Psychotic Experiences and Daily Functioning in Borderline Personality Disorder and Schizophrenia.

ABSTRACT: Psychotic experiences have been shown to be comparable in borderline personality disorder (BPD) and schizophrenia. Preliminary evidence suggests differences in the impact of psychotic experiences on daily functioning. Therefore, in this study, we aimed to investigate the role of psychotic experiences in daily functioning in BPD compared with schizophrenia. We performed post hoc analyses on data from 23 inpatients with BPD and 21 inpatients with schizophrenia, for whom results from the Psychotic Symptom Rating Scales were available. No differences were found in frequency, intensity, and disruption of life in relation to auditory verbal hallucinations and the amount of preoccupation and conviction with regard to delusions. Significant differences were found in the disruption of life due to delusions. The results emphasize that the quality of psychotic experiences in BPD and schizophrenia is comparable, but the impact of delusions on daily life is different, which may improve differential diagnosis.

Long-term course of psychogenic nonepileptic seizures: Who gets seizure-free, has better functional level and higher health-related quality of life?

BACKGROUND: The disease course of psychogenic nonepileptic seizures (PNES) over a prolonged period of time remains unclear. The aims of the study were: 1. to describe the course of illness with a median follow-up time of 4 years and a range of 2-15 years; and 2. to identify distinguishing features between participants regarding seizure cessation, functional level and health-related quality of life. METHODS: Formerly, inpatients of an epileptic ward diagnosed with PNES between 2000 and 2013 were contacted via mail. They were asked by questionnaire about illness characteristics, i.e., age at onset, PNES status at onset and in the course, treatments, psychosocial situation, and quality of life status. RESULTS: Two-thirds of the N = 63 formerly inpatients were female, their age at onset was 26.7 years. Seizure frequency decreased significantly over time, 31.7% were currently seizure-free, but still only 37% were regularly employed. Only 48% had a satisfying health-related quality of life. The remitted participants had a shorter duration of illness and higher health-related quality of life. Participants with a good level of functioning were more likely to be male, took fewer medications, and had a higher health-related quality of life. Those participants with higher quality of life were more frequently employed and had fewer seizures. CONCLUSIONS: As participants continue to be severely limited in their functional level and quality of life over the period under review, enhanced treatment approaches that address experiential avoidance seem to be needed.

One-year follow-up of functional impairment in inpatients with mood and anxiety disorders - Potentials of the Mini-ICF-APP.

BACKGROUND: The aim of the study was to investigate functional impairment and its relationship to illness severity in a sample of patients with a diagnosis of mood or anxiety disorder during inpatient treatment and 1 year after discharge. METHODS: Two hundred thirty-nine inpatients with primary diagnoses of mood or anxiety disorders were assessed at baseline and at follow-up by a range of validated instruments. Mini-ICF-APP was used for the assessment of functional impairment, BDI-II for the assessment of clinical symptoms and remission. Sample characteristics and measures of impairment at baseline and at follow-up were analysed descriptively. Symptomatically remitted and non-remitted patients were compared with regard to capacity limitations. RESULTS: Initially, the sample showed considerable impairment in many capacities, particularly endurance, spontaneous activities, structuring of tasks, competency and flexibility. After 1 year, all capacities significantly improved. The level of impairment was correlated with employment status and severity of clinical symptoms. About 50% of the patients remitted in clinical symptomatology. Retrospectively, the remitted and the unremitted did not differ in functional impairment at baseline but there were considerable differences at follow-up. CONCLUSIONS: Mini-ICF-APP is a useful instrument to monitor functional status and change in psychiatric samples, complementing the usual focus on symptom reduction.

The screen for cognitive impairment in psychiatry (SCIP) as a routinely applied screening tool: pathology of acute psychiatric inpatients and cluster analysis.

