The influence of borderline personality traits on clinical outcomes in bipolar disorder.

OBJECTIVES: Systematic reviews suggest comorbid borderline personality disorder is present in approximately 20% of individuals who have bipolar disorder, but current diagnostic systems demonstrate a move towards dimensional rather than categorical approaches to classifying personality pathology. We aimed to examine the presence and severity of borderline personality traits in bipolar I and bipolar II disorder, and to explore associations between the presence/severity of borderline personality traits and clinical outcomes in bipolar disorder. METHODS: Borderline personality traits were measured in 1447 individuals with DSM-IV bipolar disorder (1008 bipolar I disorder and 439 bipolar II disorder) using the Borderline Evaluation of Severity over Time (BEST) questionnaire. Lifetime clinical outcomes were assessed via Schedules for Clinical Assessment in Neuropsychiatry (SCAN) semi-structured interview and clinical case notes. RESULTS: Borderline personality traits were common in both bipolar disorder groups, with 86.2% participants reporting at least one trait. These included traits that overlap with (eg mood instability) and those that are distinct from the symptoms of bipolar disorder (eg fear of abandonment). Borderline personality traits were significantly more frequent and more severe in bipolar II disorder compared to bipolar I disorder. More severe borderline traits, and even the presence of a single borderline personality trait, were significantly associated with younger age of bipolar disorder onset and higher prevalence of lifetime alcohol misuse in both bipolar disorder groups. CONCLUSIONS: The presence of comorbid borderline personality traits should be considered in the management of all patients with bipolar disorder irrespective of whether criteria for a categorical borderline personality disorder diagnosis are met.

Evaluating Outcomes of a Co-Produced Theatre-Based Experiential Learning Project in Psychiatry.

INTRODUCTION: The benefits of theatre and arts-based initiatives for enhancing the health and wellbeing of adults, regardless of mental health status, are well-documented. Theatre methodologies offer a platform for co-produced experiential learning, promoting perspective-taking and effective communication among staff and service users. This project aimed to bring together service users and mental health professionals through workshops conducted by an experiential theatre company, focusing on themes such as relationship dynamics, co-production, empowerment and perspective-taking. Notably, the sessions were conducted online due to the COVID-19 pandemic. METHODS: The study sought to explore the experiences, learning outcomes and work-related wellbeing benefits of participating in this innovative project. Methods involved inviting East London Foundation Trust members to eight weekly online workshops, culminating in a co-created filmed performance. Interviews conducted 9 months to a year later with participants and facilitators were thematically analysed. RESULTS: Results revealed four key themes: (1) personal and collective growth through storytelling and embodied acting experiences; (2) the importance of workshop structure for experiential learning; (3) challenging traditional role definitions through diminished hierarchy; and (4) sustained impacts on time management at work and in personal lives. CONCLUSIONS: In conclusion, participants valued their involvement, indicating that theatre-based co-produced learning enhances communication and interpersonal skills in mental healthcare settings. These findings suggest the potential for integrating such approaches into healthcare education and training programs.

The potential impact of new TB vaccines on the burden of TB in people living with HIV in South Africa.

BACKGROUND: People living with HIV (PLHIV) are at increased risk of tuberculosis (TB). New TB vaccines may help reduce this burden. New TB vaccine candidates are safe and immunogenic in PLHIV.There is currently limited data on vaccine efficacy in this population. METHODS: Using mathematical modelling we explored the potential impact of a novel TB vaccine on TB burden in PLHIV in South Africa between 2030-2050. We compared the impact of a vaccine delivered irrespective of HIV status to vaccination of either PLHIV or people without HIV. We explored the impact of reduced vaccine efficacy and duration of protection in PLHIV relative to people without HIV on our model predictions. RESULTS: Vaccination irrespective of HIV status, with a vaccine with equal efficacy and duration in PLHIV, could avert up to 1.01 (95% range: 0.96-1.22) million TB cases in PLHIV. Restricting vaccination to PLHIV or people without HIV would achieve 65% (60-70) and 48% (46-53) of the total impact respectively. These results are strongly dependent on the assumed efficacy and duration of protection in PLHIV. Further information on these characteristics is important to identify the most efficient use of new vaccines to reduce TB burden in PLHIV. CONCLUSIONS: Our results suggest that new vaccines could play an important role in reducing the TB burden in PLHIV. Vaccines targeted at people without HIV individuals could provide significant indirect benefit to PLHIV, but vaccines which are safe and effective in PLHIV will be critical to maximizing the impact in this population.

The Effects of Beetroot Juice on Blood Pressure, Microvascular Function and Large-Vessel Endothelial Function: A Randomized, Double-Blind, Placebo-Controlled Pilot Study in Healthy Older Adults.

: Dietary nitrate (NO3-) has been reported to improve endothelial function (EF) and blood pressure (BP). However, most studies only assess large-vessel EF with little research on the microvasculature. Thus, the aim of the present pilot study is to examine NO3- supplementation on microvascular and large-vessel EF and BP. Twenty older adults (63 ± 6 years) were randomized to a beetroot juice (BRJ) or placebo (PLA) group for 28 (±7) days and attended three laboratory visitations. Across visitations, blood pressure, microvascular function and large-vessel EF were assessed by laser Doppler imaging (LDI) with iontophoresis of vasoactive substances and flow-mediated dilatation (FMD), respectively. Plasma NO3-concentrations, BP and the presence of NO3- reducing bacteria were also assessed. Plasma NO3- increased following two weeks of BRJ supplementation (p = 0.04) along with a concomitant decrease in systolic and diastolic BP of approximately -6 mmHg and -4 mmHg, respectively (p = 0.04; p = 0.01, respectively). BP remained unchanged in the PLA group. There were no significant differences in endothelium-dependent or endothelium-independent microvascular responses between groups. FMD increased by 1.5% following two weeks of BRJ (p = 0.04), with only a minimal (0.1%) change for the PLA group. In conclusion, this pilot study demonstrated that medium-term BRJ ingestion potentially improves SBP, DBP and large-vessel EF in healthy older adults. The improvements observed in the present study are likely to be greater in populations presenting with endothelial dysfunction. Thus, further prospective studies are warranted in individuals at greater risk for cardiovascular disease.