Living with sibling' drug use. Bereaved siblings' family stories.

Family members' problematic drug use is challenging for siblings affecting their well-being and their relationships within the family. Research about siblings living with brothers or sisters' problematic drug use and research on bereaved siblings' experiences indicates that life situations and support needs for both minor siblings and adult siblings can easily be overlooked, both in practice and in research. This article contributes to this knowledge gap by examining how siblings provide meaning to their sibling's drug use problem and how they position themselves and other family members accordingly. Qualitative semi-structured interviews were used for data collection, and fourteen bereaved siblings were interviewed. A narrative thematic analysis was chosen, and four themes were generated. These four themes, (1) Surviving difficult family life, (2) The relationships in continuous change, (3) It's worse for the parents, and (4) "We", as a synonym for the family, are presented in this article. Our findings demonstrated how complex and multifaceted siblings' stories about living with their brothers or sisters' ongoing drug use are. This study calls for more attention to siblings' situations. Siblings' lives are affected by their brothers or sisters' problems, and siblings should also be involved in routine support and treatment practices.

The Metamorphosis. The impact of a young family member's problematic substance use on family life: a meta-ethnography.

PURPOSE: This meta-ethnography seeks to provide insight into the impact that a young family member's problematic substance use has on family life. BACKGROUND: Problematic substance use (PSU) usually emerges in adolescence or young adulthood. Living with a family member with PSU is highly stressful. An understanding is needed of families' experiences and their needs for adapted help and support, hence we have explored the impact of a young family member's PSU on family life. METHODS: Systematic literature searches for qualitative research that explores the impact of PSU on family life and family relationships were conducted and the seven stages of meta-ethnography were used. RESULTS: Fifteen articles were included. The Metamorphosis was established as an overarching metaphor. Five main themes accompany this metaphor: stranger in the family; injuring chaos; no trust any more; family lock-up; and helpless societies. CONCLUSION: The Metamorphosis reflects the all-embracing change experienced by families. Family members have felt powerless and helpless; often they wish to stay involved but do not know how. PSU at a young age can develop into lifelong chronic health challenges. Family-oriented help must be readily available in this phase as parents and siblings become deeply involved. Family involvement is seldom incorporated into routine treatment practices; such incorporation is therefore needed.

Professional helpers' experiences of assisting the bereaved after drug-related deaths: A knowledge gap.

Background and aims: Drug-related death (DRD) is a major public health concern in the Nordic countries, in the rest of Europe and in the US. After a DRD, approximately 10-15 next of kin will be left behind. People bereaved after sudden and unexpected deaths have a documented higher risk of reduced quality of life, daily functioning, and early death. It is important to know the resources professional helpers have available to them, the barriers and possibilities they face in their work, and how they can respond to the needs of the bereaved. This knowledge can help prevent severe health and social consequences of bereavement following a DRD. In this systematic review, the aim was to explore knowledge regarding professional helpers' experiences of providing assistance to people bereaved after a DRD. Methods: Inclusion criteria were empirical studies of professional helpers' first-person perspectives on meeting the bereaved after a DRD. Quantitative, qualitative, and mixed-method studies were included. Results: The results show that there are no studies addressing professional helpers' experiences of providing assistance to the bereaved after a DRD. Conclusion: There is a vital need to develop more knowledge of professional helpers' perspectives. This knowledge is important not only to improve education and the quality of health and social services, but also to help raise awareness of the bereaved after a DRD.

Auditory event-related potentials in separating patients with depressive disorders and non-depressed controls: A narrative review.

This narrative review brings together the findings regarding the differences in the auditory event-related potentials (ERPs) between patients with depressive disorder and non-depressed control subjects. These studies' results can inform us of the possible alterations in sensory-cognitive processing in depressive disorders and the potential of using these ERPs in clinical applications. Auditory P3, mismatch negativity (MMN) and loudness dependence of auditory evoked potentials (LDAEP) were the subjects of the investigation. A search in PubMed yielded 84 studies. The findings of the reviewed studies were not highly consistent, but some patterns could be identified. For auditory P3b, the common findings were attenuated amplitude and prolonged latency among depressed patients. Regarding auditory MMN, especially the amplitude of duration deviance MMN was commonly attenuated, and the amplitude of frequency deviance MMN was increased in depressed patients. In LDAEP studies, generally, no differences between depressed patients and non-depressed controls were reported, although some group differences concerning specific depression subtypes were found. This review posits that future research should investigate whether certain stimulus conditions are particularly efficient at separating depressed and non-depressed participant groups. Future studies should contrast responses in different subpopulations of depressed patients, as well as different clinical groups (e.g., depressive disorder and anxiety disorder patients), to investigate the specificity of the auditory ERP alterations for depressive disorders.

Self-invalidation in borderline personality disorder: A content analysis of patients' verbalizations.

