Clinical management of individuals with Intellectual Disability: The outbreak of Covid-19 pandemic as experienced in a clinical and research center Research in Developmental Disabilities.

During the COVID-19 pandemic, the Oasi Research Institute of Troina (Italy) became an important hotbed for infection; in fact, 109 patients with different levels of Intellectual Disability (ID) tested positive for COVID-19. The procedures and interventions put in place at the Oasi Research Institute due to the COVID-19 pandemic are exhaustively reported in this paper. The description of the clinical procedures as well as remote/in person psychological support services provided to people with ID and their families are here divided into three different sections: Phase I (or Acute phase), Phase II (or Activity planning), and Phase III (or Activity consolidation). In each section, the main psycho-pathological characteristics of patients, the reactions of family members and the multidisciplinary interventions put in place are also described.

Randomised feasibility trial of the helping families programme-modified: an intensive parenting intervention for parents affected by severe personality difficulties.

BACKGROUND: Specialist parenting intervention could improve coexistent parenting and child mental health difficulties of parents affected by severe personality difficulties. OBJECTIVE: Conduct a feasibility trial of Helping Families Programme-Modified (HFP-M), a specialist parenting intervention. DESIGN: Pragmatic, mixed-methods trial, 1:1 random allocation, assessing feasibility, intervention acceptability and outcome estimates. SETTINGS: Two National Health Service health trusts and local authority children's social care. PARTICIPANTS: Parents: (i) primary caregiver, (ii) 18 to 65 years, (iii) severe personality difficulties, (iv) proficient English and (v) capacity for consent. Child: (i) 3 to 11 years, (ii) living with index parent and (iii) significant emotional/behavioural difficulties. INTERVENTION: HFP-M: 16-session home-based intervention using parenting and therapeutic engagement strategies. Usual care: standard care augmented by single psychoeducational parenting session. OUTCOMES: Primary feasibility outcome: participant retention rate. SECONDARY OUTCOMES: (i) rates of recruitment, eligibility and data completion, and (ii) rates of intervention acceptance, completion and alliance (Working Alliance Inventory-Short Revised). Primary clinical outcome: child behaviour (Eyberg Child Behaviour Inventory). SECONDARY OUTCOMES: child mental health (Concerns About My Child, Child Behaviour Checklist-Internalising Scale), parenting (Arnold-O'Leary Parenting Scale, Kansas Parental Satisfaction Scale) and parent mental health (Symptom-Checklist-27). Quantitative data were collected blind to allocation. RESULTS: Findings broadly supported non-diagnostic selection criterion. Of 48 participants recruited, 32 completed post-intervention measures at mean 42 weeks later. Participant retention exceeded a priori rate (HFP-M=18; Usual care=14; 66.7%, 95% CI 51.6% to 79.6%). HFP-M was acceptable, with delivery longer than planned. Usual care had lower alliance rating. Child and parenting outcome effects detected across trial arms with potential HFP-M advantage (effect size range: 0.0 to 1.3). CONCLUSION: HFP-M is an acceptable and potentially effective specialist parenting intervention. A definitive trial is feasible, subject to consideration of recruitment and retention methods, intervention efficiency and comparator condition. Caution is required in interpretation of results due to reduced sample size. No serious adverse events reported. TRIAL REGISTRATION NUMBER: ISRCTN14573230.

Employment in Personality Disorders and the Effectiveness of Individual Placement and Support: Outcomes from a Secondary Data Analysis.

Purpose Personality disorders (PDs) are associated with severe functional impairment and subsequent high societal costs, increasing the need to improve occupational functioning in PD. Individual placement and support (IPS) is an effective, evidence-based method of supported employment, which so far has been tested in various mixed patient populations with severe mental illness (SMI, including PDs). However, the effectiveness of IPS for PDs per se remains uninvestigated. Methods Data from the SCION trial were used, including 31 SMI patients with PDs and 115 SMI patients with other primary diagnoses (primarily psychotic disorders). First, the interaction effect of diagnosis (PD vs other SMI) and intervention (IPS vs traditional vocational rehabilitation) was studied. Second, in the IPS condition, difference between diagnostic groups in time to first job was studied. Results We did not find evidence of a moderating effect of PD diagnosis on the primary effect of IPS (proportion who started in regular employment) (OR = 0.592, 95% CI 0.80-4.350, p = 0.606) after 30 months. Also, PD diagnosis did not moderate the effect of time until first job in IPS. Conclusions From the present explorative analysis we did not find evidence for a moderating effect of PD diagnosis on the effectiveness of IPS among PD participants. This indicates that IPS could be as effective in gaining employment in participants with PD as it is in participants with other SMI. Future studies, implementing larger numbers, should confirm whether IPS is equally effective in PDs and study whether augmentations or alterations to the standard IPS model might be beneficiary for PD.

