Enhancing the capacity for optimal social and personality function through the mediational intervention for sensitizing caregivers: A case illustration.

OBJECTIVE: Based on the well-known principle that the ability to meaningfully relate to others starts in the context of early attachment relationships, the current case illustration uses a recent extension of mentalization-based theory and practice to demonstrate how caregivers can enhance the capacity for optimal social and personality function through the mediational intervention for sensitizing caregivers (MISC). METHODS: Case material is presented to demonstrate the implementation of the MISC affective and cognitive components with a mother of an adopted 10-year-old girl who shows signs of affect avoidance, social isolation within and outside the family, and maladaptive personality development. RESULTS: The case illustration shows how video feedback sessions facilitate the gradual use of affective and cognitive components in the daily interactions between mother and daughter, thereby scaffolding optimal social and personality development. CONCLUSIONS: Affective and cognitive components of the Mediational Intervention for Sensitizing Caregiving can be effectively integrated to enhance mentalizing capacity in caregiver-child interactions.

Five failures and five challenges for prevention and early intervention for personality disorder.

Despite global consensus regarding the early detection of personality disorder, current approaches to early intervention have failed to deliver for the majority of young people. This only serves to reinforce the enduring effects of personality disorder on functioning, mental and physical health, resulting in a reduction of quality of life and life expectancy. Here, we describe five significant challenges facing prevention and early intervention for personality disorder: identification, access to treatment, research translation, innovation and functional recovery. These challenges highlight the need for early intervention to shift from niche programmes in specialist services for a select few young people to become established in mainstream primary care and specialist youth mental health services.

Perfil de los intentos de suicidio en personas mayores de 65 años del area sanitaria de santiago de compostela en el periodo de 2015 a 2017 / Profile of suicide attempts in people over 65 years of the sanitary area of santiago de compostela in the period of 2015 to 2017

Introducción: Las personas de edad avanzada presentan las tasas más altas de suicidio en todo el mundo. A su vez, tienen las menores tasas de intentos de suicidio. Este hecho responde a diversos factores, que hacen que la conducta suicida en el anciano sea de alta letalidad, consumándose el suicidio al primer intento en un gran número de casos. Objetivo: conocer el perfil sociodemográfico y clínico de las personas mayores de 65 años que son atendidas en el servicio de urgencias del Hospital Clínico de Santiago de Compostela por un intento de suicidio. Material y métodos: en el periodo de Enero de 2015 a Diciembre de 2017 todas las personas mayores de 65 años atendidas por intento de suicidio en el servicio de urgencias e Interconsulta de psiquiatría del Hospital Clínico de Santiago de Compostela fueron evaluadas y entrevistadas. Se recogieron distintas variables clínicas y sociodemográficas de interés. Resultados: se registraron 80 tentativas de suicidio, lo que supone una incidencia de 35,3/100.000. La edad media de nuestra muestra fue de 74,85±7 años, la proporción entre hombre:mujer fue de 2:3. La mitad de la muestra estaba casada y la mayoría vivían con familia. El 25% presentaba tentativas previas, siendo la mayoría mujeres (p<0,01). El diagnóstico mayoritario pertenecía al grupo de Trastornos afectivos y el método más utilizado fue el de sobreingesta medicamentosa. El desencadenante o estresante más frecuente estuvo en relación a conflictiva intrafamiliar. Se encontraron diferencias en los subgrupos por la edad del episodio índice superior o inferior a los 65 años en cuanto al sexo, diagnóstico, e ingresos previos. Conclusiones: Las personas de más de 65 años que intentan suicidarse en nuestra área presentan un perfil sociodemográfico similar a otras muestras de nuestro entorno. Las mujeres, con ingresos previos en psiquiatría, tentativas antes de los 65 años, y con algún diagnóstico de Trastorno de la Personalidad son una población de riesgo para presentar nuevas tentativas más allá de los 65 años

