Physical multimorbidity in psychiatric patients with personality disorders: Insights within the ICD-11 framework

OBJECTIVE

Recent research has revealed poor physical health among individuals with personality disorders (PDs). We aimed to compare chronic physical illnesses (CPI) and chronic physical multimorbidity (CPM) prevalence between the general population (GEP) and PD patients, and to explore the relationship between CPM and various aspects of PD, predominantly within the ICD-11 framework.

METHODS

This cross-sectional study included 126 PD patients and 126 matched controls from the GEP. Patients were evaluated for the ICD-11 PD severity and maladaptive personality domains, subjective emptiness, and reflective functioning. CPI was assessed using a standardized self-report questionnaire.

RESULTS

PD patients had a higher mean number of CPIs (2.05 vs. 1.02) and a more frequent CPM occurrence (49.2% vs. 26.2%) compared to the matched controls (p < .001). The ICD-11 PD severity (OR = 1.143, p = .007) and maladaptive domain Negative affectivity (OR = 4.845, p = .002), and poor reflective functioning (OR = 1.694, p = .007) were significant predictors of CPM, independent of sociodemographic, clinical and lifestyle factors. Negative affectivity showed the most robust effect on CPM, while smoking did not significantly mediate these relationships.

CONCLUSION

Our study found increased CPM burden in PD patients and a link between CPM and various PD aspects under the ICD-11 framework, highlighting the need for more integrated healthcare.

Borderline Personality Disorder: Comparison of Two Treatment Modalities

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.

Gender differences in early onset of chronic physical multimorbidities in schizophrenia spectrum disorder: Do women suffer more?

AIM

The association between various physical illnesses and schizophrenia spectrum disorder (SSD) is well-established. However, the role of gender remains unclear. The present study explored the gender-based differences in the prevalence and early onset of chronic physical multimorbidities (CPM) in patients with SSD and the general population (GEP).

METHODS

We recruited 329 SSD patients and 837 GEP controls in this nested cross-sectional study. The primary outcome was the prevalence of the chronic physical multimorbidities, especially in the youngest age group (<35 years).

RESULTS

Women with SSD had more than double the odds for having CPM than men (OR = 2.47; 95% CI 1.35-4.50), while the gender-related burden of chronic diseases in controls was nearly the same (OR = 0.89; 95% CI 0.65-1.22). Furthermore, the prevalence of chronic disease in younger women patients was significantly higher than in controls (P = .002), while younger men did not seem to experience this increased comorbidity burden.

CONCLUSIONS

This study suggests that women with SSD are at increased physical comorbidity risk compared to men, particularly early in the course of psychiatric illness. Tailored and individualized treatment plans must consider this, aiming to deliver holistic care and effective treatment outcomes.

Changes in the Long-Term Psychodynamic Group Psychotherapy in Family Members of Persons with Psychotic Disorders

BACKGROUND

The experience gained in working with psychotic persons as well as the findings from the literature have pointed to the need for systematic inclusion of the families of affected individuals, facilitating the creation of partnership within treatment, and to the need for a better understanding of family dynamics that reflects on the psychological conditions of the patients.

AIM

The aim of this paper is to explore the changes in self-esteem and loneliness of group members during the therapeutic process and whether the use of more mature defence mechanisms is the answer to the treatment of group psychotherapy.

SUBJECTS AND METHODS

We followed three groups of 30 members (18 women and 12 men). At the beginning of inclusion in group psychodynamic psychotherapy and after 18 months of psychotherapy, members completed the following questionnaires: Rosenberg Self-esteem Scale, short version of UCLA Loneliness Scale (ULS-7) and Lifestyle Questionnaire (LSI).

RESULTS

The research results show a statistically significant increase in self-esteem, a significant reduction in loneliness, and significantly reduced use of defence mechanisms after 18 months of group psychotherapy.

