Emotion word repertoire in the adult attachment interview is linked to reduced suicide attempts in patients with borderline personality disorder.

Background: This study explored the association between emotion word repertoire (EWR), attachment, reflective functioning and personality organization (PO) and suicidal behavior in borderline personality disorder (BPD) patients. Methods: The current study performed a secondary data analysis from a randomized control trial for BPD patients (all female; n = 87; age: m = 27; SD = 7.42). EWR was assessed via machine-scoring transcripts of Adult Attachment Interviews (AAI) for affective words using the VETA electronic scoring software for the Levels of Emotional Awareness Scale (LEAS). Generated scores were related to impairments in PO (Structured Interview for Personality Organization; STIPO), attachment organization (AAI) and mentalization (Reflective Functioning Scale), general symptom severity (Brief Symptom Inventory; BSI-53), self-harm and suicidal behavior. Independent effects of the investigated predictors were studied using Bayesian path analysis. Results: Corrected for education, findings in Bayesian path analysis suggest an independent negative association between EWR and suicide attempts (BE = -.32; 95 % CI [-.51, -.12]) and positive associations of deficits in PO with psychiatric symptoms (BE = .23; 95 % CI [.01, .44]) as well as suicide attempts (BE = .30; 95 % CI [.08, .49]). Discussion: The findings underscore the potential role of high EWR and PO as a protective factor for suicidal behavior in individuals with BPD.

The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders.

BACKGROUND: One of the aims of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration joint program on psychiatric diagnosis and classification is the development and standardization of diagnostic assessment instruments for use in clinical research worldwide. The International Personality Disorder Examination (IPDE) is a semistructured clinical interview compatible with the International Classification of Diseases, Tenth Revision, and the DMS-III-R classification systems. This is the first report of the results of a field trial to investigate the feasibility of using the IPDE to assess personality disorders worldwide. METHODS: The IPDE was administered by 58 psychiatrists and clinical psychologists to 716 patients enrolled in clinical facilities at 14 participating centers in 11 countries in North America, Europe, Africa, and Asia. To determine interrater reliability, 141 of the IPDEs (20%) were independently rated by a silent observer. To determine temporal stability, 243 patients (34%) were reexamined after an average interval of 6 months. RESULTS: The IPDE proved acceptable to clinicians and demonstrated an interrater reliability and temporal stability roughly similar to instruments used to diagnose the psychoses, mood, anxiety, and substance use disorders. CONCLUSION: It is possible to assess personality disorders with reasonably good reliability in different nations, languages, and cultures using a semistructured clinical interview that experienced clinicians find relevant, meaningful, and user-friendly.

[Gold-silver technic--a new immunohistochemical method for detecting cell membrane antigens]. / Die Gold-Silber-Technik--ein neues immunhistochemisches Verfahren zum Nachweis von Zellmembranantigenen.

The gold-silver technique is presented as a new method for immunohistochemical labelling of cell membrane antigens. At first, membrane antigens of mouse lymphocytes, human leukaemic cells, and experimental brain tumour cells are labelled by immunoglobulin- or anti-immunoglobulin-gold complexes. Secondarily, gold colloid particles are made visible in the light microscope by means of subsequent precipitation of metallic silver around the colloid particles according to the principle of photographic development. The gold-silver reaction can be used after direct or indirect gold-labelling of cell membrane antigens. The technique is suitable for both vital and prefixed cells. Labelling of membrane antigens of vital and prefixed cells, however, results in a different pattern of the gold-silver grains. The gold-silver method is easy and quickly to perform, sensitive and not expensive.

[Change in the diagnosis and therapy of anxiety disorders. 1: Phenomenology of anxiety and new approaches in the classification of anxiety disorders]. / Wandel in Diagnose und Therapie von Angststörungen. Teil 1: Phänomenologie der Angst und neue Ansätze in der Klassifikation von Angstörungen.

The pathological states anxiety neurosis and phobias, diagnostically classified under the neuroses, are, influenced by a recent American diagnostic classification, now designated anxiety disorders in clinical psychiatry. With this approach, which is more phenomenological than etiological in orientation, new diagnostic possibilities--among other things--have arisen. In the first place, an accurate differentiation of periodic and chronic states of anxiety can be made, while the clinical phenomena can be considered from various aspects, in order to evaluate simultaneously 1. the current clinical manifestation, 2. the underlying personality traits, and 3. the physical disorders presenting.

[Change in the diagnosis and therapy of anxiety disorders. 2: Diagnostic procedure and therapy]. / Wandel in Diagnose und Therapie von Angststörungen. Teil 2: Diagnostisches Vorgehen und Therapie.