Introduction: Elderly people have the highest suicide rates in the world. In turn, they have the lowest rates of suicide attempts. This fact responds to several factors, which make suicidal behavior in the elderly a behavior of high lethality, committing suicide at the first attempt in a large number of cases. Objective: to know the sociodemographic and clinical profile of people over 65 years who are treated in the emergency department of the Clinical Hospital of Santiago de Compostela for an attempted suicide. Material and methods: from January 2015 to December 2017 all people over 65 years treated by suicide attempt in the emergency service and Psychiatry Interconsultation of the Clinical Hospital of Santiago de Compostela were evaluated and interviewed. Different clinical and sociodemographic variables of interest were collected. Results: 80 suicide attempts were recorded, which represents an incidence of 35.3 / 100,000. The average age of our sample was 74.85 ± 7 years, the ratio between male: female was 2: 3. Half of the sample was married and most lived with family. 25% had previous attempts, the majority being women (p <0.01). The majority diagnosis was the Affective Disorders group and the most used method was drug overdose. The most frequent trigger or stressor was related to intrafamiliar conflict. Differences were found in the subgroups by the age of the index episode above or below 65 years in terms of sex, diagnosis, and previous income. Conclusions: People over 65 who try to commit suicide in our area have a sociodemographic profile similar to other samples from our environment. Women, with previous income in psychiatry, attempts before the age of 65, and with some diagnosis of Personality Disorder are a risk population to present new attempts beyond 65 years

Clozapine Reduces Self-Injurious Behavior in a State Prison Population.

Self-injurious behavior (SIB) is a common, disruptive, and costly occurrence in U.S. prisons. In this study, we describe the use of clozapine to treat 10 offenders with chronic, repetitive self-injury refractory to other medications and behavioral therapies. The primary diagnosis for all 10 offenders was a personality disorder. Eight of the 10 inmates allowed weekly blood draws and took medication regularly (approximately 95% adherence), whereas two inmates discontinued treatment within the first two weeks. For these eight patients, we compared the number of in-house urgent care visits and outside emergency room visits related to SIB for the six-month periods before and after treatment with clozapine. After initiation of clozapine treatment, there were 66 fewer urgent care visits (94 versus 28) and 26 fewer emergency room visits (37 versus 11), a 70 percent reduction in each. As a secondary outcome, we assessed disciplinary infractions. There were 132 fewer infractions (197 versus 65), a 67 percent reduction. The median dose of clozapine used was 125 mg/day, substantially lower than doses typically used to treat schizophrenia. Clozapine appears to be a feasible and effective treatment for some patients with chronic, repetitive SIB for whom other treatments have failed.

Are suicide risk factors gender specific? / Czy czynniki zwiazane z ryzykiem samobójstwa sa specyficzne dla plci?

OBJECTIVES: Suicide is an important clinical problem in psychiatric patients. The highest risk of suicide attempts is noted in affective disorders. In this study we tested 20 factors described in the literature (sociodemographic and clinical factors as well as family burden) in association with suicidal behavior and we analyzed whether the significance of those factors differs between males and females. METHODS: In the study we included patients with major depressive disorder (MDD; n = 249) and bipolar affective disorder (BP; n = 582). The Structured Clinical Interview for DSM-IV Axis I (SCID I), the Operational Criteria Diagnostic Checklist (OPCRIT) and a questionnaire of family history were used. RESULTS: In the study population we observed an association between suicidal attempts and the following factors: family history of psychiatric disorders, affective disorders and psychoactive substance abuse/dependence; family history of attempted/completed suicide; occurrence of specific symptoms in the course of depressive episode (inappropriate guilt, sense of worthlessness, early morning awakening); and psychotic symptoms. Having children was also associated with suicide attempts. The risk factors of suicide attempt differ between males and females. The age of onset of MDD and coexistence of substance abuse/dependence with affective disorder were significant for lifetime risk of attempted suicide only in female group. Having children was associated with suicide attempts in the whole group and in the male subgroup, but not in the female subgroup. CONCLUSIONS: Suicide attempts are significantly associated with 10 out of 20 analyzed clinical factors in our group of affective patients, however, the significance (or lack of it) of these factors differed in female and male groups in half the cases.

