Comparing the symptom presentation similarities and differences of complex posttraumatic stress disorder and borderline personality disorder: A systematic review.

Complex posttraumatic stress disorder (CPTSD) is characterized in the International Classification of Diseases-11 by affect dysregulation, negative self-concept, and relationship impairments, symptoms also presented in borderline personality disorder (BPD). Some research shows CPTSD as a distinct disorder, others as a subgroup or a replacement for BPD. No review currently amalgamates the findings on whether CPTSD presents too similarly to BPD to be a standalone disorder. This article systematically reviewed similarities and differences in symptom presentations of the two disorders. Six databases were searched (PsycINFO, EMBASE, PubMed, Web of Science, PsycEXTRA, and Open Access Theses and Dissertations) and identified papers were summarized narratively. The majority of studies found distinct profiles for CPTSD and BPD. One study found no differences between the constructs; however, this used a population without severe trauma. CPTSD and BPD can present comorbidly, these individuals will have likely experienced earlier and more frequent interpersonal trauma and display greater functional impairment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Developments in Group Transference-Focused Psychotherapy.

Several evidence-based psychotherapies for personality disorders have been developed in recent decades, including transference-focused psychotherapy (TFP), a contemporary model of psychodynamic psychotherapy developed by Otto Kernberg. Kernberg established Group TFP (TFP-G) as an alternative or adjunct treatment to individual TFP. Although not yet manualized, TFP-G is used in publicly and privately funded mental health services, including outpatient clinics, subacute hospitals, therapeutic inpatient units, partial hospitalization services, and rehabilitation services serving people with borderline personality. Kernberg's model of TFP-G psychotherapy, its application in clinical settings, and what differentiates it from other group psychotherapy models is described as well as illustrated with some examples useful to practitioners.

Transference-focused psychotherapy as an aid to learning psychodynamic psychotherapy: qualitative analysis of UK psychiatry trainees' views.

AIMS & METHOD: Learning psychotherapy can be difficult and stressful. We explore core trainees' (n = 5) views on undertaking a psychodynamic psychotherapy training case using transference-focused psychotherapy (TFP), in an East London NHS Foundation Trust supervision group. We used framework analysis of focus group interviews to examine trainees' concerns, their views about this experience and its impact on general psychiatric practice. RESULTS: Trainees described various concerns on starting: providing an effective intervention, insufficient experience and training-related pressures. However, they found that TFP addressed some of them and was helpful for learning psychodynamic psychotherapy. Difficulties around the countertransference remained at end-point. Trainees suggested that introductory teaching and learning through observation might be worthwhile. CLINICAL IMPLICATIONS: Trainees' experience suggests that an evidence-based operationalised approach such as TFP can be integrated into the core psychiatry curriculum as a psychodynamic psychotherapy learning method. Trainees report benefits extending to other areas of their practice.

Views on psychotherapy research among members of the Medical Psychotherapy Faculty of the Royal College of Psychiatrists.

AIMS AND METHOD: Research drives innovation and improved practice in psychotherapy. We describe views of members of the Faculty of Medical Psychotherapy of the Royal College of Psychiatrists (RCPsych) regarding their knowledge, experience and perspectives on psychotherapy research. We sent questionnaires to the Faculty membership emailing list. RESULTS: In total, 172 psychiatrists from all levels of training returned fully complete responses. Respondents considered knowledge of psychotherapy research to be important to clinical work. Many have qualifications and experience in research but lack current opportunities for research involvement and would welcome the Faculty doing more to promote psychotherapy research. Perceived obstacles to research involvement included lack of competence, competing demands and wider organisational factors. CLINICAL IMPLICATIONS: The lack of research opportunities for medical psychotherapists may lead to their underrepresentation in psychotherapy research and a less medically informed research agenda. Providing support at academic, RCPsych and National Health Service organisational levels will allow more clinically relevant research not only in psychotherapy but in other psychiatric disciplines as well.

Teaching trainee psychiatrists a Mentalization-Based Treatment approach to personality disorder: effect on attitudes.

AIMS AND METHOD: To evaluate whether a brief training using a Mentalization-Based Treatment (MBT) model improves attitudes of trainee psychiatrists working with patients with personality disorder. Trainee psychiatrists (n = 49) completed the Attitudes to Personality Disorder Questionnaire before and after a training consisting of two 3 h lectures on (a) theory of personality disorder and (b) practical skills using an MBT role-play. RESULTS: There was a significant improvement on composite scores of attitude, with small to moderate effect size (Wilcoxon signed-rank test Z = 3.961, P < 0.001, r = 0.40). CLINICAL IMPLICATIONS: Brief MBT-informed teaching oriented to the clinical situation appears to have a positive effect on attitudes towards people with personality disorder.