CONCLUSION

Research findings confirmed positive changes in family members who gradually feel better and safer, with less anxiety and fear, all positively reflecting on the family atmosphere, the ability to accept and understand the sick member, as well as his better quality of recovery.

Psychodynamic Group Psychoterapy in the Early Intervention Program for Patients with Psychosis (RIPEPP)

Psychiatric Hospital "Sveti Ivan" in Zagreb, Croatia, offers an outpatient Early intervention programme for patients with psychotic disorders (RIPEPP), consisting of psychoeducational workshops and group psychodynamic psychotherapy. Psychodynamic group psychotherapy presents a unique conceptual format not offered by other types of psychotherapy, and it is especially useful for population of patients with psychotic disorders. During group work, gradual establishment of communication and interactions, and creating a network of relations through experiences of corrective emotional symbiosis, affect the constellation of internal objects and relationships between members, and their restructuring. The function of group psychotherapy is not only to offer relief, support, and elements of education, but also to enable internal changes. Therapeutic factors contributing to the improvement of people with schizophrenia include supportive aspects such as universality, acceptance, cohesion, hope and altruism. This paper contains vignettes from inpatient and outpatient group dynamics.

Guidelines for Individual and Group Psychodynamic Psychotherapy for the Treatment of Persons Diagnosed with Psychosis and/or Schizophrenia

The hereby presented guidelines for the use of psychodynamic psychotherapy are based on references and research in the field of individual and group therapy and they refer to psychotherapy for patients suffering from the first psychotic episode, schizophrenia, schizoaffective psychosis, bipolar disorder and paranoid psychosis. The aim was to provide an overview of present literature and to give recommendations based on current knowledge. Clinical experience and research of the outcomes of psychodynamic psychotherapy encourage positioning of such treatments among recommendations for treating various mental disorders, as well as in the field of psychotherapy of patients with psychotic disorders (PD).

Treatment of patients in early phase of psychosis on psychotherapeutic inpatient unit - presentation of the therapeutic programme and evaluation of some aspects

BACKGROUND

Treatment of early phase of psychosis is important not only for overcoming the acute symptoms but also for the later treatment and attitude towards the illness. Psychotherapeutic approach is an integrative part of this treatment. In Psychiatric hospital "Sveti Ivan" in Zagreb, Croatia both psychotherapeutic and sociotherapeutic methods are used on the inpatient unit for young people with psychosis along with medications. The aim of this work is to present the work on the psychotherapeutic inpatient unit and to investigate whether during the hospitalisation of individuals with first psychotic episode changes occur in attitudes towards medications, quality of life, insight and self-esteem.

SUBJECTS AND METHODS

37 individuals with first psychotic episode (20 men, 17 women) completed the following battery of questionnaires upon hospital admission and before discharge: Drug attitude inventory (DAI-10), The World Health Organization Quality of Life (WHOQOL), Insight scale and Rosenberg's Self-Esteem Scale.

RESULTS

Before being discharged from hospital, patients assessed their quality of life as significantly improved over time (p=0.000), especially concerning their physical health (p=0.004), psychological health (p=0.004), and satisfaction with their environment (p=0.001). Also, positive trends were observed in attitudes towards drugs and self-esteem. No changes were shown regarding patients' insight.

CONCLUSIONS

The findings are encouraging: during treatment on psychotherapeutic inpatient unit, significant improvement in quality of life was observed, as well as positive trends in self-esteem and attitudes towards medications.

Object Relations and Self-Esteem in young Adults with Schizophrenia in Long-Term Psychodynamic Group Psychotherapy

Introduction

Psychodynamic concepts describe object relations deficits in patients with schizophrenia originating from their earliest developmental stage, which is due to reduced ability of direct caregivers to adequately stimulate the child, as well as genetic factors. During psychodynamic group psychotherapy, members through psychotherapy gradually release the old family roles and experiment with new models of behaviour and thus change internalized object representations.

