Psychiatric providers' attitudes toward patients with borderline personality disorder and possible ways to improve them.

OBJECTIVE: Tending to patients with a diagnosis of borderline personality disorder (BPD) is a challenging task for clinicians due to stigma and differences in opinion within the psychiatric community. Various symptoms of BPD including affective instability, mood reactivity, and extremes of idealization are associated with challenging emotions toward patients with BPD. This observational research study utilized an adaptation of the 37-question Attitude to Personality Disorder Questionnaire (APDQ) to assess the attitudes of clinicians toward patients with BPD. METHODS: This questionnaire was distributed to 139 clinicians including psychiatry attendings, psychiatry residents, registered nurses, nurse practitioners, social workers, recreation and art therapists, and psychologists who worked with patients diagnosed with BPD on an inpatient unit. Responses of participants were compared based on occupation, gender, and duration of years worked on an inpatient psychiatric unit. RESULTS: Results show that individuals employed in occupations under the "other health professionals" category had more positive transference (which included feelings of respect toward BPD patients along with feelings of closeness and warmth) toward patients with BPD, and nurses had an increased total score for lack of valid difficulties compared with other health professionals. When grouping by gender and duration of year spent working on an inpatient unit, there were no significant differences in the response toward patients with BPD in affective situations. CONCLUSION: Clinical implications are discussed, as well as the need for training to help improve staff attitudes toward this patient population.

Construct Validity of the Pictogram Test for Diagnosis of Schizophrenia.

OBJECTIVES: To examine construct validity of the Pictogram Test (PT) which assesses disturbances in thinking in individuals with schizophrenia. The PT was developed in Russia; it was found to be applicable for the English-speaking population of the USA. The variables of the PT were correlated with Minnesota Multiphasic Personality Inventory (MMPI-2). METHOD:  Russian-and English-speaking participants completed the PT and MMPI-2 in their native languages. RESULTS:  The PT variables that reflected attribute selection choice of intermediate concepts for memorization and the variables that were geometrical shapes had significant correlations with MMPI-2 scales linked to schizophrenia. This represents evidence of convergent validity. The same PT indices did not significantly correlate with most of the MMPI-2 scales that are not elevated in schizophrenia, representing some discriminant validity of the PT. CONCLUSIONS: The less often the participants were able to connect target words with economical intermediate concepts, the higher were the elevations of schizophrenia-related scales. Also, the more abstract and remote their intermediate concepts, the less often they recalled targets. These findings give evidence of the validity of the PT in assessing the thinking of individuals with schizophrenia and related conditions.

Cross-cultural diagnostic applicability of the Pictogram Test.

The aim of this study was to determine whether the Pictogram Test (PT; Vygostsky, 1960) a test of logical memory that was developed in Russia, is applicable for diagnosing and understanding thought disturbances in schizophrenia within an English-speaking population. Participants included 62 patients with schizophrenia or schizoaffective disorders and 80 community nonpatients from Russia and the United States. We used correlational analysis to organize PT variables into Concrete (CI), Attribute (AI), and Geometric (GI) indexes. Discriminant function analysis revealed that only AI and GI had significant discriminatory power. These indexes correctly classified 91% of English-speaking and 86% of Russian-speaking participants as either patients or nonpatients. Controlling for age and education, multivariate analysis revealed that patients had significantly lower AI and significantly higher GI scores relative to nonpatients, and those differences were similar across languages. These results indicate that the PT can discriminate between patients with schizophrenia or schizoaffective disorders and nonpatients, which suggests that characteristics of the PT could be used to understand the mechanism of logical thinking in patients and nonpatients.