Since, apart from the clinical phenomena and personality traits, the life history, conflict dynamics, development and quality of inter-partner relationships, and the evolution of the physician/patient relationship can be of decisive importance in anxiety disorders, a multidimensional diagnostic approach and therapy is often required. In view of this complexity, attention is drawn to the various therapeutic and pharmacotherapeutic approaches and the possibilities of integrating them. An aim for the future will be to bring about a reduction in the more than 30% failures of therapy, and to shorten the chronic evolution of the disorder, which can often persist for 10 years and more.

[Anxiety disorders--syndrome, personality and relationships. Results of multi-methodology diagnosis]. / Angststörungen--Syndrom, Persönlichkeit und Beziehung. Ergebnisse einer multimethodalen Diagnostik.

Patients attending the Polyclinic of the Psychiatry Department of the Ludwig Maximilian University in Munich for ambulatory examination and counseling because of panic anxiety states with agoraphobia, were investigated using methods of descriptive-phenomenological diagnostic evaluation of syndromes and personality (structured clinical interviews on the basis of DSM III Criteria) and with methods of empirical married couple and family diagnostic evaluation (Giessen-Paar-Test, Family-Assessment-Measure). On the basis of the findings established on three different observational planes--syndrome, personality and inter-personal relationships--it was shown that anxiety disorders are expressed not merely in the symptomatology (panic disorders) and the behavior (e.g. agoraphobia) of the patient; rather, evidence of co-morbidity involving (concomitant?) personality disorders was found in almost 50% of the patients investigated. In comparison with non-clinical control groups, the patients and their partners also indicated considerable disorders in the emotive field and in their affective relationships and contact with others.

Pilot study on the therapeutic efficacy, clinical safety, and dosage finding of enciprazine in out-patients with anxious and anxious-depressive syndromes.

The new basic propanolamine derivative enciprazine (D 13 112) was tested in an open single-blind phase-II trial with regard to therapeutic efficacy, clinical safety, and dosage finding. The drug showed a good efficacy in mildly ill patients. Under the highest dosage frequently fatigue was reported. In 78% of the patients the enciprazine trial succeeded in shifting patients from benzodiazepines to non-benzodiazepines or in discontinuation of psychopharmacotherapy after completion of the trial.

[Conversion symptoms of patients in psychiatric liaison care]. / Konversionssymptome bei Patienten im psychiatrischen Konsiliardienst.

At the consultation-psychiatric service of a large university hospital conversion disorders present ca. 50% of the "somatoform disorders". The rate of incidence of conversion disorders was 4% of all patients seen in the service, i.e. 20-30 referrals per annum. A report on 103 patients referred during 1987-1990 is given concerning basic sociodemographic data, symptom clusters, course of illness, age at onset of the disorder, psychiatric and family history, psychosocial conditions and intrapsychic conflicts, additional affective disorders and psychophysiological symptoms, illness behaviour, cognitive attitudes towards illness. The rate of 35% patients showing an underlying somatic disorder in addition to their conversion symptoms had to be appreciated. Possible relations of conversion disorders to affective illness, somatization disorder and neurologic disease had to be discussed as to course of illness and theoretical concepts.

[Development of the theoretical orientation of psychotherapists. SPR Collaborative Research Network]. / Zur Entwicklung der theoretischen Orientierung von PsychotherapeutInnen. SPR Collaborative Research Network.

This article explores the extent to which, and ways in which, German speaking psychotherapists modify their theoretical orientations as a function of increasing clinical experience. The data for this come from the Development of Psychotherapists Common Core Questionnaire (CCQ), an instrument designed by the SPR Collaborative Research Network to collect a broad range of information about the therapist's background, training, practice etc. Two sections ask directly about the theoretical framework used by therapists to guide their therapeutic work, using a set of scales to assess the degree to which practitioners rely on various general models (analytic/psychodynamic, behavioral, humanistic, cognitive, systems theory, other). This permits the construction of profiles of formal and content based theoretical orientation patterns. By asking the question separately about the therapist's current practice, and about their practices as beginners, it also permits an evaluation of self-assessed change. In order to amplify the meaning of the theoretical background we ask therapists to indicate the relative importance of their patients realizing each of a series of therapeutic goals. The findings show very clearly that psychotherapists are very diverse both in the formal patterns and specific contents of their therapeutic orientations, and that they tend, as a role, to integrate two or more distinct theoretical approaches in guiding their clinical work with patients. The adherence to theoretical orientations has a strong impact on the goals that therapists typically work toward with their patients. Our findings show that therapists do pursue different goals depending on which conceptual framework they rely on.