Aim

The aim of this study was to investigate changes in object relationships and self-esteem in the psychodynamic group psychotherapy in young patients suffering from schizophrenia.

Subjects and methods

The study included a total of 41 patients diagnosed with schizophrenia. Before joining the psychodynamic group therapy and after two years of participation in the treatment, all patients completed a test of object relations and the Rosenberg self-esteem scale.

Results

Comparison of the results in two time periods showed downward trend results in all tested dimensions of object relations, a statistically significant difference was found for dimension symbiotic fusion: after two years of participation in the psychodynamic group psychotherapy, patients had significantly expressed less need for symbiotic relationships. Self-esteem was higher in the second period of testing, but without statistical significance.

Conclusion

Taking into account the limitations of this study, we can conclude that the results are encouraging. During psychodynamic group processes in young patients with schizophrenia there is a trend of positive changes in terms of object relations and self-esteem and a significant reduction in the need for symbiotic merging.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Personality characteristics of psychotic patients as possible motivating factors for participating in group psychotherapy

BACKGROUND

This study aimed to examine the relationship between some personality characteristics of patients diagnosed with psychotic disorders and the quality of their engagement in psychodynamic group psychotherapy. Given that previous research has shown that self-stigma is significantly negatively associated with the engagement of patients, the measure of self-stigma was used as a correlate of patients' motivation to participate in group psychotherapy.

SUBJECTS AND METHODS

A total of 48 outpatients (52.1% women; mean age 35.30 years) attending group psychodynamic psychotherapy completed The Inventory of Personality Organization, The Pathological Narcissism Inventory, The Measure of Parental Style, The Relationship Questionnaire, and The Internalized Stigma of Mental Illness scale.

RESULTS

The findings showed that patients with higher levels of self-stigma have unhealthy attachments styles, perceived their mothers' parental style as indifferent and achieved greater scores on narcissistic vulnerability scale. They are also are prone to primitive psychological defences, have poorly integrated identity, and achieved lower scores on reality testing dimension.

CONCLUSION

Taking into account the limitations of this study, these findings may contribute to improved understanding of the quality of participation and engagement of psychotic patients in group psychotherapy, and may help to develop more effective therapeutic approaches.

Changes in aspects of cognitive functioning in young patients with schizophrenia during group psychodynamic psychotherapy: a preliminary study

BACKGROUND

The "Sveti Ivan" psychiatric hospital in Zagreb, Croatia, offers an outpatient Early Intervention Program for psychotic patients. This program consists of psycho-educational workshops and group psychodynamic psychotherapy. Two important objectives of the program are improving and maintaining adequate cognitive functioning.

AIMS

The current study examined changes in aspects of cognitive functioning in young patients with schizophrenia after 18 months and after 3 years of psychodynamic group psychotherapy.

METHODS

The study included 28 patients who attended the Early Intervention Program for young patients with psychotic disorders; 10 patients had completed only the psycho-educational part of the program (comparative group), and 18 patients continued with group psychodynamic psychotherapy (experimental group). All patients completed the Revised Beta Examination.

RESULTS

We observed a trend in the experimental group to achieve higher scores than the comparative group. The results for both groups tended to increase with time, and this increase was greater in the experimental group.

CONCLUSIONS

While acknowledging the limitations of this preliminary study, we conclude that participating in psychodynamic group psychotherapy is related to increases in the cognitive functioning of patients with schizophrenia, and our results provide a sound basis for future research.

Dreams and fantasies in psychodynamic group psychotherapy of psychotic patients

Work with dreams in the group analysis represents an important part of the analytical work, with insight into unconscious experiences of the individual dreamer, and his transferrential relations with the therapist, other members of the group, and with the group as a whole. The way dreams are addressed varies from one therapist to another, and in line with that, members of the group have varying frequency of dreams. In groups of psychotic patients dreams are generally rarely discussed and interpreted by the group, with analysis mainly resting on the manifested content. This paper describes a long-term group of psychotic patients which, after sharing the dreams of several members and daydreams of one female patient, their interpretation and reception in the group achieved better cohesion and improved communication and interaction, i.e. created a group matrix. Furthermore, through the content of dreams in the group, traumatic war experiences of several of the group members were opened and discussed, which brought with it recollections of the traumatic life situations of other group members. In expressing a daydream, a female member of the group revealed the background for her behaviour which was earlier interpreted as a negative symptom of the illness.

