One-year prevalence and psychiatric comorbidity of borderline personality disorder in a medical certificate population: a registry study of psychiatric outpatients in community mental health care in the city of Oulu.

OBJECTIVE: Borderline personality disorder (BPD) is a common disorder in healthcare settings but estimates of BPD prevalence vary greatly. This study aimed to estimate the one-year prevalence of BPD in psychiatric outpatients and analyze the psychiatric comorbidity presented with BPD. METHOD: The data comprised 18-60-year-old patients who had a BPD diagnosis recorded in their medical certificate B (mcB) and were treated in specialized psychiatric outpatient services in the city of Oulu, northern Finland, in 2014. An mcB is a comprehensive summary of a patient's medical history written by a doctor, and patients need it in the Finnish healthcare system when applying for social benefits and rehabilitation measures. RESULTS: The prevalence of BPD was 12.8% among patients with an mcB treated in the psychiatric outpatient services. BPD was 3.0 times more common in female than male psychiatric outpatients with an mcB. The most common comorbid psychiatric disorders written in mcBs of BPD patients were mood (81.0%) and anxiety (39.2%) disorders. The only statistically significant gender difference was found in behavioral and emotional disorders (16.7% in men, 1.6% in women). CONCLUSIONS: The mcB-based BPD prevalence estimate and psychiatric comorbidity was consistent with previous studies researching psychiatric outpatients with BPD. McBs appear to be a reliable and comprehensive data source for diagnostic information in research.

Comparison of early maladaptive schemas between borderline personality disorder and chronic depression.

Borderline personality disorder (BPD) and chronic depression (CD) are common and challenging mental disorders. Maladaptive cognitive schemas have been proposed to increase vulnerability to both disorders. In order to elucidate the role of maladaptive cognitive schemas in BPD and CD, this study compared psychiatric outpatients with BPD (N = 30) and CD (N = 30) in terms of early maladaptive schemas (EMSs). The groups were compared using the Young Schema Questionnaire short form-extended (YSQ-S2-extended) and the 15D health status questionnaire. BPD patients showed higher endorsement on the majority of EMSs, poorer social functioning, and greater concurrent distress than CD patients. However, after controlling for concurrent effects of psychological distress, the groups did not differ in 14 out of the 18 EMSs. These findings point to significant similarities in maladaptive beliefs between the 2 disorders and do not support broad, specific patterns of EMSs associated with either disorder. The results highlight the need for further study of the role of maladaptive schemas in the development and treatment of chronic mental disorders.

Association of parasuicidal behaviour to early maladaptive schemas and schema modes in patients with BPD: The Oulu BPD study.

The present study aimed to examine which early maladaptive schemas (EMSs) and schema modes emerged in parasuicidal and non-parasuicidal patients with BPD participating in the Oulu BPD study. The patients' EMSs were assessed using the Young Schema Questionnaire, and schema modes using the Young Atkinson Mode Inventory. Sixty patients with BPD responded to both the schema and schema mode questionnaires; of these, 46 (76.7%) fulfilled the criteria for parasuicidality. In BPD patients with parasuicidality, the EMSs of emotional deprivation, abandonment/instability, mistrust/abuse and social isolation were the most prevalent, and the schema modes of vulnerable child, angry child, detached protector and compliant surrender were prominent. In patients without parasuicidality, the schema modes of healthy adult and happy child were the most prevalent. Significant correlations were observed between the schema modes of detached protector, vulnerable child, punitive parent and angry child and almost every EMS in BPD patients with parasuicidality. Our preliminary findings suggest that associations between certain EMSs and schema modes to parasuicidality in BPD patients may provide valuable information when planning and implementing their treatment.

Changes in schemas of patients with severe borderline personality disorder: the Oulu BPD study.

Borderline personality disorder (BPD) is a relatively common and severe psychiatric disorder that can impair quality of life in many ways. The aim of this study was to determine whether a combined treatment model for BPD patients, utilising major principles from schema-focused therapy (SFT) and dialectical behavioral therapy (DBT), could be more effective in relieving early maladaptive schemas of BPD patients, compared to treatment as usual (TAU). This study is a part of the Oulu BPD study conducted at mental health care services run by Oulu city social and health care services. The study is a multisite, randomized controlled trial conducted over a one year period, involving two groups of patients with severe BPD: (1) Community Treatment By Experts (CTBE) patients (n = 18) receiving the combined treatment model, and 2) TAU patients (n = 27). The patients' schemas were assessed using the Young Schema Questionnaire (YSQ-L3a) before and after one year of treatment. The results reveal that CTBE patients who attended the combined treatment model showed a statistically significant reduction in eight out of 18 early maladaptive schemas, while patients receiving treatment as usual did not demonstrate any significant changes in schemas. The cognitive therapeutic treatment model can be applied for clinical use in public mental health settings using existing professionals, and appears to produce positive changes in patients with BPD.

Preliminary evaluation of psychometric properties of the Finnish Borderline Personality Disorder Severity Index: Oulu-BPD-Study.

BACKGROUND: Borderline personality disorder (BPD) is a severe disorder decreasing the functional ability of the patient and places an extensive burden on the healthcare system. There is a need for a reliable and valid instrument with which unstable recent BPD symptoms can be assessed in a short-term perspective, and which is applicable for clinical evaluations and treatment-outcome research. AIMS: We evaluated the psychometric properties of the Borderline Personality Disorder Severity Index IV (BPDSI-IV) interview in a sample of Finnish BPD patients. Our study is a part of the randomized, monocentre Oulu-BPD trial, which compares the effectiveness of treatment by experts with treatment as usual. METHODS: Patients (n = 71) were enrolled in a 2-year randomized controlled trial. The BPDSI-IV was used to assess recent manifestations of BPD. The internal consistency of the BPDSI-IV in the Finnish patient sample was analysed with Cronbach's alpha coefficient and mean item-total correlation. Discriminant validity was examined by comparing the Finnish BPD patient sample with the Dutch BPD patient and non-patient samples. RESULTS: The Cronbach's alphas ranged from 0.58 to 0.79 being highest in Dissociation and lowest in Relationships. A total of five subscales out of nine exceeded the acceptable limit (≥ 0.70). With respect to mean item-total correlation, seven out of nine subscales had an acceptable correlation ≥ 0.30. CONCLUSIONS: The BPDSI-IV interview was applied for the first time in a Finnish sample of BPD patients. It appears to be a useful instrument for measuring and following the severity and the change of symptoms of patients with BPD.