A multifaceted approach to assessment of mentalization: the mentalization profile in patients with eating disorders.

Purpose: The existing literature, however sparse, suggests an association between eating disorders (ED) and mentalization ability. The aim of this study was to investigate the mentalization profile (MP) in patients with ED. It was hypothesized that patients with ED would have a lower degree of mentalization ability compared to healthy controls (HC).Materials and methods: The study is based on a cross-sectional survey on a sample of patients diagnosed with ED compared to a HC group.Results and conclusion: A total of 88 participants, distributed between patients with ED (N = 30) and HC (N = 58) were included.Results: The study results show statistically significant differences between patients with ED and HC. Thus, patients with an ED scored significantly higher on Reflective Functioning Questionnaire (uncertainty about mental states) (RFQ-U) (mean difference: 0.31, p = 0.048) and Toronto Alexithymia Scale (TAS-20) (mean difference: 0.44, p = 0.019) compared to the HC. Furthermore, the results indicated that patients with Bulimia Nervosa (BN) may have a lower ability to mentalize about oneself as well as a generally lower ability to mentalize across different dimensions of the mentalization profile as the BN group scored significantly higher on RFQ-U (mean difference: 0.71, p = 0.023) and TAS-20 (mean difference: 0.89, p = 0.006) compared to the Anorexia Nervosa (AN) group. Further research should be conducted to gain knowledge on the mentalization ability in patients with an ED.

Valence in the eyes: An emotion decoding profile of adults with major depressive disorder and a history of childhood maltreatment.

BACKGROUND: Individuals with major depressive disorder (MDD) and childhood maltreatment have been proposed to constitute a subgroup with worse illness course and outcomes. To elucidate a potential social cognitive vulnerability in this subgroup, this study compared the emotion decoding abilities of MDD patients with and without a history of childhood maltreatment. METHODS: Participants with a diagnosis of MDD were recruited from nationwide mental health organizations. Emotion decoding abilities were assessed using the Reading the Mind in the Eyes Test, while childhood maltreatment was measured with the Adverse Childhood Experiences Questionnaire. RESULTS: The MDD patients with a history of childhood maltreatment exhibited poorer emotion decoding abilities than MDD patients without such past. This difference applied specifically to the decoding of positive and negative emotions, while no group differences emerged for the decoding of neutral emotions. When specific maltreatment types were considered as predictors only emotional neglect was associated with lower emotion decoding abilities. These associations remained when adjusting for demographic and clinical covariates. CONCLUSIONS: By indicating that emotion decoding difficulties characterize the MDD subgroup with childhood maltreatment, the findings highlight a potential vulnerability that merits further examination in terms of its developmental antecedents and prognostic relevance.

Infancy weight faltering and childhood neurodevelopmental disorders: a general population birth-cohort study.

While it is known that intrauterine growth restriction is associated with later mental disorders, it is still unclear whether similar associations exists for postnatal weight faltering, also known as 'failure to thrive' in infancy. This study examined the potential connection between infancy weight faltering and mental disorders diagnosed in childhood focusing specifically on neurodevelopmental disorders. The Copenhagen Child Cohort (CCC2000) was used to explore weight gain in infancy assessed by community health nurses. Data from the Danish national registries were used to quantify ICD-10 mental disorders diagnosed between birth and 12 years of age, as well as potential child and family confounders. Of 4.476 children with sufficient weight data, 339 (7.3%) children were diagnosed with a mental disorder in childhood. Both any (weight gain < -1SD) and severe infancy weight faltering (weight gain < -2SD) were associated with psychomotor delays, while severe infancy weight faltering was also associated with intellectual impairments. Notably, no significant associations were found between weight faltering and autism spectrum disorders or attention deficit hyperactivity disorders. Weight faltering in infancy may be an early marker of neurodevelopmental delays. This possibility should be considered when assessing infants with slow weight gain, to early identification and treatment of co-occurring neurodevelopmental disorders.

Effect of deliberate practice training of graduate students in general psychotherapeutic skills compared with theoretical teaching: protocol for the randomised controlled TRIPS trial.

INTRODUCTION: Psychology students at universities in Denmark and worldwide often receive relatively little clinical training, even though such training is crucial to job performance after graduation. Training common psychotherapeutic skills, such as being empathic and facilitating the therapeutic alliance, is critical since these skills are related to psychotherapy outcomes. In this study, a deliberate practice-based approach to student training will be compared with theoretical teaching. The main hypothesis is that deliberate practice training will result in a larger improvement in students' observer-rated interpersonal skills. METHODS AND ANALYSIS: The TRaining of graduate students In general Psychotherapeutic Skills study has a double-centre, randomised, assessor-blinded, two-way crossover study design. About 200 graduate students from two Danish universities will be randomised into two groups, (a) deliberate practice training of common psychotherapeutic skills using role-play and Skillsetter, an online skill-building system with therapy videos or (b) theoretical teaching. Group a will first receive the experimental condition, followed by the control condition, while group b will receive the conditions in reverse order. Each condition consists of 15 hours of classroom participation and homework. The primary outcome is facilitative interpersonal skills-observer. Secondary outcomes include the facilitative interpersonal skills-self-report, the Counselor Activity Self-Efficacy Scales and the Interpersonal Reactivity Index. Outcomes will be measured at baseline (week 0), after the first condition (week 5; before the crossover, reflecting true randomisation) and after both conditions (week 10). Main outcome analyses will be performed at week 5. Several predictors of the effect of deliberate practice will be explored. ETHICS AND DISSEMINATION: Ethical approval from university ethics boards has been obtained. All participants will be asked to provide informed consent before participation. Once completed, the study can potentially transform the training of psychotherapy in graduate education, which, ultimately, may positively influence psychotherapy outcomes (IP-IRB / 03092021). TRIAL REGISTRATION NUMBER: NCT05164497.