BACKGROUND: Cognitive dysfunction has been reported in acute psychiatric patients for a long time. The detection of cognitive deficits is crucial both for clinical treatment and for predicting the psychosocial functional level in the further course of the disease. The SCIP is a well-evaluated screening instrument for the examination of cognitive performance in psychiatric patients. We recently integrated the SCIP into our routine admission and discharge assessments on two inpatient wards, and we examined the cognitive profiles of patients with psychotic and affective disorders over the course of their admission. METHODS: Shortly after admission, and prior to discharge, patients were routinely referred for examination with the SCIP. A total of 529 assessments were completed on admission, and 227 returned for SCIP at the time of discharge. After standardization of the test results against a normative sample, we examined the normalized test values in terms of percentages of pathological cognitive performance based on the total SCIP score, and each of the SCIP subscale scores. We conducted cluster analysis to identify cognitive subgroups within the clinical sample. RESULTS: More than 70% of the SCIP results on admission were pathological. At discharge, improvements were observed, especially on tests with attention and speed components. Cluster analysis identified two groups. The cluster with chronic patients showed poorer results at admission, but greater improvement and reached the level of the others at discharge. CONCLUSIONS: The SCIP appears to have value in routine diagnostic assessments, and in the quantification of improvements in cognitive performance during an inpatient stay. The greatest benefit was observed in chronically ill patients with many previous stays. TRIAL REGISTRATION: DRKS00019825 (retrospectively registered on 03.12.2019).

[Clinical courses of depressive and anxiety disorders over 1 year : Direct comparison of four treatment settings in psychiatry and psychosomatic medicine-results of the PfAD study]. / Erkrankungsverläufe depressiver und Angststörungen über ein Jahr : Direkter Vergleich von vier Behandlungssettings in Psychiatrie und Psychosomatik ­ Ergebnisse der PfAD-Studie.

BACKGROUND: Inpatient care for patients with depressive and anxiety disorders (ICD-10 F3/F4 diagnoses) is provided in Germany in different settings of psychiatry and psychosomatic medicine. OBJECTIVE: Apart from the question of the effectiveness of treatment, it is of interest whether the course of the disease differs between four different settings up to a period of 1 year after discharge. MATERIAL AND METHODS: A total of 320 patients with main clinical diagnoses from the ICD-10 F3/F4 spectrum were recruited and interviewed consecutively in four treatment settings (psychiatric depression unit, psychiatric crisis intervention unit, psychiatric day hospital, psychosomatic acute hospital). The interviews were conducted after admission, before discharge and 6 and 12 months after discharge. RESULTS: Overall, treatment in all four settings was shown to be highly effective. The slight increase in symptoms in the postinpatient phase described in the literature was observed across all settings. In terms of treatment intensity, those treated in the crisis intervention unit received the most services after index treatment; however, this group was also the one with the most pronounced symptom burden at admission. Patients treated in the psychosomatic department had the lowest symptom burden at admission and overall received the least inpatient services over the observation period; however, outpatient follow-up treatment was apparently used most by those patients. CONCLUSION: The treatments proved to be effective in the long-term in both psychiatric and psychosomatic units. The different settings seem to be successful in adapting the treatments to the respective patient groups.

[Open doors of a psychiatric intensive care unit with addiction patients: A 3-year Follow up study]. / Auswirkungen der Teilöffnung einer Suchtaufnahmestation ­ Follow-Up nach 3 Jahren.

OBJECTIVE: A psychiatric addiction admission ward was conceptually modified in 2014 into a therapeutic and an intensive care unit. The effects of this restructuring procedure were now studied in a 3-year follow up. METHODS: Data about times of closed doors, length of stay and coercive measures were evaluated over 3 measurement phases (Prä, Post, Follow-Up), each covering a 5-months period. RESULTS: After restructuring, the door was closed significantly less often. In the follow-up period the results improved once more. CONCLUSIONS: The conceptual restructuring on a therapeutic, organizational and constructional level resulted in a sustained change in terms of custodial measures and length of stay.

[Effects of an animal-assisted intervention on psychiatric in-patient addiction treatment - a pilot study]. / Effekte einer tiergestützten Intervention in der stationären psychiatrischen Suchtbehandlung ­ eine Pilotstudie.

OBJECTIVE: Animal-assisted therapies, especially with therapy dogs, are getting increasingly popular in inpatient psychiatric treatment. In the present pilot study, we examined how chronic and comorbid patients in psychiatric addiction treatment assess this form of therapeutic support. METHODS: Pre-post-evaluation of the intervention variable "therapy dog" in a prospective, naturalistic setting. Without intervention 50 patients, with intervention 52 patients were requested to answer a questionnaire on topics covering social interaction / ward atmosphere, emotional competences and pathological addiction behavior. RESULTS: The two studied groups differed highly significantly in most of the items on the topics social interaction / ward atmosphere, emotionality and addiction pathology, in favor of animal-assisted therapy. Also, the frequency of smoking and dealing with craving were significantly reduced in this group. Effect sizes were medium to high. CONCLUSIONS: Patients consider the presence of a therapy dog on a psychiatric addiction ward very positively. Ward atmosphere is experienced as more pleasant and patients see a possibility of behavioral change with respect to social and emotional competences.

