The prediction of the level of personality organization on reduction of psychiatric symptoms and improvement of work ability in short- versus long-term psychotherapies during a 5-year follow-up.

OBJECTIVES: How level of personality organization (LPO) predicts psychiatric symptoms and work ability in short- versus long-term psychotherapies is poorly known. We investigated the importance of the LPO on the benefits of short-term versus long-term psychotherapies. DESIGN: A cohort study based on 326 outpatients with mood or anxiety disorder was allocated to long-term (LPP) and short-term (SPP) psychodynamic psychotherapy, and solution-focused therapy (SFT). METHODS: The LPO was assessed by interview at baseline and categorized into neuroses and higher level borderline. Outcome was assessed at baseline and 4-9 times during a 5-year follow-up, using self-report and interview-based measures of symptoms and work ability. RESULTS: For patients receiving SPP, improvement in work ability, symptom reduction, and the remission rate were more considerable in patients with neuroses than in higher level borderline patients, whereas LPP or SFT showed no notable differences in effectiveness in the two LPO groups. In patients with neuroses, improvement was more considerable in the short-term therapy groups during the first year of follow-up, and in higher level borderline patients LPP was more effective after 3 years of follow-up. The remission rate, defined as both symptom reduction and lack of auxiliary treatment, was higher in LPP than in SPP for both the LPO groups considered. CONCLUSIONS: In neuroses, short-term psychotherapy was associated with a more rapid reduction of symptoms and increase in work ability, whereas LPP was more effective for longer follow-ups in both LPO groups. Further large-scale studies are needed. PRACTITIONER POINTS: Level of personality organization is relevant for selection between short- and long-term psychotherapies. Short-term therapy gives faster benefits for neurotic patients but not for patients with higher level borderline personality organization. Sustained remission from symptoms is more probable after long-term than short-term therapy.

[Update on Current Care Guideline: Borderline personality disorder]. / Epävakaa persoonallisuus.

Borderline personality disorder is a severe disorder that increases disability to a considerable extent. Emotional instability, difficulties in regulating behavior and interpersonal relationships are essential features of the disorder. Borderline personality disorder has a more favorable course than previously thought. Dialectic behavioral therapy, cognitive therapy, mentalization therapy and transference-focused psychotherapy seem to be effective. Hospital treatment should be carried out primarily in day hospital settings. Antipsychotics and mood stabilizers may be used for a range of symptoms. SSRIs may be useful in the treatment of impulsivity and aggression. Benzodiazepines should be avoided.

[A systematic review for psychosocial risk factors of borderline personality disorder]. / Epävakaan persoonallisuuden psykososiaaliset riskitekijät.

Borderline personality disorder (BPD) is a serious personality disorder characterized by affective instability, impulsivity and interpersonal disturbance. Currently, intensive research is being conducted concerning the etiology of BPD. This study focuses on psychosocial risk factors to propose a conceptual model of the development of BPD. A systematic review of the literature focusing on evidence based psychosocial risk factors for BPD is provided. Utilizing this knowledge, a multi-pathway outbreak model is developed to illustrate how these data may be processed into a conceptual model of the development of BPD and used in the psychotherapy of BPD.

The transformation of the internal dead mother into the internal living mother in the psychoanalytic psychotherapy of anorexia nervosa.

The aim of this study is to show the central role of the concept of the dead mother in the psychic process of anorexia nervosa, and the dead mother's transformation into the living mother by means of the use of the therapist in a successful psychoanalytic psychotherapy process. This psychoanalytic psychotherapy approach to anorexia nervosa is especially useful when patients are young, because even though they are often unstable and not yet mature, they are at the same time open to positive psychic changes in their personality structure--as the clinical case shows. The resurrection of the internal dead mother into the internal living mother, by means of the object usage of the therapist in the described therapy process, brought about the anorectic patient's recovery from a "dead swan" to a young "living swan."