Time for a new zeitgeist in perinatal mental health.

Perinatal depression, and to a lesser extent anxiety, has been the focus of interest for perinatal psychiatrists for several decades. Policy and substantial funding has supported this. We argue that it is now time to change this focus and to invest greater funding to support clinical and research effort in 'high-risk' caregivers and their infants. We define high-risk caregivers as those who are likely to have attachment and relationship difficulties with their infant as a result of their own developmental experiences, personality difficulties and/or trauma-related mental disorders, often complicated by substance abuse, depression and anxiety. We propose that early intervention with such caregivers, focussing on both maternal mental health and on the needs of the infant for responsive and sensitive interaction and emotional care, would contribute to prevention of infant developmental disorders, with real gains to be made in breaking the transgenerational cycle of development of severe personality disorder.

Motivaton for change as a predictor of treatment response for dysthymia / Motivación para el cambio como predictor de la respuesta terapéutica en la distimia

OBJECTIVE: Dysthymia constitutes a chronic, mild affective disorder characterized by heterogeneous treatment effects. Several predictors of clinical response and attendance have been postulated, although research on the role of the psychological variables involved in this mental disorder is still scarce. METHOD: Fifty-four adult patients, who met criteria for dysthymia completed an ongoing naturalistic treatment based on the brief interpersonal psychotherapy (IPT-B), which was delivered bimonthly over 16 months. As potential predictor variables, the therapeutic alliance, coping strategies, perceived self-efficacy, and motivation for change were measured at baseline. Outcome variables were response to treatment (Clinical Global Impression and Beck's Depression Inventory) and treatment attendance. RESULTS: stepwise multiple linear regression analyses revealed that higher motivation for change predicted better response to treatment. Moreover, higher motivation for change also predicted treatment attendance. Therapeutic alliance was not a predictor variable of neither clinical response nor treatment attendance. CONCLUSIONS: These preliminary findings support the adjunctive use of motivational interviewing (MI) techniques in the treatment of dysthymia. Further research with larger sample size and follow-up assessment is warranted

OBJETIVO: la distimia constituye un trastorno afectivo crónico caracterizado por una respuesta heterogénea al tratamiento. Se han postulado diversas variables predictoras de dicha respuesta terapéutica, aunque la investigación acerca del papel de las variables psicológicas es todavía escasa. MÉTODO: cincuenta y cuatro pacientes diagnosticados de distimia completaron un tratamiento naturalístico bimensual de 16 meses de duración basado en la psicoterapia interpersonal. Como posibles variables predictoras se evaluó al inicio del tratamiento la alianza terapéutica, las estrategias de afrontamiento, la autoeficacia percibida y la motivación para el cambio. Las variables de tratamiento fueron la respuesta terapéutica (Escala de Impresión Clínica Global e Inventario de Depresión de Beck) y la adherencia terapéutica. RESULTADOS:los análisis de regresión múltiple indicaron que una mayor motivación para el cambio predijo una mejor respuesta al tratamiento. Por otra parte, una mayor motivación para el cambio también predijo una mayor adherencia al tratamiento. La alianza terapéutica no fue una variable predictora ni de la respuesta ni de la adherencia al tratamiento. CONCLUSIONES: estos resultados preliminares apoyan el uso complementario de la entrevista motivacional en el tratamiento de la distimia. Son necesarios estudios adicionales con un mayor tamaño muestral y evaluaciones adicionales durante el seguimiento postratamiento

Influence of vulnerability factors in panic disorder severity / Influencia de factores de vulnerabilidad en la gravedad del trastorno de pánico