Efficacy of a combined intervention program for the reduction of internalized stigma in people with severe mental illness.

BACKGROUND: Internalized stigma (IS) is a key factor in the recovery, quality of life and functioning of people with severe mental illness (SMI), and effective intervention programs are needed to reduce IS in all its dimensions. The aim of this report was to design and evaluate the effectiveness of a new psychological intervention group program for the reduction of IS in people with SMI. METHODS: A 9-session hands-on intervention program was designed with a group format in which different therapeutic techniques were combined. To evaluate the effectiveness of the program, 80 people with SMI and high levels of IS were selected and randomly assigned to one of two groups: program (n = 41, experimental group) or conventional treatment (n = 39, control group). RESULTS: Mixed analysis of variance showed improvements in total IS and all of its dimensions (cognitive, emotional and behavioral) (p ≤ 0.01) and in depressive symptomatology (p = 0.01) in the experimental group after the treatment phase. CONCLUSION: The results indicate that the program effectively reduces IS and its dimensions as well as other relevant associated variables in a sample of people with SMI.

People with severe problematic personality traits and offending histories: What influences occupational participation?

BACKGROUND: Occupational participation is important for personality disordered offenders (PDOs) because it is integral to health and desistance from offending. What influences occupational participation is unknown for PDOs in the community, limiting effective intervention to affect change. In England and Wales, the Offender Personality Disorder Pathway aims to improve outcomes for people considered highly likely to have a severe personality disorder and who present a high risk of reoffending, who are determined to be PDOs on the basis of a structured assessment. This study identified the influencers of occupational participation for the population who receive this service. METHOD: In this critical realist, qualitative study, narrative interviews were conducted with 18 PDOs supervised by probation in England. Transcripts were analyzed using a grounded theory approach to establish influencers of occupational participation. RESULTS: Four themes describe influencers of occupational participation: function of occupations; influence of the past; external forces; and learning and adaptation. The latter theme reflected understandings of occupational adaptation described by the Model of Human Occupation. CONCLUSIONS: An intervention to increase prosocial occupational participation should be developed and evaluated for PDOs in the community, taking account of occupational participation over the life course.

Personality and Alzheimer's disease: An integrative review.

The objective of this article is to review and integrate interrelated areas of research on personality and Alzheimer's disease (AD). Prospective studies indicate that individuals who score higher on conscientiousness (more responsible and self-disciplined) and lower on neuroticism (less anxious and vulnerable to stress) have a reduced risk of developing dementia, even in the presence of AD neuropathology. Personality is also related to measures of cognitive performance and cognitive decline, with effect sizes similar to those of other clinical, lifestyle, and behavioral risk factors. These associations are unlikely to be due to reverse causality: Long-term prospective data indicate that there are no changes in personality that are an early sign of the disease during the preclinical phase of AD. With the onset and progression of dementia, however, there are large changes in personality that are reported consistently by caregivers in retrospective studies and are consistent with the clinical criteria for the diagnosis of dementia. The review also discusses potential mechanisms of the observed associations and emphasizes the need for prospective studies to elucidate the interplay of personality traits with AD neuropathology (amyloid and tau biomarkers) in modulating the risk and timing of onset of clinical dementia. The article concludes with the implications of personality research for identifying those at greater risk of AD and the potential of personality-tailored interventions aimed at the prevention and treatment of AD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effectiveness of a brief adjunctive yoga intervention for short-term mood and psychiatric symptom change during partial hospitalization.

OBJECTIVE: Evidence concerning the effectiveness of yoga in partial hospital programs is limited. Yet, partial hospitals provide treatment at a critical juncture by bridging inpatient and outpatient care. The present study tested the effectiveness of a single-session group yoga intervention for short-term mood and psychiatric symptom change in participants attending a 1- to 2-week partial hospital program. METHOD: Participants included 104 partial hospital patients who participated in the single-session yoga intervention and completed a measure of positive/negative affect before and after the group. Participants, as well as partial hospital patients who did not attend the yoga intervention (n = 438), completed measures of depression and anxiety symptoms at admission and discharge from the program. At discharge, they also rated their perceived improvement and the overall quality of the care they received. RESULTS: Participants who attended the yoga intervention experienced significant improvements in positive and negative affect during the group. They did not show greater improvements in symptoms of anxiety or depression over the course of treatment compared to individuals who did not attend the group. Yoga intervention participants nonetheless gave higher ratings to the quality of the care they received. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Findings demonstrated that attending a single yoga session during partial hospitalization was associated with short-term mood benefits, and with enhanced overall perceptions of treatment. Further research is needed to determine the conditions under which participation in yoga during partial hospitalization could contribute to symptom change in this context. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Personality profiles of substance and behavioral addictions.