Referral of patients with emotionally unstable personality disorder for specialist psychological therapy: why, when and how?

Although we commonly work with patients with emotionally unstable personality disorder (EUPD) in community mental health teams (CMHTs), only some enter evidence-based psychological therapies. Many patients are not considered ready to engage in specialist treatments and remain in CMHTs without any clear focus or structure to their treatment, which is unsatisfactory for patients, clinicians and services. We present a fictional case and synthesise available literature and lived experience to explore readiness and ways to promote it. We highlight relevant issues for trainees to consider in practice. Patients with EUPD who have not received specialist treatment can be considered in terms of the transtheoretical model's stages of change. Identifying a patient's stage can help guide how to increase readiness for referral and decide when to refer. Interventions available to all healthcare professionals which may promote readiness include: psychoeducation, personal formulations, crisis planning, goal-setting, peer support, distress tolerance skills, motivational interviewing and mindfulness.

A systematic review of personality disorder, race and ethnicity: prevalence, aetiology and treatment.

BACKGROUND: Although psychoses and ethnicity are well researched, the importance of culture, race and ethnicity has been overlooked in Personality Disorders (PD) research. This study aimed to review the published literature on ethnic variations of prevalence, aetiology and treatment of PD. METHOD: A systematic review of studies of PD and race, culture and ethnicity including a narrative synthesis of observational data and meta-analyses of prevalence data with tests for heterogeneity. RESULTS: There were few studies with original data on personality disorder and ethnicity. Studies varied in their classification of ethnic group, and few studies defined a specific type of personality disorder. Overall, meta-analyses revealed significant differences in prevalence between black and white groups (OR 0.476, CIs 0.248 - 0.915, p = 0.026) but no differences between Asian or Hispanic groups compared with white groups. Meta-regression analyses found that heterogeneity was explained by some study characteristics: a lower prevalence of PD was reported among black compared with white patients in UK studies, studies using case-note diagnoses rather than structured diagnostic interviews, studies of borderline PD compared with the other PD, studies in secure and inpatient compared with community settings, and among subjects with co-morbid disorders compared to the rest. The evidence base on aetiology and treatment was small. CONCLUSION: There is some evidence of ethnic variations in prevalence of personality disorder but methodological characteristics are likely to account for some of the variation. The findings may indicate neglect of PD diagnosis among ethnic groups, or a true lower prevalence amongst black patients. Further studies are required using more precise cultural and ethnic groups.

Personality disorder: still the patients psychiatrists dislike?

Aims and method In 1988, Lewis and Appleby demonstrated that psychiatrists hold negative attitudes towards patients with personality disorder. We assessed the attitudes of psychiatry trainees towards patients with borderline personality disorder and depression, expecting an improvement. 166 trainees were block randomised to receive one of four case vignettes that varied by diagnosis and ethnic group. We used Lewis and Appleby's original questionnaire and the Attitudes to Personality Disorder Questionnaire (APDQ). Results We received 76 responses. Lewis and Appleby's questionnaire showed more negative attitudes towards personality disorder than depression, with no significant patient ethnic group effects, and the APDQ also showed a (weak) trend towards more negative attitudes to personality disorder. In subgroup analysis, only in the White British patient group were there significantly more negative attitudes to personality disorder. Factor analysis showed significantly less sense of purpose when working with personality disorder. Clinical implications The perceived greater lack of purpose in working with personality disorder should be the target of clinical training and intervention. Targeted interventions that include training in managing personality disorder, supervision and practice in non-specialist, general psychiatry settings are important.

Screening for personality disorder: a comparison of personality disorder assessment by patient and informants.

The Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II Version 2.0) is becoming the most favoured instrument to measure personality disorder but takes up to an hour to complete. The Standardized Assessment of Personality (SAP), an informant-based measure, takes 10 to 15 minutes to complete. Both instruments have been validated independently. This study aimed to determine whether the SAP is a suitable screening instrument for personality disorder as measured by the SCID-II. Fifty-seven psychiatric patients were assessed for personality disorder using both the SAP and the SCID-II. The SAP assessments were conducted blind to the results of the SCID-II assessments. Agreement between the two instruments in this population was low (kappa = 0.3). The level of agreement differed between personality disorder categories, ranging from kappa = 0.4 (antisocial) to 0.1 (narcissistic). In this population of patients, the SAP proved to be a poor screen for the SCID-II. The study highlights the discrepancy between informant and self-report assessments for personality disorder.

