Development and preliminary evaluation of the psychometric properties of the psychological flexibility in epilepsy questionnaire (PFEQ).

The present study describes the development and preliminary psychometric evaluation of the Psychological Flexibility in Epilepsy Questionnaire (PFEQ), which was developed to measure the construct referred to as Psychological Flexibility (PF) in epilepsy. Results from 81 participants with epilepsy support a one-factor solution, consisting of 12 items, indicating a satisfactory structure and reliability with an alpha coefficient of 0.92. Criterion validity of the instrument was supported by moderate correlations with outcomes predicting quality of life, PF in the general population, depressive symptoms, and anxiety symptoms. Number of seizures in the past three and 12 months was positively correlated with scores on the PFEQ. These findings are consistent with the instrument's underlying theory. Further development and investigation of the PFEQ is recommended, as the preliminary results of the questionnaire suggest that the scale has the potential to be a valuable contribution to the future exploration of the role of PF in epilepsy.

Clinical severity as a moderator of outcome in psychodynamic and dialectical behavior therapies for borderline personality disorder.

The aim of the present study was to assess the effect of initial level of psychiatric severity on treatment outcome in psychodynamic therapy and dialectical behavior therapy (DBT) for borderline personality disorder (BPD). It was hypothesized that DBT would lead to better outcome for patients with high psychiatric severity, whereas dynamic treatment would lead to better outcome for patients with lower psychiatric severity. Data from the 5th-year follow-up of the Stockholm City Council's and the Karolinska Institute's Psychotherapy Project were used in the present study. A total of 106 female patients diagnosed with BPD with at least 2 past suicide attempts were randomized into object-relational psychotherapy (ORP; based on transference-focused psychotherapy), DBT, and treatment as usual. Patients' baseline global severity index was used as a moderator. Global Assessment of Functioning (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [American Psychiatric Association, 1994]) was used to examine outcome. There was a significant 3-way interaction of Time × Treatment × Severity. Post hoc analyses suggested that patients with lower levels of severity had significantly better outcomes in object-relational psychotherapy. For patients with higher severity, the 3 treatments resulted in similar outcomes in terms of level of functioning. Outcome of treatment for BPD might differ significantly for patients depending on their initial levels of overall psychiatric severity. If our findings are replicated for patients with low severity and supported for a high-severity sample, psychiatric severity can be used as a low-cost and effective tool to match patients with BPD to optimal treatments. (PsycINFO Database Record

Manualized supportive-expressive psychotherapy versus nonmanualized community-delivered psychodynamic therapy for patients with personality disorders: bridging efficacy and effectiveness.

OBJECTIVE: Time-limited manualized dynamic psychotherapy was compared with community-delivered psychodynamic therapy for outpatients with personality disorders. METHOD: In a stratified randomized clinical trial, 156 patients with any personality disorder diagnosis were randomly assigned either to 40 sessions of supportive-expressive psychotherapy (N=80) or to community-delivered psychodynamic therapy (N=76). Assessments were made at intake and 1 and 2 years after intake. Patients were recruited consecutively from two community mental health centers (CMHCs), assessed with the Structural Clinical Interview for DSM-IV Axis II Personality Disorders, and included if they had a diagnosis of any DSM-IV personality disorder. The outcome measures included the presence of a personality disorder diagnosis, personality disorder severity index, level of psychiatric symptoms (SCL-90), Global Assessment of Functioning Scale score, and number of therapy sessions. General mixed-model analysis of variance was used to assess group and time effects. RESULTS: In both treatment conditions, the global level of functioning improved while there were decreases in the prevalence of patients fulfilling criteria for a personality disorder diagnosis, personality disorder severity, and psychiatric symptoms. There was no difference in effect between treatments. During the follow-up period, patients who received supportive-expressive psychotherapy made significantly fewer visits to the CMHCs than the patients who received community-delivered psychodynamic therapy. CONCLUSIONS: Manualized supportive-expressive psychotherapy was as effective as nonmanualized community-delivered psychodynamic therapy conducted by experienced dynamic clinicians.

[Pharmacological treatment of borderline personality disorders. Several options for symptom reduction but nothing for the disorder per se]. / Farmakologisk behandling vid borderline-personlighetsstörning. Flera alternativ för symtomlindring men inget mot störningen i sig.