BACKGROUND: we studied herein the predictive value for panic severity of three well-based vulnerability factors: personality traits (neuroticism and extraversion; NEO-PI-R), anxiety sensitivity (ASI), and perceived control (ACQ-R). METHOD: the sample was composed of 52 participants diagnosed with panic disorder, with or without agoraphobia, according to DSM-IV-TR criteria. RESULTS: our results revealed that the anxiety facet is a better predictor of panic severity than neuroticism. Anxiety sensitivity increases the predictive value for panic severity and, finally, perception of control of emotions is the only perception control subscale that increases the predictive value for panic severity more than the anxiety facet and anxiety sensitivity. CONCLUSIONS: this finding supports the assumption of the importance of taking into account the assessment of the lower order dimensions of the vulnerability factors in the field of psychopathology studies. Furthermore, the predictive value of perception of control of emotions indicates the importance of this specific vulnerability factor in the etiology of panic disorder (with or without agoraphobia) and, thus, shows the necessity to include emotion regulation strategies in the psychological treatments

ANTECEDENTES: en este trabajo se estudia el valor predictivo sobre la gravedad del pánico de tres factores de vulnerabilidad bien establecidos: rasgos de personalidad (neuroticismo y extraversión; NEO-PI-R), sensibilidad a la ansiedad (ASI) y percepción de control (ACQ-R). MÉTODO: la muestra fue de 52 participantes con diagnóstico de trastorno de pánico, con o sin agorafobia, según criterios DSM-IV-TR.RESULTADOS: nuestros resultados revelan que la faceta de ansiedad es mejor predictor de la gravedad del pánico que el neuroticismo. La sensibilidad a la ansiedad aumenta el valor predictivo sobre la gravedad del pánico y, finalmente, la percepción de control de las emociones es la única subescala de la percepción de control que aumenta la capacidad predictiva más allá de la faceta de ansiedad y la sensibilidad a la ansiedad. CONCLUSIONES: estos resultados apoyan el supuesto sobre la importancia de evaluar las dimensiones de orden inferior de los factores de vulnerabilidad en los estudios psicopatológicos. Además, el valor predictivo de la percepción de control de las emociones indica la importancia de este factor específico de vulnerabilidad en la etiología del trastorno de pánico (con o sin agorafobia) lo que muestra la necesidad de incluir estrategias de regulación emocional en los tratamientos psicológicos

Big Five personality traits may inform public health policy and preventive medicine: Evidence from a cross-sectional and a prospective longitudinal epidemiologic study in a Swiss community.

BACKGROUND: Some evidence documents the importance of personality assessments for health research and practise. However, no study has opted to test whether a short self-report personality inventory may comprehensively inform health policy. METHODS: Data were taken from a population-based epidemiologic survey in Zurich, Switzerland, conducted from 2010-2012. A short form of the Big Five Inventory was completed by n=1155 participants (54.4% women; mean age=29.6 years), while health-related outcomes were taken from a comprehensive semi-structured clinical interview. A convenience subsample averaging n=171 participants additionally provided laboratory measures and n=133 were subsequently followed-up at least once over a maximal period of 6 months. RESULTS: Personality traits, in particular high neuroticism and low conscientiousness, related significantly to poor environmental resources such as low social support (R(2)=0.071), health-impairing behaviours such as cannabis use (R(2)=0.071), and psychopathology, including negative affect (R(2)=0.269) and various mental disorders (R(2)=0.060-0.195). The proportion of total variance explained was R(2)=0.339 in persons with three or more mental disorders. Personality significantly related to some laboratory measures including total cholesterol (R(2)=0.095) and C-Reactive Protein (R(2)=0.062). Finally, personality prospectively predicted global psychopathological distress and vegetative symptoms over a 6-month observation period. CONCLUSIONS: Personality relates consistently to poor socio-environmental resources, health-impairing behaviours and psychopathology. We also found some evidence for an association with metabolic and immune functions that are assumed to influence health. A short personality inventory could provide valuable information for preventive medicine when used as a means to screen entire populations for distinct risk exposure, in particular with respect to psychopathology.

Maternal personality traits associated with patterns of prenatal smoking and exposure: Implications for etiologic and prevention research.