Bed/population ratios in South African public sector mental health services.

BACKGROUND: In post-apartheid South Africa, mental health service planners face critical decisions regarding appropriate and affordable inpatient care. Before a fashion of deinstitutionalisation is followed blindly in South Africa, effective community services should be in place and sufficient psychiatric beds should remain in hospitals for those who cannot be catered for in the community. In order to maintain the delicate balance between hospital and community-based services, it is essential that useful indicators of inpatient care are established. This study documents current bed/population ratios per 100 000 population in public sector mental health services in South Africa. METHOD: A questionnaire was distributed to provincial mental health coordinators requesting psychiatric bed numbers in acute and medium-long stay facilities across all service levels. The information was supplemented by consultations with mental health coordinators in each of the nine provinces. Population data were obtained from preliminary findings of the 1996 census. RESULTS: For acute facilities, the mean bed/population ratio was 13 (provincial range: 6-18) per 100 000 population. For medium-long stay facilities, it was 16 (provincial range: 0-29) excluding contracted facilities, and 35 (provincial range: 0-83) including contracted facilities per 100 000 population. CONCLUSIONS: There were low levels of inpatient service provision in South Africa, and there was considerable variability between provinces. This study gives further support to the need to develop acute inpatient psychiatric services, reduce levels of chronic care where appropriate, and redirect resources towards the development of community-level residential and day-care services. It is crucial to develop accurate indicators to monitor this process.

Patterns and determinants of acute psychiatric readmissions.

OBJECTIVES: Deinstitutionalisation and shortage of psychiatric beds worldwide has led to extensive research into the risk factors and interventions associated with rapid and recurrent admission to hospital. Little research of this nature has taken place in South Africa, particularly with regard to acute hospital admissions. This study attempted primarily to assess the effect of length of stay and administration of depot antipsychotics in hospital on time to readmission. DESIGN: A retrospective cohort of 180 admissions was followed up for 12 months, after an index discharge, by means of multiple hospital and community-based record reviews. Each readmission was analysed as an event using a survival analysis model. SETTING: Chris Hani Baragwanath Hospital, Gauteng. SUBJECTS: A random sample of patients admitted during a 6-month period in 1996. OUTCOME MEASURES: Time to readmission. RESULTS: Two hundred and eighty-four admissions were analysed. The only factor that provided a significant protective effect was being married or cohabiting (P = 0.015). Clinic attendance showed a slight protective effect early on but conferred a significantly higher risk of readmission on those who had been out of hospital for a long period (P = 0.001). Only 21% of discharged patients ever attended a clinic. The overall risk of readmission was significantly higher in the first 90 days post discharge. CONCLUSIONS: The lack of impact of length of hospital stay and use of depot neuroleptics on time to readmission may indicate that patients are being kept for appropriate duration and that the most ill patients are receiving depot medication. Several sampling and statistical artefacts may explain some of our findings. These results confirm the worldwide difficulty in finding consistent and accurate predictors of readmission. Low rates of successful referral to community aftercare need to be addressed before their effectiveness can be reasonably assessed. The inherent instability of the post-discharge period is a potential area for further investigation and intensive management.

Standardised Assessment of Personality - Abbreviated Scale (SAPAS): preliminary validation of a brief screen for personality disorder.

BACKGROUND: There is a need for a brief and simple screen for personality disorders that can be used in routine psychiatric assessments. AIMS: To test the concurrent validity and test-retest reliability of a brief screen for personality disorder. METHOD: Sixty psychiatric patients were administered a brief screening interview for personality disorder. On the same day, they were interviewed with an established assessment for DSM-IV personality disorder. Three weeks later, the brief screening interview was repeated in order to examine test-retest reliability. RESULTS: A score of 3 on the screening interview correctly identified the presence of DSM-IV personality disorder in 90% of participants. The sensitivity and specificity were were 0.94 and and 0.85 respectively. CONCLUSIONS: The study provides preliminary evidence of the usefulness of the screen in routine clinical settings.