondary outcomes include the severity of general psychopathology, borderline personality pathology, social and occupational functioning and change in brain resting state connectivity. The primary endpoint is week 12 and secondary endpoint is week 39. CONCLUSION The results will inform treatment decisions for individuals with borderline personality disorder who present with auditory verbal hallucinations.
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Affiliation(s)
- Andrew M Chanen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Jennifer Betts
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Henry Jackson
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Patrick McGorry
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barnaby Nelson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Sue M Cotton
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Cali Bartholomeusz
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Martina Jovev
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Aswin Ratheesh
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Christopher Davey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Victoria, Australia
| | - Louise McCutcheon
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Shona Francey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Amit Bhaduri
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia.,Orygen Youth Health, Northwestern Mental Health, Melbourne, Victoria, Australia
| | - Danielle Lowe
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Victoria Rayner
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine Thompson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Victoria, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
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15
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Thompson KN, Cavelti M, Chanen AM. Psychotic symptoms in adolescents with borderline personality disorder features. Eur Child Adolesc Psychiatry 2019; 28:985-992. [PMID: 30511234 DOI: 10.1007/s00787-018-1257-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/14/2018] [Indexed: 02/08/2023]
Abstract
Psychotic symptoms have been found to be relatively common among adults with borderline personality disorder (BPD), and to be a marker of BPD severity, but are not recognised in daily clinical practice in these patients. This study is the first to examine the prevalence of psychotic symptoms in 15-18-year olds with BPD features. It was hypothesised that adolescents with full-threshold BPD would have significantly more psychotic symptoms than adolescents with sub-threshold BPD features, and that both these groups would have significantly more psychotic symptoms than adolescents with no BPD features. A total of 171 psychiatric outpatients, aged 15-18 years, were assessed using a structured interview for DSM-IV personality disorder and categorised into three groups: no BPD features (n = 48), sub-threshold BPD features (n = 80), and full-threshold BPD (n = 43). The groups were compared on measures of psychopathology and functioning (e.g. Youth Self Report, Symptom Check List-90-R, SOFAS). Adolescents with full-threshold BPD reported more psychotic symptoms than the sub-threshold BPD group (p < .001), and both these groups reported more psychotic symptoms than those with no BPD features (p < .001). Adolescents with full-threshold BPD reported more confusion (p < .01), paranoia (p < .001), visual hallucinations (p < .001) and strange thoughts (p < .01), than the other two groups. Psychotic symptoms predicted group membership, determined by BPD severity, after adjusting for other psychopathology and functional impairment (p < .01). Assessment of unusual perceptual experiences, paranoia or odd thoughts is highly clinically relevant in adolescents with BPD features, as these symptoms are associated with a more severe clinical presentation of BPD.
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Affiliation(s)
- Katherine N Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Marialuisa Cavelti
- Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, VIC, 3052, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.,Translational Research Centre, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Locked Bag 10, Parkville, VIC, 3052, Australia. .,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia. .,Orygen Youth Health, Melbourne, Australia.
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16
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Paust T, Theodoridou A, Müller M, Wyss C, Obermann C, Rössler W, Heekeren K. Borderline Personality Pathology in an At Risk Mental State Sample. Front Psychiatry 2019; 10:838. [PMID: 31798481 PMCID: PMC6874151 DOI: 10.3389/fpsyt.2019.00838] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction: Transient psychotic symptoms in patients with borderline personality disorder seem to be similar to those in patients with psychotic disorders. Especially in the field of early detection of psychosis, this might lead to individuals with borderline personality disorder being wrongly classified as subjects at risk for developing a manifest psychosis. The aim of the present study was to investigate the occurrence of borderline symptoms in a sample of subjects at risk for psychosis as well as possible effects on the transition rate. Methods: Seventy help-seeking individuals of an early psychosis recognition center were additionally examined for borderline symptoms by the borderline symptom checklist. Results: We found a significant correlation between borderline symptomatology and positive symptoms assessed by the structured interview for prodromal symptoms. There were no associations between basic symptoms for psychosis and borderline symptoms. In addition, there was no influence of borderline symptomatology on the rate of transition into a manifest schizophrenic disease. Summary: In conclusion, borderline personality disorder should not be an exclusion criterion for the screening for psychosis or for an early intervention treatment. On the other hand, not every patient with borderline personality disorder, (especially those not suffering from hallucinations, unusual thought content, or persecutory ideas) should automatically be screened for the risk of developing a psychotic disorder.