BACKGROUND: Little is known about the characteristics of women who smoke during pregnancy beyond demographic factors. We examined the relationship between novelty seeking, harm avoidance, and self-directedness and (a) abstinence from smoking during pregnancy and (b) average daily cigarette consumption during pregnancy. METHODS: Participants were 826 birth mothers who made adoption placements in the Early Growth and Development Study and completed the Temperament and Character Inventory - Short Form, and interview-based smoking assessments 3-6 months postpartum. Never smokers (n=199), pregnancy abstainers (n=277), pregnancy light smokers (n=184), and pregnancy heavy smokers (n=166) were compared on personality dimensions and smoking-related processes. Using regression analyses we examined relationships between personality and (a) abstinence versus smoking during pregnancy; and (b) average daily cigarette consumption among lifetime smokers, controlling for nicotine dependence, birth father substance dependence, maternal antisocial behavior, and depressive symptoms during pregnancy. RESULTS: Smokers with higher self-directedness and lower harm avoidance were more likely to abstain during pregnancy [O.R. 1.380; 95% C.I. (1.065-1.787); B(SE)=.322(.132); p=.015] and [O.R. .713; 95% C.I. (.543-.935); B(SE)=-.339(.138); p=.014], respectively. Novelty seeking differentiated never smokers from lifetime smokers (t=-3.487; p=.001), but was not significant in multivariate models. Lifetime smokers who abstained during pregnancy reported fewer depressive symptoms relative to never smokers. CONCLUSIONS: Personality dimensions associated with abstinence from smoking and cigarettes per day during pregnancy may be important to consider in etiologic and intervention research.

Evaluating a selective prevention program for substance use and comorbid behavioral problems in adolescents with mild to borderline intellectual disabilities: Study protocol of a randomized controlled trial.

BACKGROUND: Substance use and abuse is a growing problem among adolescents with mild to borderline intellectual disabilities (ID). Substance use patterns in general population are similar to patterns among non-disabled peers, but substance use has more negative consequences for adolescents with mild to borderline ID, and they are at an increased risk for developing a substance use disorder. Nevertheless, effective and evidence based prevention programs for this groups are lacking. The study described in this protocol tested the effectiveness of a selective intervention aimed at reducing substance use in adolescents with mild to borderline ID and behavioral problems. In the intervention, participants acquire competences to deal with their high-risk personality traits. METHODS: A randomized controlled trial will be conducted among 14-21-year old adolescents with mild to borderline ID and behavioral problems admitted to treatment facilities in the Netherlands. Inclusion criteria are previous substance use and personality risk for substance use. Participants will be individually randomized to the intervention (n = 70) or control (n = 70) groups. The intervention group will be exposed to six individual sessions and five group sessions carried out by two qualified trainers over six-week period. Primary outcomes will be the percentage reduction in substance use (for alcohol: percentage decrease of binge drinking, weekly use and problematic use, for cannabis: the percentage decrease of lifetime cannabis use and weekly use and for hard drug: the percentage decrease of lifetime use). Secondary outcomes will be motives for substance use, intention to use, and internalizing and externalizing behavioral problems. All outcome measures will be assessed after two, six, and twelve months after the intervention. DISCUSSION: This study protocol describes the design of an effectiveness study of a selective prevention program for substance use in adolescents with mild to borderline ID and behavioral problems. We expect a significant reduction in alcohol, cannabis and hard drug use among adolescents in the intervention group compared with the control group. TRIAL REGISTRATION: This trial is registered in the Dutch Trial Register (Cochrane Collaboration) as NTR5037 registered at 15 April 2015.