[Quality of the therapeutic relationship: do common factors in psychotherapy correspond with common characteristics of psychotherapists? SPR Collaborative Research Network]. / Die Qualität der therapeutischen Beziehung: Entsprechen gemeinsame Faktoren in der Psychotherapie gemeinsamen Charakteristika von PsychotherapeutInnen? SPR-Collaborative Research Network.

In view of the great diversity to be found among psychotherapists in many countries in terms of professional background, theoretical orientation, and other personal and demographic characteristics, it is surprising to find certain areas of great commonality. Among the most striking of these are therapists' reports of their ideals and perceptions concerning their manner of relating to their patients. A very large majority of nearly 2,400 therapists surveyed in an on-going study of psychotherapeutic development wanted to and did see their behavior vis-a-vis patients as accepting, friendly, warm, tolerant, committed, and involved. These traits, which indicate a strong proclivity toward forming a positive therapeutic bond or alliance, also closely match qualities that therapists perceive in their own personal relationships. Discussion of these findings focuses on the possible sources and therapeutic consequences of this common pattern of interpersonal behavior.

[Development of a model of operational psychodynamic diagnosis]. / Entwicklung eines Modells der operationalen psychodynamischen Diagnostik (OPD).

Since 1992 a working group called "Operationalized Psychodynamic diagnoses" conceptualized a model of operationalized psychodynamic diagnosis in Germany. This model includes the most important diagnostic dimensions from psychodynamic view which are: Axis I: Experience with illness and treatment preconditions. Axis II: Habituated relationships of the patient, Axis III: Intrapsychic conflicts of the patient, Axis IV: the structure of personality development of the patient, Axis V: The level of symptoms or syndromes. This axis is adapted to ICD-10. The development of these axis is done in special subgroups during 1992 and 1994 and in first empirical studies the reliability and other test-related dimensions of the model were proved. In this paper the essentials of the diagnostic model are shown and further developments are discussed.

[Structure and structural disorder]. / Struktur und strukturelle Störung.

One of the central tasks of psychodynamic diagnosis, next to determining intrapsychic conflicts, central relational patterns, and subjective forms of experiencing is assessing the psychic structure or the structural disorder. This article develops the structure term from object relationship theoretical, ego-psychological, and self-psychological concepts of psychoanalysis. This "Structure of the self in the relationship to others" thus obtained is described with six structural criteria (self-perception, self-control, defence, object perception, communication, attachment). In order to be able to distinguish the extent and the quality of structural disorders four structure levels of integration based on psychoanalytic experience in the out-patient and the in-patient setting are differentiated. A basis for an operationalization is then made; it is made in the system OPD (Operationalized Psychodynamic Diagnostics). First studies regarding practicalibility and reliability are promising.

Psicopatología y psicodinámica en la primera entrevista psiquiátrica. (El aporte de la "Entrevista Estructural" de Otto Kernberg). / Psychopathology and psychodynamics in the initial psychiatric interview. (Contribution to O. Kernber's \"structural interview\"

Una de las formas de entender la relación entre psiquiatría y psicoanálisis es estudiando la primera entrevista psiquiátrica desde una perspectiva histórica. El psicoanálisis ha destacado la importancia que tienen los aspectos dinámicos de la relación médico-paciente en el desarrollo del tratamiento. La psiquiatría, en cambio, pone de relieve el momento descriptivo-diagnóstico y psicopatológico de la primera entrevista. A pesar de algunos esfuerzos integradores -que se revisan- la diferencia radica en los distintos modelos epistemológicos subyacentes a ambos enfoques y remiten a su vez a las respectivas obras de Freud y Jaspers de comienzos de siglo. Como un moderno ejemplo de esfuerzo integrador de psicopatología y psicodinámica en la primera entrevista psiquiátrica se expone y discute la "entrevista estructural" de Otto Kernberg. Los autores piensan que tal entrevista integra menos que lo que promete en un primer momento, constituyendo más bien un procedimiento sólo adecuado para el diagnóstico de los pacientes"borderline". Más que la introducción de un nuevo paradigma diagnóstico -como pretende Kernberg- los autores se inclinan por una actitud pluralista que permita tanto la exploración psicopatológica como el entendimiento psicodinámico, y desde la cual, y con la flexibilidad que correspondea, pueda estar el entrevistador en condiciones de aplicar, ya a los pocos minutos de iniciado el primer contacto con el paciente, un modelo de entrevista diferenciado, esto es, más psicopatológico o más psicodinámico según el tipo de paciente, las características del encuadre y las necesidades de corto y largo plazo.