OBJECTIVE: The ability to trust one's own perceptions is crucial for psychological well-being and growth. The relevance of its opposite, self-invalidation (SI), to the psychopathology of borderline personality disorder (BPD) is emphasized in many contemporary theories of evidence-based treatments for BPD. Empirical research on this topic remains scarce, however. This study aimed to describe manifestations of SI in individuals with BPD during a 40-session psychoeducational intervention based mainly on schema therapy. METHOD: Transcripts of videotaped group sessions were analyzed inductively using qualitative content analysis. RESULTS: SI emerged as a recurrent, ubiquitous phenomenon. The content analysis yielded three core categories of SI: (1) a self-critical and harsh attitude towards the self (subcategories reflected punitive internalizations that could engender fear-based inertia, self-erasing, submissive coping behavior, and temporal fluctuation in SI), (2) a deficient sense of normalcy, and self-doubt, and (3) self-stigma. We also found an association of SI with various dimensions of BPD, including difficulty in the identification of emotions, secondary emotional reactions such as guilt, shame, anger, and resentment, self-related and interpersonal problems, and suicidal urges. CONCLUSIONS: SI is a detrimental cognitive-emotional process relevant to BPD that merits treatment. Efforts to reduce self-stigma, a pernicious aspect of SI, are imperative.

"If you don't have a word for something, you may doubt whether it's even real" - how individuals with borderline personality disorder experience change.

This study explored how psychological change was experienced and what treatment-related factors or events were perceived as supporting or hindering their process by individuals with borderline personality disorder.Eight BPD sufferers attended a 40-session psychoeducational group intervention at a community mental health care center. At intervention end, personal experience of meaningful change was explored in an in-depth interview and data were content-analyzed. Change in BPD symptoms was assessed by the Borderline Personality Disorder Severity Index IV interview.The qualitative content analysis on subjectively perceived meaningful change yielded three core categories: (1) improved ability to observe and understand mental events, (2) decreased disconnection from emotions, emergence of new or adaptive emotional reactions and decrease in maladaptive ones, and (3) a new, more adaptive experience of self and agency. Accordingly, (1) learning and (2) normalizing emerged as the main categories of helpful treatment factors. In turn, treatment-related factors perceived as obstacles were: (1) aggression in the group, and (2) inflexibility. With respect to symptom change, four participants were considered clinically as remitted, and two showed a reliable change.Long-term psychoeducational group therapy seems to enhance mentalization / metacognitive functioning and promote self (or personality) integration in BPD patients.

How do family members experience drug death bereavement? A systematic review of the literature.

Despite high rates of drug-related deaths (DRDs), drug-related bereavement has been sparsely investigated. A systematic literature search for qualitative and quantitative studies was conducted. Studies on bereaved DRD family members and systems influencing bereavement were eligible for inclusion. Eight studies were included. Three themes emerged from the thematic analysis (Emotional Roller Coaster, Lack of Understanding by the Social World, and Meaning Making) describing an emotional and existential overload, stigmatization and lack of understanding and help from support systems. The results also shed light on life after the loss. Directions for further research were subsequently outlined.

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.

[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.

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.

Medical and psychology students' self-assessed communication skills: A pilot study.

OBJECTIVE: The purpose of this study was to describe how psychology and medical students assess their own competency and skills before and after training, in which role-play was used to teach interpersonal and communication skills. METHOD: Interpersonal and communication skills were assessed with a semi-structured questionnaire before and after the training. RESULTS: The students of both medicine and psychology estimated their skill levels to be higher after the course. The psychology students estimated their skills for communication, motivating interviewing, empathy and reflection, and change orientation to be better at the end of the course. Medical students estimated their communication skills, motivating interviewing skills, and change orientation skills to be better at the end of the course. CONCLUSION: Even a short period of training in interpersonal and communication skills can positively affect the self-assessed skills of the medical students. PRACTICE IMPLICATIONS: In the future, it would be worthwhile to pay attention to reflective teaching practices in the training of both medical and psychology students. The cognitive and emotional components of these practices help students to develop their own communication skills.

Quitting a weight loss program is associated with anhedonia: preliminary findings of the Lifestyle Intervention Treatment Evaluation Study in northern Finland.

OBJECTIVES: To examine whether a diagnosis for major depression, chronic depression or specific symptoms of depression is associated with the risk of quitting a weight loss program. STUDY DESIGN: The study involved 82 overweight adults participating in the Lifestyle Intervention Treatment Evaluation (LITE) follow-up study at Oulu University Hospital in northern Finland. METHODS: Psychiatric diagnostic assessments were based on the Structured Clinical Interview for DSMIV disorders (SCID-I) conducted by a clinical psychiatrist. Anhedonia (lack of pleasure) was assessed as one of the core symptoms of major depression and chronic depression (dysthymia). Anhedonia was defined to be present if the participants reported having suffered a major loss of interest during the previous month. RESULTS: Twenty participants (24.4%) quit during the 6-month intervention period. Anhedonia put individuals at risk of quitting the weight loss program (bivariate analysis OR 3.1, 95% CI 0.8-11.6, p=0.091, multivariate analysis OR 6.5, 95% CI 1.1-38.2, p=0.038). However, a diagnosis for major depression or chronic depression did not predict quitting. CONCLUSIONS: Individual assessments of obesity and overweight should also include an assessment for subthreshold depression, mainly anhedonia.