There are few guidelines for pharmacological treatment of personality disorders. Some possible explanations for this is discussed: methodological problems, comorbidity and treatment traditions. The few controlled studies published are marred by methodological difficulties such as high frequency of drop outs, lack of compliance, short period of follow-up and differences in diagnostic procedures. The authors propose a dimensional approach focusing on cognitive, affective, anxiety and impulse dysfunction when selecting suitable pharmacological treatment. Global improvement can be seen, when target symptoms are successfully treated. Pharmacological treatment can not replace other treatment strategies such as psychosocial programs. The authors also discuss how pharmacological treatment can be understood in a psychological context. Non-selective MAO-inhibitors are probably underused in Sweden.

Do personality problems improve during psychodynamic supportive-expressive psychotherapy? Secondary outcome results from a randomized controlled trial for psychiatric outpatients with personality disorders.

Studies involving patients with personality disorders (PDs) have not focused on improvement of core aspects of the PD. The authors examined changes in quality of object relations, interpersonal problems, psychological mindedness, and personality traits in a sample of 156 patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed.) PD diagnoses being randomized to either manualized or nonmanualized dynamic psychotherapy. Effect sizes adjusted for symptomatic change and reliable change indices were calculated. The authors found that both treatments were equally effective at reducing personality pathology. Only in neuroticism did the nonmanualized group do better during the follow-up period. The largest improvement was found in quality of object relations. For the remaining variables, only small and clinically insignificant magnitudes of change were found. (PsycINFO Database Record

Supportive-expressive psychotherapy for comorbid personality disorders: a case study.

Supportive-expressive psychotherapy (SEP) has generated some empirical evidence supporting its effectiveness for treating a variety of Axis I disorder; however, no evidence supporting its use for patients with severe personality disorders has been published. This article describes a patient suffering from several personality disorders-avoidant, obsessive-compulsive, paranoid, narcissistic, and antisocial--using the core conflictual relationship theme (CCRT) method. Supportive-expressive psychotherapy focuses on connecting the CCRT with symptoms and maladaptive personality traits, with the goal of resolving these conflicts. Most maladaptive traits for such a complex patient are ego-syntonic, not experienced as internal conflicts, and therefore not easily accessible to therapeutic exploration. Such a patient is likely to experience the external environment as hostile once his ego-syntonic wishes are not automatically granted and thus the therapeutic alliance may suffer. This article will show the interpersonal processes that are activated when a patient is treated with time-limited, manualized psychotherapy.

Psychological distress and functional impairment in patients with personality disorders.

The study is aimed at investigating the impact of a personality disorder (PD) diagnosis, in terms of functional impairment and subjective distress, in order to better understand the burden of this diagnosis and its implications. Among the 462 consecutive psychiatric patients diagnosed with the DSM structured interview for Axis I, II and V diagnoses, almost 60% had PD. Patients with PD displayed considerable vulnerability and suffering in many domains, including finances and interpersonal relationships. Despite the educational and occupational similarities of PD patients and non-PD patients, the PD patients had more problems maintaining permanent job positions. They also had more symptomatic suffering and concerns about health than non-PD patients. Generally, the results were in line with findings in the literature but more thoroughly captured the challenges that PD patients face in various areas of life. Awareness of the frequent comorbidity of PD with Axis I disorders seems crucial in developing future treatment plans with an emphasis on psychosocial rehabilitation, vocational training and social support.

Patient factors predicting dropout from supportive-expressive psychotherapy for patients with personality disorders.

In this prospective study of psychiatric outpatients with personality disorders, the authors examined patient factors that predicted dropout from supportive-expressive (SE) psychotherapy. Eighty patients were randomized to 40 sessions of time-limited SE psychotherapy. The dropout rate was 35%; 50% of dropouts terminated psychotherapy before Session 7, and 10% were nonengagers. A model including age, type of Axis II cluster, total amount of interpersonal distress, and degree of focus on 1 particular type of interpersonal problem predicted 71% of the completers and 50% of the dropouts. The prediction model was more accurate for men than women. The findings regarding age and type of Axis II cluster are consistent with those of prior studies. The findings for total amount of interpersonal distress and degree of focus on 1 particular type of interpersonal problem are in accordance with key concepts in interpersonal theory and research. Thus, patients' manner of relating to others is associated with dropout. Researchers are encouraged to examine the association between interpersonal factors and dropout in greater depth.