Validación española de la Iowa Rating Scale for Personality Change (IRSPC) para la valoración de los cambios de personalidad en pacientes con daño cerebral adquirido / Spanish validation of the Iowa Rating Scale for Personality Change (IRSPC) for the appraisal of changes in personality in patients with acquired brain injury

Introducción. La Iowa Rating Scale for Personality Change (IRSPC) presenta una serie de características (énfasis en las funciones motivacionales y emocionales, evaluación de las funciones ejecutivas ‘cognitivas’ en la vida cotidiana, estimación de la personalidad premórbida, valoración de la fiabilidad del informador) que hacen muy interesante su utilización tanto en la clínica como en la investigación. Objetivo. Validar en castellano la IRSPC para la evaluación de los ‘cambios de personalidad’ secundarios a las lesiones cerebrales de la corteza prefrontal en general y del área ventromedial en particular. Pacientes y métodos. Tras el proceso de traducción y adaptación de la guía de la escala al castellano, se realizó un estudio de validación con 31 pacientes con daño cerebral traumático y se obtuvieron unos resultados de fiabilidad muy adecuados. Resultados. Los resultados obtenidos al medir la consistencia interna de la IRSPC y los coeficientes de fiabilidad interobservadores y test-retest apoyan dicha afirmación. La validez del instrumento es confirmada por la validez concurrente (comparándolo con el inventario neuropsiquiátrico) y la validez de constructo (comparando las puntuaciones de los pacientes antes y después del traumatismo). Conclusiones. La IRSPC es un instrumento fiable y válido para la exploración clínica, en el contexto de una evaluación integral de los síntomas derivados de las enfermedades neurológicas en general, y en particular de aquéllas en las que se encuentra involucrada la corteza prefrontal ventromedial (AU)

Introduction. The Iowa Rating Scale for Personality Change (IRSPC) presents some features (puts an emphasis on the motivational and emotional functions; evaluates the ‘cognitive’ executive functions in the daily life; estimates the premorbid personality; values the informant reliability) that make it use really interesting for both clinical and research. Aim. The aim of this study was the Spanish validation of the IRSPC, which evaluates the ‘personality changes’ secondary to prefrontal cortex brain injury and particularly those located in the ventromedial area. Patients and methods. After the translation and the Spanish adaptation of the scale guide, we carried out a validation study with 31 patients suffering from traumatic brain injury, getting good reliability. Results. The data obtained by measuring the internal consistency of the IRSPC and the inter rater and test-retest reliability support this statement. The instrument validity is confirmed by the results of the concurrent validity (comparing IRSPC and Neuropsychiatric Inventory) and the construct validity (scores before and after the trauma). Conclusions. The IRSPC is a valid and reliable instrument for clinical examination in the context of a comprehensive evaluation of the symptoms resulting from neurological diseases and particularly from the ventromedial prefrontal cortex injury (AU)

Pensamiento constructivo como medida de inteligencia emocional en patología dual / No disponible

Introducción: El objetivo de este estudio es comparar el pensamiento constructivo, una medida de inteligencia emocional, entre una muestra clínica de pacientes adultos diagnosticados de patología dual y una muestra no clínica. Método: Mediante un diseño de investigación comparativo, una muestra no clínica de 835 sujetos se comparó con una muestra de 180 sujetos diagnosticados de patología dual: 78 con trastornos clínicos o del Eje I y102 con trastornos de la personalidad o del Eje II, según criterios DSM-IV-TR. Resultados: Los resultados indican un pensamiento constructivo superior en la muestra no clínica, así como un pensamiento destructivo superior en la muestra con patología dual. No se apreciaron diferencias entre trastornos clínicos y de personalidad. Conclusiones: La muestra clínica presenta un patrón destructivo o desadaptativo de afrontamiento en comparación con población no clínica, que en el caso de pacientes con trastornos de personalidad se ve incrementado por ilusiones, supersticiones y pensamientos esotéricos que contribuyen a su afrontamiento deficitario