Dissociation in patients with borderline personality disorder in acute inpatient care - A latent profile analysis.

PURPOSE: Dissociation is a common symptom in Borderline Personality disorder (BPD) and its consideration is important for the therapeutic outcome. The aim of this cross-sectional study was to scrutinize the co-occurrence of BPD symptoms and dissociative experiences. In particular, we were interested in the occurrence of specific symptom clusters characterizing qualitatively different patient groups in a clinical sample of BPD patients. BASIC PROCEDURES: We analyzed the data of 103 patients in a specialized acute inpatient care crisis intervention unit. Measures were the Borderline Symptom List (BSL-95), a German adaption of the Dissociative Experience Scale (FDS), and the Symptom Checklist SCL-90-R. We applied a Latent Profile Analysis (LPA) using the subscales of BSL-95 and FDS to investigate the existence of distinct latent classes of symptom profiles. Afterwards, we related the obtained profiles to other clinical and demographic characteristics. MAIN FINDINGS: Dissociative experiences of moderate to severe intensity were common among patients with BPD. LPA revealed that a model of three classes fitted the data best: one class was characterized by co-occurrence of severe borderline symptoms and frequent dissociative experiences, one class showed low symptom burden in both measures, and one class showed considerable borderline symptoms but only moderate dissociative experiences. The classes were closely related to the severity of other self-rated psychological problems and showed significantly different occurrences of stress-related comorbid disorders. PRINCIPAL CONCLUSIONS: The results underline that dissociation is an important factor in many (but not all) BPD patients. This should be addressed by increased attention to dissociative symptoms in the diagnostic process and the adjustment of treatment plans.

Similarities and differences in borderline personality disorder and schizophrenia with voice hearing.

The aim of the study was to identify psychopathological similarities and differences in borderline personality disorder (BPD) and schizophrenia. We compared 23 female patients with a BPD and 21 female patients with schizophrenia according to auditory verbal hallucinations (AVHs), dissociation, childhood trauma, and additional psychotic symptoms. The character of AVH was similar with regard to commenting voices, location, and foreign voices. Major differences were found in the prevalence of negative symptoms, bizarre delusions, and formal thought disorder. These characteristics were more frequent in schizophrenia and negatively correlated with childhood traumatization. A history of childhood traumatization and dissociative symptoms was significantly more frequent in BPD. AVHs in BPD and schizophrenia are not distinguishable in terms of the historically grown criteria in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision for diagnosing schizophrenia. Other symptoms such as delusions, negative symptoms, formal thought disorder, and dissociative psychopathology could help to differentiate between both groups.

Generic substitution of antiepileptic drugs--a survey of patients' perspectives in Germany and other German-speaking countries.

In this study, we sought to determine the patients' attitudes towards generic substitution of antiepileptic drugs (AEDs) and their experiences with the usage of generic antiepileptic drugs in Germany and other German-speaking countries. A questionnaire was designed for a cross-sectional study. Two thousand copies of the questionnaire were delivered with a magazine edited by a patients' organization. Additionally, the questionnaire was placed on the internet platform of another patients' organization. Thirty-two percent of the patients who already experienced a switch to generic AEDs complained of problems with the switch. Patients who answered the magazine survey worried significantly more about generic substitution of AEDs than patients who answered the internet version. Patients who had never switched were more concerned about generic substitution than those who had already switched. Moreover, patients' beliefs differed between the use of generic drugs in acute medical conditions such as pain and infections and the use of generic AEDs in epilepsy.

[Schema Therapy with Sheep: Animal-assisted Intervention in Schema Therapeutic Psychiatric Addiction Treatment]. / Schematherapie mit Schafen: Tiergestützte Intervention in der schematherapeutischen, psychiatrischen Suchtbehandlung.

AIM OF THE STUDY: Schematherapy is often used in addiction treatment. The question is whether animal-assisted interventions can improve the effects. METHOD: During an inpatient psychiatric stay with a schematherapeutic focus, an animal-assisted intervention with sheep was implemented. A case report is presented. RESULTS: After the intervention, the individual mode model of the presented patient shows significant changes towards a strengthening the healthy adult and happy child mode and a reduction of dysfunctional modes. CONCLUSION: The animal-assisted intervention, embedded in a schematherapeutic context, was experienced in this patient as well implementable and impressively effective with regard to a modification of the mode model.