Substance-related and behavioral addictions are extremely prevalent and represent a major public health concern. In the ongoing attempt to understand the addictive personality, contradictory results have arisen from studies that have explored personality traits in different addiction populations. The diversity across addiction types suggests that some of these inconsistencies stem from distinct personalities underlying each addiction. The present study compares the personality profiles of several addictions, representing both substance (drugs and alcohol) and behavioral (gambling and sex) subtypes. 216 addicted individuals and 78 controls completed personality and sociodemographic questionnaires. Notable personality distinctions were found among different types of addiction. Whereas impulsivity and neuroticism were higher across all addiction populations, as compared to controls, people with alcohol use disorders also scored significantly lower on the traits of extraversion, agreeableness, and openness to experience. People with drug use disorders and those with compulsive sexual behavior were surprisingly similar, scoring lowest on the traits of agreeableness and conscientiousness. Finally, people with gambling disorder demonstrated a personality profile similar to that of the control group. Of note, personality profiles were also related to several demographic characteristics, including socioeconomic status and religiosity. Our findings support a potential role for personality in distinguishing among different types of addiction. This study suggests that different addictions may, to some extent, stem from distinct processes that are involved in personality development. These findings may provide a useful framework for understanding why different people develop different addictions.

Measuring the contribution of art therapy in multidisciplinary treatment of personality disorders: The construction of the Self-expression and Emotion Regulation in Art Therapy Scale (SERATS).

Despite the use of art therapy in clinical practice, its appreciation and reported beneficial results, no instruments are available to measure specific effects of art therapy among patients with personality disorders cluster B/C in multidisciplinary treatment. In the present study, we described the development and psychometric evaluation of the Self-expression and Emotion Regulation in Art Therapy Scale (SERATS). Structural validity (exploratory and confirmatory factor analysis), reliability, construct validity and sensitivity to change were examined using two independent databases (n = 335; n = 34) of patients diagnosed with personality disorders cluster B/C. This resulted in a nine-item effect scale with a single factor with a high internal reliability and high test-retest reliability; it demonstrated discriminant validity and sensitivity to change. In conclusion, the SERATS is brief and content-valid and offers objective and reliable information on self-expression and emotion regulation in art therapy among patients with personality disorders cluster B/C. Although more research on construct validity is needed, the SERATS is a promising tool to be applied as an effect scale and as a monitoring tool during art therapy treatment. © 2017 The Authors Personality and Mental Health Published by John Wiley & Sons Ltd.

Seeking to understand lived experiences of personal recovery in personality disorder in community and forensic settings - a qualitative methods investigation.

BACKGROUND: Understandings of personal recovery have emerged as an alternative framework to traditional ideas of clinical progression, or symptom remission, in clinical practice. Most research in this field has focussed on the experience of individuals suffering with psychotic disorders and little research has been conducted to explore the experience of individuals with a personality disorder diagnosis, despite the high prevalence of such difficulties. The nature of the personality disorder diagnosis, together with high prevalence rates in forensic settings, renders the understanding of recovery in these contexts particularly problematic. The current study seeks to map out pertinent themes relating to the recovery process in personality disorder as described by individuals accessing care in either community or forensic settings. METHODS: Individual qualitative interviews were utilised to explore the lived experience of those receiving a personality disorder diagnosis and accessing mental health care in either community or forensic settings. A thematic analysis was conducted to identify shared concepts and understanding between participants. RESULTS: Fourty-one individual participant interviews were conducted across forensic and community settings. Recovery was presented by participants as a developing negotiated understanding of the self, together with looked for change and hope in the future. Four specific themes emerged in relation to this process: 1. Understanding early lived experience as informing sense of self 2. Developing emotional control 3. Diagnosis as linking understanding and hope for change 4. The role of mental health services. CONCLUSIONS: Through considering personal recovery in personality disorder as a negotiated understanding between the individual, their social networks and professionals this study illustrates the complexity of working through such a process. Clarity of understanding in this area is essential to avoid developing resistance in the recovery process. Understanding of recovery in a variety of diagnostic categories and social settings is essential if a truly recovery orientated mental health service is to be developed.