Introduction: The objective of this study is to compare the constructive thinking, a measure of emotional intelligence, between a clinical sample of adult patients diagnosed with dual diagnosis and a non-clinical sample. Method: By means of a comparative design of investigation, a not clinical sample of 835 subjects was compared with a sample of 180 subjects diagnosed of dual diagnosis: 78 with clinical disorders or of the Axix I and 102 with disorders of the personality or of the Axis II, according to DSM-TR-IV. Results: The results indicate a constructive thinking greater than in the non-clinical sample, as well as a destructive thinking higher in the sample with dual diagnosis. There were no differences between clinical disorders and personality. Conclusions: The clinic sample presents a destructive pattern of coping or no adaptative compared with non-clinical population, which in the case of patients with personality disorders is increased by illusions and superstitions and esoteric thoughts that contribute to their coping deficit

[A 43-year-old patient with character changes, recurrent impaired consciousness and retrograde amnesia]. / 43-jähriger Patient mit Wesensveränderung, rezidivierenden Bewusstseinsstörungen und retrograder Amnesie.

A 43-year-old male patient with recurring impaired consciousness and retrograde amnesia was admitted to the department of neurology. During the neurological evaluation no pathological findings could initially be revealed but one day the patient was confused again and presented with inadequate behavior: at this time a blood glucose value of 40 mg/dl was measured. For further evaluation the patient was transferred to our department. As the reason for the impaired consciousness was suspected to be of neuroglucopenic origin a rapid adrenocorticotropic hormone (ACTH) stimulation test was first performed to rule out adrenal insufficiency. For further evaluation a fasting test was conducted: after 48 h an episode with neuroglucopenic symptoms occurred again which disappeared after intravenous administration of glucose. The laboratory results of glucose, insulin and c-peptide determined at this point in time led to the diagnosis of an insulinoma. By ultrasound examination a hypoechogenic lesion 1.5 cm in size could be shown in the head of the pancreas and was confirmed by magnetic resonance imaging (MRI). After duodenum-preserving partial pancreatic head resection with enucleation of the insulinoma no further neuroglucopenic symptoms occurred.

Personality pathology factors predict recurrent major depressive disorder in emerging adults.

OBJECTIVE: Prior investigations consistently indicate that personality pathology is a risk factor for recurrence of major depressive disorder (MDD). Lack of emipircal support, however, for the Diagnostic and Statistical Manual of Mental Disorders (DSM) Fourth Edition organization of Axis II disorders supports the investigation of empirically derived factors of personality pathology as predictors of recurrence. METHOD: A sample of 130 previously depressed emerging adults (80% female; aged 18 to 21 years) were assessed for personality disorder symptoms at baseline. Participants were then followed for 18 months to identify MDD recurrence during the first 2 years of college. RESULTS: Based on a previous factor analysis of DSM personality disorder criteria, eight personality pathology factors were examined as predictors of MDD recurrence. Survival analysis indicated that factors of interpersonal hypersensitivity, antisocial conduct, and social anxiety were associated with increased risk of MDD recurrence. CONCLUSIONS: These findings suggest that an empirically based approach to personality pathology organization may yield useful predictors of MDD recurrence during emerging adulthood.

Trastornos de personalidad en el DSM-5. Una aproximación crítica / Personality disorders in DSM-5. A critical approach

Introducción: En la preparación del nuevo manual diagnóstico DSM-5 los modelos dimensionales se presentan como la base para la modificación de los criterios diagnósticos de los trastornos de personalidad. Los criterios de las ediciones anteriores han comportado algunos problemas, como una excesiva comorbilidad y una dificultad en la comprensión de ésta. Material y métodos: Se analizan de forma crítica las bases teóricas sobre las que se sustentan dichos modelos. Por otro lado, se consideran a la luz de los desarrollos hermenéuticos del siglo pasado. Resultados: Los modelos dimensionales suponen un avance cuanto a la integración de la información para su uso clínico y de investigación. Sin embargo, tienen algunas limitaciones implícitas que queremos destacar. Conclusiones: Se presentan dos propuestas desarrolladas desde una perspectiva hermenéutica, y se señalan las diferencias entre estas aproximaciones y los modelos dimensionales a nivel epistemológico y ético (AU)