[An Outpatient Withdrawal Treatment of Kratom in Social Phobia: Psychotherapeutic Surgery Meets Addiction Psychiatric Outpatient Clinic]. / Eine ambulante Entzugsbehandlung von Kratom bei sozialer Phobie: psychotherapeutische Praxis trifft suchtpsychiatrische Institutsambulanz.

BACKGROUND: An increase in the use of kratom is reported worldwide. The substance is not classified as illegal in Germany. The psychoactive effects and withdrawal symptoms are opioid-like. METHOD: A patient visited a psychotherapy practice for treatment of his social phobia. Problematic use of kratom was disclosed, and treatment planning was adjusted accordingly. RESULTS: The physical withdrawal treatment was carried out in cooperation of the psychiatric outpatient clinic and the psychotherapeutic practice. Securing abstinence and treatment of social phobia are now upcoming goals in the psychotherapeutic practice. DISCUSSION: The use of kratom is more widespread than apparently assumed. Detoxification can be performed on an outpatient basis. CONCLUSION: The case underlines the importance of a detailed addiction anamnesis, but especially of the individual case-related cooperation therapists.

[Can you See and Hear How Bad I Feel Right Now? - Self-Injury and Suicidal Communication in Borderline Personality Disorder - A Secondary Analysis]. / Kannst Du sehen und hören, wie schlecht es mir gerade geht?

Non-suicidal self-injurious behavior (NSSV) and suicide attempts are well-known features of borderline personality disorder; communicative behavior is poorly studied. Differences between patients with and without NSSV as well as differences in current suicide attempts regarding suicidal communication and NSSV were investigated.In a secondary analysis, data on current and anamnestic NSSV, suicide attempts, suicidal communication, and clinical symptomatology of 87 inpatients were studied.Patients with and without current NSSV did not differ in anamnestic but did differ in current suicide attempts and suicidal communication. In regard to the current inpatient stay, it was observed that patients with and without suicide attempts differed considerably in the variables NSSV (100 vs. 32.5 %) and suicidal communication (71.4 vs. 7.5 %).Current self-injury and suicidal communication are highly significant for risk assessment of current suicidality.

[Case Report on the Treatment of Inner Restlessness with Biofeedback and Behavior Therapy]. / Fallvorstellung zur Behandlung innerer Unruhe mit Biofeedback und Verhaltenstherapie.

BACKGROUND: Inner restlessness is a frequently mentioned symptom in psychiatric-psychotherapeutic clinical practice, from which patients with various mental illnesses suffer. METHOD: A patient with major depression was treated with a total of eight biofeedback sessions with the physiological parameter heart rate variability and three behavioral therapy sessions. Questionnaires were used to assess the symptom of inner restlessness and a possible success of the therapy. RESULTS: Inner restlessness, ability to relax, disease burden and self-efficacy improved significantly over the 3-week treatment period. DISCUSSION: Inner restlessness could be treated surprisingly successfully. CONCLUSION: More importance should be given to the treatment of inner restlessness.

The impact of antiepileptic polytherapy on mood and cognitive function.

This retrospective study was performed to reevaluate the effect of polytherapy on mood and cognitive function. 139 patients with refractory epilepsy were screened with a neuropsychological test battery and a depression score. Our regression model with age at admission, duration of the disorder and number of antiepileptic drugs as independent variables had a significant influence on 10 out of 11 neuropsychological parameters but not on depression. Looking at the significance of each predictor variable the number of antiepileptic drugs had a significant effect only on the estimation of the fluid intelligence. A significant effect on five neuropsychological parameters was found for the predictor variable duration of the disorder. Therefore our data do not support the commonly reported hypothesis that antiepileptic polytherapy itself is a substantial risk factor for cognitive deficits or depression in patients with refractory epilepsy. But there may be an influence of accumulative drug load during the course of the disorder as reflected by the effect of the duration of the disorder on five neuropsychological parameters.

[Assessment and treatment of patients with nonepileptic dissociative seizures in a department of epileptology]. / Diagnostik und Therapie von Patienten mit nicht-epileptischen dissoziativen Krampfanfallen in einer Abteilung fur Epileptologie.