Rates of past-year alcohol treatment across two time metrics and differences by alcohol use disorder severity and mental health comorbidities.

INTRODUCTION: Little is known about how alcohol treatment rates vary across age or years since onset of an alcohol use disorder (AUD). We examined past-year treatment prevalence and associations across these important time metrics. METHOD: Data on 22,278 adults ages 18-50 were from the National Epidemiologic Survey on Alcohol and Related Conditions-III (2012-2013). We examined the age-varying prevalence of alcohol treatment and associations of past-year AUD severity, MDD status, and DUD status with treatment. Additionally, for individuals with a lifetime AUD (N=7089), we examined associations of severity, MDD, and DUD across years since AUD onset. RESULTS: Individuals with Moderate/Severe past-year AUD had significantly higher treatment rates at nearly all ages, compared to those with Mild or no AUD. For those with Moderate/Severe AUD, treatment rates were highest during late adolescence and middle adulthood and lowest during early adulthood. Mental health comorbidities were positively associated with treatment at certain age ranges in mid-adulthood. Among individuals with a lifetime AUD, those with Moderate/Severe past-year AUD had significantly higher past-year treatment rates across all years since onset. MDD and DUD were both positively associated with treatment at nearly all years since AUD onset. CONCLUSIONS: Alcohol treatment rates varied notably by age and, to a lesser extent, by years since AUD onset. Greater AUD severity was consistently associated with higher rates of treatment, whereas Mild AUD had a much weaker relationship. MDD and DUD showed similar patterns of positive association with treatment. Our results highlight important subgroups where unmet treatment needs are highest.

[Treatment outcomes of psychiatric rehabilitation: a follow-up study at an italian therapeutic community]. / Gli esiti del trattamento riabilitativo in comunità terapeutica: uno studio di follow-up.

INTRODUCTION: The treatment of severely ill patients with psychotic and personality disorders is often conducted in residential settings such as the Therapeutic Communities (TC). In these facilities a multidisciplinary model is employed to ensure integrative care of the complex psychiatric patient. Although the cost of such programs is very high, evidence of efficacy and effectiveness is scarce, especially in Italy. AIM AND METHODS: Aim of the study is to evaluate the efficacy of TC treatment in a group of patients with severe psychotic and personality disorders. Eighty-one patients have been assessed at baseline and after 6 and 12 months of follow-up in the following areas: global functioning, quality of life, emotion regulation, coping strategies, and insight into illness. RESULTS: At the end of follow-up we could find an improvement in functioning, quality of life, a greater engagement in goal-oriented behaviors, together with a lesser utilization of avoidant coping strategies. However the high dropout rates, which are associated with substance abuse and a diagnosis of personality disorders, should be acknowledged. DISCUSSION AND CONCLUSIONS: The present study reports the efficacy of residential TC treatment for some severely ill patients with psychotic and personality disorders. Strategies aimed at increasing the motivation and preparation of patients before the program begins should be implemented in order to reduce the high dropout rates.

[Multimorbid Patients in Forensic Psychiatry: Chances of Being Discharged]. / Entlasschancen multimorbider Patienten im psychiatrischen Maßregelvollzug.

OBJECTIVE: to determine the chances of discharge of forensic psychiatric patients (section 63 of the German Legal Code) diagnosed with comorbid psychiatric and somatic disorders. METHODS: N = 364 patients were evaluated. Diagnostic groups were compared with regard to types and frequencies of comorbid diagnoses, and treatment duration. RESULTS: Both personality disorders as main diagnoses and comorbid personality disorders were associated with prolonged inpatient treatment. Substance dependence in addition to a personality disorder was an aggravating factor. Comorbid somatic disorders affected treatment duration of patients diagnosed with a psychotic disorder. CONCLUSIONS: Somatic comorbidity may negatively interact with the treatment of psychiatric problems in schizophrenic patients and thus affect the prospects of discharge in this patient group.

Personal recovery in personality disorder: Systematic review and meta-synthesis of qualitative methods studies.

BACKGROUND AND AIMS: Support of personal recovery represents the aim for many modern mental health services. There is a lack of conceptual clarity around the application of the term however and this is particularly problematic with regard to the personality disorder diagnoses. This study sought to review the existing qualitative methods literature in relation to the experience of personal recovery in personality disorder. METHODS: A systematic literature search was conducted. Identified studies were incorporated through meta-synthesis in order to develop higher order descriptive themes representative of the individual experience described within included studies. RESULTS: Three studies were identified and incorporated into the meta-synthesis. Three novel higher order themes were developed: Safety and containment as a prerequisite to recovery, social networks and autonomy in the recovery process and identity construction as a process of change. CONCLUSION: Personal recovery in personality disorder is revealed as a complex process reflecting both personal and social experiences or desires. These findings have important implications for clinical practice - emphasising the need to work closely with individuals and to develop an understanding of both their social experience and networks. Further research, taking greater account of social context in the recovery process, is necessary.