In the new diagnostic manual DSM- 5, dimensional models are presented as the base to modify the diagnostic criteria of personality disorders. The criteria on previous editions of the DSM have brought about some problems in regards to an excess of comorbidity and an inability to understand this comorbidity. Material and methods: Theoretical grounds of these models have been examined in a critical way. On the other hand, these are also consider under the light of last century hermeneutical developments. Results: With dimensionals models there is an improvement in the integration of the information in and of itself for its clinical and research use. But it also has some implicit limitations that we want to highlight. Conclusions: Two new proposals from an hermeneutical point of view are shown and contrasted with dimensional models in an epistemological and ethical level (AU)

Implicit theories of personality and attributions of hostile intent: a meta-analysis, an experiment, and a longitudinal intervention.

Past research has shown that hostile schemas and adverse experiences predict the hostile attributional bias. This research proposes that seemingly nonhostile beliefs (implicit theories about the malleability of personality) may also play a role in shaping it. Study 1 meta-analytically summarized 11 original tests of this hypothesis (N = 1,659), and showed that among diverse adolescents aged 13-16 a fixed or entity theory about personality traits predicted greater hostile attributional biases, which mediated an effect on aggressive desires. Study 2 experimentally changed adolescents' implicit theories toward a malleable or incremental view and showed a reduction in hostile intent attributions. Study 3 delivered an incremental theory intervention that reduced hostile intent attributions and aggressive desires over an 8-month period.

[Personality disorders and working capacity]. / Persoonallisuushäiriöt ja työkyky.

Personality disorders are common: some personality disorder is present in 6 to 10% of the populations. These disorders appear mostly together with some other psychiatric disorder which often has a larger impact on the working ability than the personality disorder. Because personality disorders appear particularly in interactive relationships, the patients may impose strain on their work community and jeopardize the working capacity of their workmates. Work itself is likely to improve the prognosis of personality disorders. Thus, for a person with personality disorder after losing his/her working capacity, primary objectives are active therapeutic approach, as short sick leave as possible and support for returning to work.

Intervención psicológica en pacientes con comorbilidad del consumo de cocaína y alcohol y trastornos de personalidad / Psychological intervention in patients with comorbid cocaine and alcohol and personality disorders

Nos encontramos ante un tipo complejo de patología dual que se ha asociado históricamente con el fracaso terapéutico. Se sabe que las asunciones de algunos profesionales que han impedido que se profundice en las estrategias de intervención se están cuestionando a causa de los hallazgos de diferentes investigaciones. La intervención psicológica con drogodependientes que presentan un trastorno de personalidad pasa por superar numerosos retos, entre los cuales encontramos: las dificultades en el establecimiento de la relación terapéutica, abordar la egosintonía para implicar al paciente en el tratamiento, la evolución del trastorno de personalidad en ausencia de consumos puntuales o recaídas, el trabajo en equipo, la adecuación de los programas de prevención de recaídas a las particularidades que se derivan de esta concomitancia, el empleo de estrategias terapéuticas específicas para un determinado paciente en un momento específico de su evolución y, principalmente, el reto vinculado con la dificultad que encontramos cuando se quieren modificar rasgos de la personalidad. La superación de estos retos está conduciendo a resultados satisfactorios en el tratamiento de drogodependientes con trastornos de personalidad (AU)

We face a complex dual pathology that has been historically associated with treatment failure. We know that many of the assumptions of some professionals have probably prevented further intervention strategies, are being questioned today because of findings from different investigations. Psychological intervention with drug users has a personality disorder going to overcome many challenges among which are: difficulties in establishing the therapeutic relationship, addressing egosintonía to involve the patient in treatment, the evolution of personality disorder absence of specific consumption or relapse, teamwork, the adequacy of relapse prevention programs to the specific arising from this conjunction, the use of specific therapeutic strategy for a particular patient at a specific point in its evolution and mainly the challenges connected with the difficulty we found when you want to modify personality traits. Overcoming these challenges is leading to satisfactory results in the treatment of drug addicts with personality disorders (AU)