Early intervention program for psychotic disorders at the psychiatric hospital "Sveti Ivan"

The Early intervention program for the first episodes of psychotic disorders (RIPEPP) at the Psychiatric Hospital "Sveti Ivan" in Zagreb encompasses patients hospitalized due to various psychoses (acute psychotic disorder, schizophrenia, schizoaffective and delusional disorder, bipolar affective disorder with psychotic symptoms) in the "critical period" of illness, i.e. within five years after the occurrence of the first symptoms. The RIPEPP Program consists of an in- and out-patient part, and includes psychotherapeutic and psychoeducative components as well as the administration of antipsychotics. The Psychotherapeutic part, conducted by psychotherapists - group analysts, comprises psychodynamic group psychotherapy for patients and for family members. The Psychoeducative part, led by cognitive-behavioral therapists, is carried out through educative interactive workshops for both patients and their family members. The paper describes the theoretical framework, as well as the professional, personnel, educative and organizational basis of the Program, the principles of evaluation and some experiences after five years of implementation.

Comparative study on gene tags of the neurotransmission system in schizophrenic and suicidal subjects

Schizophrenia and suicidal behaviour are sever and complex mental disorders, largely determined by factors of inheritance. Both disorders present pathological changes in the catecholamine neurotransmitter system. The study was conducted on three groups; a group of subjects suffering from schizophrenia, a second compounded by individuals who attempted suicide and a third group of phenotypically healthy examinees. The blood samples of schizophrenic patients as of those who attempted suicide were obtained at the Psychiatric Hospital "Sveti Ivan" in Zagreb in the year 2004. Tests were conducted on the statistic relation between a total of 18 SNPs within three candidate-genes of the dopamine and adrenergic system (DRD4, SLC6A3 and ADRA2B) and the manifestation of schzophrenia and suicidal behaviour. Cases were genotyped by use of SNPlex system. Statistically significant differences were determined in the allelic frequency between the mentioned groups. Findings show a significant connection between 4 SNPs (ADRA2B rs749457, SLC6A3 rs464094, DRD4 rs11246226 and rs4331145) and schizophrenia, and 2 SNPs with suicidal attempt (ADRA2B rs1018351 i SLC6A3 rs403636). In addition, this is the first study that highlights the potential role/effect of polymorphisms in ADRA2B on the manifestation of schizophrenia, as on suicidal behaviour.

Serotonin and cortisol as suicidogenic factors in patients with PTSD

Post-traumatic stress disorder (PTSD) frequently occurs in commorbidity with different mental disorders, including suicidal behaviour. Group of biological factors, including serotonergic system, HPA axis and some genetic factors, are being studied as potential markers, able to differentiate suicidal and non-suicidal behaviour across the group of PTSD patients. This study is examining statistical relation between platelet serotonine concentration and serum cortisole concentration, within the group of PTSD patients with and without attempted suicide, treated at "Sveti Ivan" Psychiatric Hospital in Zagreb. The hypothesis of this study is that periferal biochemical markers are different across the groups of PTSD patients with and without attempted suicide and the group of healthy controls. Our results have shown significantly lower platelet serotonine concentration in PTSD patients with and without suicide behaviour, compared to healthy controls. There are no statistically significant differences of the serum cortisole concentration across observed groups. Our results correspond with those reported by other authors in this area of research, suggesting that platelet serotonine level might be used as potential periferal marker to detect risk of suicidal behaviour in PTSD patients.