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Affiliation(s)
- Tobias Paust
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Mario Müller
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Christine Wyss
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Caitriona Obermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Wulf Rössler
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Department of Psychiatry and Psychotherapy, Charité University Medicine, Berlin, Germany
| | - Karsten Heekeren
- The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy I, LVR-Hospital Cologne, Cologne, Germany
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17
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Puntis S, Oke J, Lennox B. Discharge pathways and relapse following treatment from early intervention in psychosis services. BJPsych Open 2018; 4:368-374. [PMID: 30202598 PMCID: PMC6127960 DOI: 10.1192/bjo.2018.50] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 07/19/2018] [Accepted: 03/03/2018] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Early intervention in psychosis (EIP) services are the dominant service model in the treatment of first-episode psychosis. They are a time-limited intervention and little is known about discharge destinations and outcomes once EIP treatment has concluded. AIMS To understand discharge pathways and predictors of relapse in an EIP service. METHOD We collected data on all patients with an electronic health record treated by EIP services in Oxford Health NHS Foundation Trust in the UK between 12 January 2006 and 7 March 2017 (n = 701). Our primary outcomes were discharge destination at end of treatment and relapse. RESULTS Most patients (83.5%) were discharged to primary care. Transfer to secondary care was associated with previous in-patient admissions (odds ratio (OR) = 1.92, 95% CI 1.54-2.39) and longer EIP treatment (OR = 1.04, 95% CI 1.03-1.06). Relapse rate was highest shortly after leaving EIP services. Relapse was associated with transfer to secondary care (hazard ratio (HR) = 2.75, 95% CI 1.75-4.31), higher deprivation (HR = 1.03, 95% CI, 1.01-1.05), a substance misuse disorder (HR = 1.81, 95% CI 1.01-3.26) and a comorbid diagnosis of a personality disorder (HR = 2.96, 95% CI 1.39-6.29). CONCLUSIONS Most patients treated by the EIP service in Oxfordshire did not receive ongoing mental healthcare from secondary mental health services. We identified high deprivation and those with substance misuse problems or personality disorders as EIP populations with a high risk of relapse. DECLARATION OF INTEREST None.
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Affiliation(s)
- Stephen Puntis
- Research Fellow, Department of Psychiatry, University of Oxford, Warneford Hospital, UK
| | - Jason Oke
- Senior Statistician, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Belinda Lennox
- Associate Professor, Department of Psychiatry, University of Oxford, Warneford Hospital, UK
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18
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Quirk SE, Stuart AL, Berk M, Pasco JA, Brennan Olsen SL, Koivumaa-Honkanen H, Honkanen R, Lukkala PS, Chanen AM, Kotowicz M, Williams LJ. Personality disorder is an excess risk factor for physical multimorbidity among women with mental state disorders. Psychiatry Res 2017; 257:546-549. [PMID: 28888138 DOI: 10.1016/j.psychres.2017.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 08/03/2017] [Accepted: 08/09/2017] [Indexed: 10/19/2022]
Abstract
We examined whether mental state disorders (lifetime mood, anxiety, eating, substance misuse) with comorbid personality disorder are associated with physical multimorbidity in a population-based sample of women. Mental state and personality disorders were assessed using semi-structured diagnostic interviews. Clinical measures were performed and medical conditions, medication use and lifestyle factors were documented by questionnaire. Mental state disorders were associated with higher odds of physical multimorbidity; risk was especially high for those with comorbid personality disorder. These findings suggest that mental state and physical comorbidity might be worsened by the additional comorbidity of personality disorder.
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Affiliation(s)
- Shae E Quirk
- Deakin University, Geelong, Australia; Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia
| | | | - Michael Berk
- Deakin University, Geelong, Australia; Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Department of Psychiatry, University of Melbourne, Australia; Florey Institute for Neuroscience and Mental Health, Melbourne, Australia; Barwon Health University Hospital, Geelong, Australia
| | - Julie A Pasco
- Deakin University, Geelong, Australia; Barwon Health University Hospital, Geelong, Australia; Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, Australia
| | - Sharon L Brennan Olsen
- Deakin University, Geelong, Australia; Institute of Health and Ageing, Australian Catholic University, Melbourne, Australia; Australian Institute for Musculoskeletal Science (AIMSS), The University of Melbourne-Western Precinct, St Albans, Australia
| | - Heli Koivumaa-Honkanen
- Department of Psychiatry, Lapland Hospital District, Rovaniemi, Finland; Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland; School of Medicine, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland
| | - Risto Honkanen
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland; Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Pyry S Lukkala
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland; Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, Australia
| | - Mark Kotowicz
- Deakin University, Geelong, Australia; Barwon Health University Hospital, Geelong, Australia; Melbourne Medical School-Western Campus, The University of Melbourne, St Albans, Australia
| | - Lana J Williams
- Deakin University, Geelong, Australia; Barwon Health University Hospital, Geelong, Australia.
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