Understanding recovery in the context of lived experience of personality disorders: a collaborative, qualitative research study.

BACKGROUND: Concepts of recovery increasingly inform the development and delivery of mental health services internationally. In the UK recent policy advocates the application of recovery concepts to the treatment of personality disorders. However diagnosis and understanding of personality disorders remains contested, challenging any assumption that mainstream recovery thinking can be directly translated into personality disorders services. METHODS: In a qualitative interview-based study understandings of recovery were explored in extended, in-depth interviews with six people purposively sampled from a specialist personality disorders' service in the UK. An interpretive, collaborative approach to research was adopted in which university-, clinical- and service user (consumer) researchers were jointly involved in carrying out interviews and analysing interview data. RESULTS: Findings suggested that recovery cannot be conceptualised separately from an understanding of the lived experience of personality disorders. This experience was characterised by a complexity of ambiguous, interrelating and conflicting feelings, thoughts and actions as individuals tried to cope with tensions between internally and externally experienced worlds. Our analysis was suggestive of a process of recovering or, for some, discovering a sense of self that can safely coexist in both worlds. CONCLUSIONS: We conclude that key facilitators of recovery - positive personal relationships and wider social interaction - are also where the core vulnerabilities of individuals with lived experience of personaility disorders can lie. There is a role for personality disorders services in providing a safe space in which to develop positive relationships. Through discursive practice within the research team understandings of recovery were co-produced that responded to the lived experience of personality disorders and were of applied relevance to practitioners.

THE OFFENDER PERSONALITY DISORDER PATHWAY: RISKING REHABILITATION?

Following over a decade of treatment refusal by 'risky' offenders preventively detained in Dangerous and Severe Personality Disorder hospital and prison units, the coalition government now aims to improve treatment engagement in high secure prisons by clarifying pathways out of detention. This article asks whether the reconfiguration will end reliance upon preventive detention for public protection. Drawing on original empirical data collected by the author, it is argued that the government is unaware that offenders with 'severe personality disorder' appear to engage with treatment only if it increases their chances of achieving expedited parole. Hitherto, this incentive was provided by the Indeterminate Sentence for Public Protection; its replacement with determinate sentences under the Legal Aid, Sentencing and Punishment of Offenders Act 2012 will worsen treatment engagement, because they provide offenders with a prison release date. The troubling result may be increased reliance by the Secretary of State for Justice on his inherent jurisdiction under the Mental Health Act 1983 to transfer offenders due for prison release to secure psychiatric hospitals. To counter this limitation of risk-focused decision-making, it is proposed that judges be able to impose a new hybrid order combining a custodial term with a subsequent community mental health treatment requirement.

[Non-response to therapy in acute and rehabilitative psychosomatic inpatient care - a systematic review]. / Therapie-Non-Response in der psychosomatischen Krankenhausbehandlung und Rehabilitation - Eine systematische Übersicht.

OBJECTIVES: The study reviews the state-of-the art on failure research in acute and rehabilitative psychosomatic inpatient care. The main focus of interest lies in describing the frequency and possible predictors of unsuccessful therapeutic treatments. METHODS: We systematically searched the databases MEDLINE, PsycARTICLES, PsycINFO und PSYNDEX and selected studies from the past 20 years focusing on treatment failure in the inpatient psychosomatic treatment of adult patients. RESULTS: A total of 31 studies were included, 15 of which allowed the extraction of predictors of non-response or deterioration. 20 %to 30%of patients leave psychotherapeutic treatment without any significant change; 5 %to 10%deteriorate during their stay.A high level of symptom distress at intake, a chronic course of the disease as well as somatoform or personality disorders are associated with non-response and deterioration. Early response to treatment and a dysfunctional therapeutic alliance are possible further predictors, whereas sociodemographic and sociomedical variables are unlikely to have a predictive validity. CONCLUSIONS: Hypotheses about possible predictors can be derived from the results of this review. However, the interpretation of the results is limited by the heterogeneity of the methodology and of the samples of the studies included. Nevertheless the results can be used as a basis for further hypothesis-driven research.