Eating behavior in obese and overweight persons with and without anhedonia.

The aim of this study was to evaluate differences in body mass index and eating behavior in obese and overweight persons with and without anhedonia during a weight loss intervention study. Psychiatric diagnostics were based on the Structured Clinical Interview for DSM-IV disorders. Eating behavior was assessed by the Three Factor Eating Questionnaire (TFEQ-18) and binge eating by the Binge Eating Scale (BES). Out of 82 participants, 20 (24.4%) reported experiencing anhedonia at least once during the study period. Those suffering from anhedonia scored significantly higher values in BES at baseline and at follow-up. They also reported more uncontrolled and emotional eating at the first follow-up. Overall, persons suffering from anhedonia achieved a poorer outcome in weight loss compared to those without anhedonia. Anhedonia was associated with uncontrolled eating, emotional eating, and binge eating, all of which may have contributed to the poorer outcomes achieved in weight loss.

The prevalence and predictive value of individual criteria for metabolic syndrome in schizophrenia: a Northern Finland 1966 Birth Cohort Study.

The metabolic syndrome (MetS) is associated with elevated risk of diabetes and cardiovascular morbidity. However, little is known of the sensitivity, specificity and predictive value of individual criteria in patients with schizophrenia. We studied the prevalence of MetS using the International Diabetes Federation (IDF) and adapted National Cholesterol Education Program (NCEP-ATPIII) criteria in the Northern Finland 1966 Birth Cohort population. In addition, the sensitivity, specificity and predictive values for individual criteria were determined. Both adapted NCEP-ATPIII and IDF criteria for MetS identified the same cases (29% of all schizophrenia patients). Among the IDF criteria, hypertriglyceridemia had the highest sensitivity, correctly identifying 77.8% of the patients. Reduced HDL cholesterol was the most specific criteria, with 95% specificity equalling a positive likelihood ratio of 9.78. Thus both the IDF and NCEP-ATPIII criteria may be equally useful in identifying MetS.

Agreement between self-reported and pharmacy data on medication use in the Northern Finland 1966 Birth Cohort.

OBJECTIVE: To compare self-reported (SR) medication use and pharmacy data for major psychoactive medications and three classes of medications used for different indications, and to determine the socio-economic factors associated with the congruence. METHODS: Postal questionnaire data collected in 1997 were compared with the register of the Social Insurance Institution of Finland on the reimbursed prescriptions purchased during 1997. Altogether 7625 subjects were included in this study. Drugs were categorized according to the Anatomical Therapeutic Chemical (ATC) system. RESULTS: Kappa values were 0.77, 0.68, 0.84, 0.92 and 0.55 for antipsychotics, antidepressants, antiepileptics, antidiabetics and beta-blocking agents, respectively. Prevalence-adjusted and bias-adjusted kappa values were almost perfect (0.98-1.00). Reliability of antipsychotics use was better for married subjects than for those who were not married; and of antidepressants use for highly educated and married subjects than for those who were less educated and were not married. Altogether 414 (5.4%) responders and 285 (7.1%) non-responders had used at least one of the selected medications. CONCLUSION: Agreement between the SR and pharmacy data was moderate for psychoactive medication use. Even though data collected by postal questionnaire may underestimate the prevalence of medication use due to non-participation it can be assumed accurate enough for study purposes.

Severe injuries in adolescence predict psychosis: a nested case control study of the Northern Finland 1966 Birth Cohort.

Adolescents who later develop schizophrenia are likely to have problems with motor coordination and many adolescents with schizophrenia have self-injurious behaviour before treatment of first psychosis but association between injuries in adolescence and onset of psychotic disorder is unknown. The aim of this study was to describe what type of injuries psychotic individuals had during adolescence and in which age these injuries occurred. The study population consists of 155 members of the Northern Finland 1966 Birth Cohort with diagnosis of schizophrenia spectrum disease and 620 matched controls. All injuries which had occurred before onset of psychosis were extracted from Finnish Hospital Discharge Register. Individuals with psychotic disorder were more likely to have a history of severe injury. During the age 12-19, 11% of psychotic subjects and 5.3% of healthy controls had an injury (z=2.38; P=0.017) and the most common type of injury was fractures. Our findings suggest that severe injury in adolescence may be a predictor of psychosis.