OBJECTIVES: We examined the frequency of dissociative seizures in inpatients of a specialized ward for epilepsy as well as their diagnostic and therapeutic course. The basic principle of the latter is the therapeutic triad of value-free communication of the diagnosis, training of techniques for seizure interruption and problem solving of inner conflicts. METHODS: All inpatients in a department of epileptology with a diagnosis of dissociative seizures were examined retrospectively for the year 2009. RESULTS: 65 patients (11 %) were diagnosed with dissociative seizures, 23 patients with a primary diagnosis of epilepsy and 42 with a secondary diagnosis, epilepsy being the primary diagnosis. Symptoms occurred in the 23 patients with dissociative seizures as primary diagnosis between 2 weeks and 40 years. Possible predisposing factors and psychological comorbidities for the development of dissociative seizures were manifold. A psychopharmacological medication was established in 9 patients (39 %), and psychotherapy was recommended explicitly in all patients. CONCLUSIONS: There is a great heterogeneity in patients with dissociative seizures with a sometimes long course of the disorder.

[Aftercare of Psychiatric and Psychosomatic Inpatients with ICD-10 Disorders F3 and F4 (PfAD Study)]. / Poststationäre Weiterbehandlung von Patienten mit ICD-Diagnosen F3 und F4 in Psychiatrie und Psychosomatik (PfAD-Studie).

OBJECTIVE: We investigated treatment pathways after discharge from in-patient treatment and their predictors. METHODS: Within a prospective naturalistic study, 320 adult inpatients treated in four settings were examined at admission, discharge, and two follow-up time points. In addition to sociodemographic and clinical data, standardized instruments have been employed to collect data on pathways within the mental care system a half year before and one year after index treatment, respectively. Descriptive analyses and logistic regression models were applied. RESULTS: Inpatient admissions in the first half of the follow-up year were common in psychiatric inpatients as planned aftercare. The majority of participants received outpatient aftercare. Main predictors of both inpatient readmission and outpatient psychotherapy after discharge were the setting of the index-treatment (psychiatry versus psychosomatics) as well as previous and planned forms of care. CONCLUSION: Though according to plan, the pathways of aftercare in psychiatry and psychosomatics are predominantly disconnected and show little overlap.

Successful interventions on an organisational level to reduce violence and coercive interventions in in-patients with adjustment disorders and personality disorders.

BACKGROUND: Self-directed and other violence as well as subsequent coercive interventions occur in a substantial proportion of patients with personality disorders during in-patient treatment. Different strategies may be required to reduce coercive interventions for patients of different diagnostic groups. METHODS: We specialised one of our acute admission wards in the treatment of personality disorders and adjustment disorders (ICD-10 F4 and F6). Patients are not transferred to other acute wards in case of suicidal or violent behaviour. Violent behaviour and coercive interventions such as seclusion or restraint were recorded in the same way as in the rest of the hospital. We recorded the percentage of subjects affected by diagnostic group and average length of an intervention in the year before and after the change in organisational structure. RESULTS: The total number of coercive interventions decreased by 85% both among patients with an F4 and those with an F6 primary diagnosis. Violent behaviours decreased by about 50%, the proportion of involuntary committed patients decreased by 70%. CONCLUSION: The organisational change turned out to be highly effective without any additional cost of personnel or other resources.

[Evaluation of Suicide Risk Levels in Hospitals: Validity and Reliability Tests]. / Evaluation klinikinterner Suizidrisikostufen für den stationären Bereich: Validitäts- und Reliabilitätsprüfung.

OBJECTIVE: Examination of in-hospital suicide risk levels concerning their validity and their reliability. METHOD: The internal suicide risk levels were evaluated in a cross sectional study of in 163 inpatients. A reliability check was performed via determining interrater-reliability of senior physician, therapist and the responsible nurse. Within the scope of the validity check, we conducted analyses of criterion validity and construct validity. RESULTS: For the total sample an "acceptable" to "good" interrater-reliability (Kendalls W = .77) of suicide risk levels were obtained. Schizophrenic disorders showed the lowest values, for personality disorders we found the highest level of interrater-reliability. When examining the criterion validity, Item-9 of the BDI-II is substantial correlated to our suicide risk levels (ρm = .54, p < .01). Within the scope of construct validity check, affective disorders showed the highest correlation (ρ = .77), compatible also with "convergent validity". They differed with schizophrenic disorders which showed the least concordance (ρ = .43). CONCLUSION: In-hospital suicide risk levels may represent an important contribution to the assessment of suicidal behavior of inpatients experiencing psychiatric treatment due to their overall good validity and reliability.