The Complexity of Borderline Personality Disorder: Network Analysis of Personality Factors and Defense Styles in the Context of Borderline Personality Organization.

OBJECTIVE: Borderline personality disorder (BPD) is known to share characteristics with a variety of personality disorders (PDs) and exhibits diverse patterns of defense mechanisms. To enhance our understanding of BPD, it's crucial to shift our focus from traditional categorical diagnostics to the dimensional traits shared with other PDs, as the borderline personality organization (BPO) model suggests. This approach illuminates the nuanced spectrum of BPD characteristics, offering deeper insights into its complexity. While studies have investigated the comorbidity of BPD with other PDs, research exploring the relationship between various personality factors and defense mechanisms within BPD itself has been scarce. The present study was undertaken to investigate the complex interrelationships between various personality factors and defense styles in individuals diagnosed with BPD. METHODS: Using a network analysis approach, data from 227 patients diagnosed with BPD were examined using the Defense Style Questionnaire and Personality Disorder Questionnaire-4+ for assessment. RESULTS: Intricate connections were observed between personality factors and defense styles. Significant associations were identified between various personality factors and defense styles, with immature defense styles, such as maladaptive and image-distorting being particularly prominent in BPD in the centrality analysis. The maladaptive defense style had the highest expected influence centrality. Furthermore, the schizotypal, dependent, and narcissistic personality factors demonstrated relatively high centrality within the network. CONCLUSION: Network analysis can effectively delineate the complexity of various PDs and defense styles. These findings are expected to facilitate a deeper understanding of why BPD exhibits various levels of organization and presents with heterogeneous characteristics, consistent with the perspectives proposed by the BPO.

Neurophysiological insights into impaired mentalization in borderline personality disorder an electroencephalography study.

Introduction: Borderline personality disorder (BPD) is characterized by interpersonal and emotional instabilities, recurring suicidal tendencies, and feelings of emptiness. Childhood adverse event is reported in 70%-80% of cases involving BPD. Furthermore, the deficiency in mentalization capacity plays a significant role in emotion dysregulation and social interaction problems within individuals with BPD. This study explored the relationship among childhood adverse experiences, mentalization capacity, and neurophysiological activity in patients with BPD. Methods: Resting-state electroencephalography was used to identify the neural correlates associated with childhood adversity and mentalization deficits. The participants included 45 patients with BPD and 15 healthy controls. Results: The BPD group exhibited reduced alpha activity during eyes-closed rest, indicating heightened arousal even during relaxation. Correlations were found between the power spectral density (PSD) and mentalization capacity in the delta and theta ranges, suggesting an association between PSD and emotional awareness and expression. Gamma activity negatively correlated with psychic equivalence, implying a blurring of the boundaries between internal mental experiences and the external world. Conclusion: These findings offer insights into the pathophysiology of BPD, provide potential diagnostic markers, and suggest personalized treatment approaches based on mentalization traits.

Acute Impact of the Coronavirus Disease Outbreak on Behavioral Patterns and Emotional States of Pediatric Psychiatric Patients and Caregivers in Daegu, South Korea.

OBJECTIVE: This study aimed to investigate the changes in interpersonal relationships, behavioral patterns, and emotional states of children and adolescents with psychiatric disorders and their caregivers immediately after the coronavirus disease of 2019 (COVID-19) outbreak in Daegu, South Korea. METHODS: A total of 147 patients and 147 caregivers participated in the Survey for Outing and Time Usage for Child, Adolescent, and Parents and the COVID-19 Visual Analog Scale for Emotion. We classified the patients and their caregivers into the internalizing disorder (ID) and externalizing disorder (ED) groups and compared the changes. RESULTS: Parent-child relationships for adolescent patients and caregivers were interrupted, and friend relationships in all participants were disrupted, while sibling relationships improved in adolescent patients. They experienced negative emotional changes. Time spent outdoor decreased and digital screen time increased for all participants. Friend and parent-child relationships were interrupted in the ED group compared to those in the ID group. ED patients experienced negative changes in emotional states, while ID patients showed no significant changes. CONCLUSION: Results are meaningful as a reference for predicting changes in interpersonal relationships and mental status of pediatric psychiatric patients and for determining healthcare system adaptations to allow mental health support during the COVID-19 outbreak.

Psychiatric understanding and treatment of patients with amputations.

Amputation changes the lives of patients and their families. Consequently, the patient must adapt to altered body function and image. During this adaptation process, psychological problems, such as depression, anxiety, and posttraumatic stress disorder, can occur. The psychological difficulties of patients with amputation are often accepted as normal responses that are often poorly recognized by patients, family members, and their primary physicians. Psychological problems can interfere with rehabilitation and cause additional psychosocial problems. Therefore, their early detection and treatment are important. A multidisciplinary team approach, including mental health professionals, is ideal for comprehensive and biopsychosocial management. Mental health professionals could help patients set realistic goals and use adaptive coping styles. Psychiatric approaches should consider the physical, cognitive, psychological, social, and spiritual functions and social support systems before and after amputation. The abilities and limitations of physical, cognitive, psychological, and social functions should also be considered. To improve the patient's adaptation, psychological interventions such as short-term psychotherapy, cognitive behavioral therapy, mindfulness meditation, biofeedback, and group psychotherapy can be helpful.

The psychological impact of the coronavirus disease pandemic on hospital workers in Daegu, South Korea.

OBJECTIVE: This study aimed to assess the immediate stress and psychological impact experienced by healthcare workers and other personnel during the Coronavirus disease (COVID-19) pandemic. METHOD: The sample consisted of 2554 hospital workers (i.e., physicians, nurses, allied health professionals, and auxiliary staff members) who were working in Yeungnam University Hospital in Daegu, South Korea. The Impact of Event Scale-Revised (IES-R) was administered to the hospital workers twice over a 2 week interval. A high-risk group, identified on the basic of first total IES-R, was assessed further with the Mini International Neuropsychiatric Interview (MINI) and the Clinical Global Impressions-Severity (CGIS) scale and was offered periodic psychiatric consultations on a telephone. RESULTS: The participating nurses and auxiliary staff members had significantly higher IES-R scores (p < 0.01) than the physicians. During the second evaluation, the IES-R scores of the high-risk participants had decreased by 13.67 ± 16.15 points (p < 0.01), and their CGI-S scores had decreased by 1.00 ± 0.74 points (p < 0.01). The psychological symptoms of the high-risk group who received telephone-based psychiatric consultation showed improvement after 2 weeks. CONCLUSIONS: The present findings suggest that hospital workers experience high levels of emotional stress during a pandemic. In particular, the present findings underscore the need to provide more information and support to nurses and other administrative workers. There is a need for greater awareness about the importance of mental health care among hospital workers, and rapid and ongoing psychiatric interventions should be provided to workers during the pandemic period.

Characteristics of Individuals Who Converted to Dementia during a 5-Year Follow-Up.

INTRODUCTION: Early diagnosis of dementia is important; however, the diagnostic criteria for the preclinical stage of dementia, including biomarkers and pathophysiological markers, are not suitable for application in patients in real-world clinical settings. One potential noninvasive method to predict the risk of dementia conversion is the neuropsychological test. Therefore, in this study, we examined the results of various assessments, such as comprehensive neuropsychological tests, and the daily function of participants who were evaluated periodically for 5 years. METHODS: All participants were outpatients or inpatients with subjective cognitive complaints, who visited a local university hospital for neuropsychiatric evaluation, between January 2011 and January 2019. Of a total of 1,652 subjects who underwent initial screening during this period, 107 were nondemented individuals. These participants underwent periodic comprehensive cognitive tests for up to 5 years. Survival and factors affecting dementia conversion were analyzed using the time-dependent Cox regression analysis. Assessment items included demographic information, including age, sex, and education; 5 cognitive domains of a comprehensive neuropsychological test including memory, language, attention, visuospatial functions, and frontal (executive) function; Barthel's activities of daily living; the mini-mental state examination findings; and clinical dementia rating (CDR) scores. RESULTS: This study included 61 participants (21 women and 40 men) who developed dementia during the study period. Verification of the cognitive variables affecting dementia conversion revealed that better memory was associated with a lower risk of conversion (hazard ratio [HR] = 0.614, p = 0.005) and higher attention was associated with a higher risk of conversion (HR = 1.602, p = 0.023). In the analysis of the subscales of the CDR, a higher community affairs score (i.e., less social activities) was associated with a higher risk of conversion (HR = 10.814, p = 0.028). CONCLUSION: Individuals with prominent memory decline or problems with social activities should be carefully observed for dementia conversion. Cognitive intervention techniques for cognitive stimulation, such as social and leisure activities, as well as cognitive training need to be actively used for patients in whom dementia is a concern.