Early Maladaptive Schemas in Bipolar Disorder Patients With and Without Suicide Attempts.

Patients with bipolar disorder (BD) are at an increased risk of attempted and completed suicide. To elucidate the beliefs and assumptions associated with suicidality in BD, the present study compared BD patients with and without a history of suicide attempt in terms of early maladaptive schemas (EMSs). The sample consisted of 49 remitted BD patients who completed the Young Schema Questionnaire-Short Version. Information on suicide attempts was obtained through interviews combined with medical records. Compared with BD patients without suicide attempts, the BD patients with suicide attempts scored significantly higher on 3 EMSs: social isolation, practical incompetence, and entitlement. The findings suggest that specific EMSs may be implicated in suicidal behaviors in BD. These results have implications for the assessment and treatment of suicidality in BD.

Characteristics, correlates and outcomes of perceived stigmatization in bipolar disorder patients.

BACKGROUND: The aim of this study was to elucidate the characteristics, correlates and outcomes of perceived stigmatization in patients with Bipolar Disorder (BD). METHODS: At baseline 50 remitted BD patients completed the Stigma Questionnaire (SQ), the Work and Social Adjustment Scale (WSAS), and the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Auto-Questionnaire - Short Version (TEMPS-A). The BD patients were followed for 24 months as part of their ongoing treatment. Information on illness course and treatments was obtained at baseline and at follow-up through medical records and interviews. RESULTS: The prevalence of perceived stigmatization ranged from 37% to 57% across the areas measured by the SQ. The areas with most perceived stigmatization were work-ability and psychiatric hospitalization. Psychoeducation and affective temperaments emerged as significant independent predictors of perceived stigmatization. Perceived stigmatization was not related to affective recurrences. LIMITATIONS: The follow-up period might have been too short to measure the long-term impact of perceived stigmatization. CONCLUSIONS: The findings suggest that BD patients consider issues concerning work-ability and psychiatric hospitalizations to be particularly affected by stigmatization. Psychoeducation and affective temperaments were, furthermore, identified as factors implicated in perceived stigmatization in this population.

Theory of Mind in Children With Specific Language Impairment: A Systematic Review and Meta-Analysis.

The relation between language and theory of mind (ToM) has been debated for more than two decades. In a similar vein, ToM has been examined in children with specific language impairment (SLI), albeit with inconsistent results. This meta-analysis of 17 studies with 745 children between the ages of 4 and 12 found that children with SLI had substantially lower ToM performance compared to age-matched typically developing children (d = .98). This effect size was not moderated by age and gender. By revealing that children with SLI have ToM impairments, this finding emphasizes the need for further investigation into the developmental interface between language and ToM as well as the extended consequences of atypical language development.

Low self-compassion in patients with bipolar disorder.

BACKGROUND: Emerging research suggests that low self-compassion may be linked to psychopathology and in particular depressive symptoms. To further elucidate this topic, the present study investigated self-compassion in patients with Bipolar Disorder (BD). METHOD: Thirty remitted BD patients were compared to thirty age- and sex matched controls on the Self-Compassion Scale (SCS). The BD patients also completed the Altman Self-Rating Mania Scale (ASRM), the Major Depression Inventory (MDI), the Work and Social Adjustment Scale (WSAS), the Satisfaction With Life Scale (SWLS) and the Internalized Stigma of Mental Illness Scale (ISMI-10) and further reported their illness history on a survey sheet. RESULTS: The BD patients were found to have significantly lower self-compassion than controls. In addition, self-compassion correlated positively and significantly with life-satisfaction but no significant correlations with functional impairment, internalized stigma or frequency of past affective episodes were found. LIMITATIONS: The small sample size entailed reduced statistical power. CONCLUSIONS: By suggesting that self-compassion is reduced and possibly linked to life-satisfaction in BD, the findings highlight a potential vulnerability meriting further investigations.

Early Maladaptive Schemas: A Comparison Between Bipolar Disorder and Major Depressive Disorder.

BACKGROUND: It is still unclear how bipolar disorder (BD) differentiates from major depressive disorder (MDD) outside major mood episodes. To further elucidate this area, the present study compared the two mood disorders in terms of early maladaptive schemas (EMSs) during remission. METHOD: The sample consisted of 49 participants with BD and 30 participants with MDD who were currently in remission. The participants completed the Young Schema Questionnaire. RESULTS: The BD group scored significantly higher than the MDD group on seven EMSs: abandonment, failure to achieve, insufficient self-control, subjugation, unrelenting standards, enmeshment and entitlement. CONCLUSION: By suggesting that EMSs are more severe in BD compared with MDD, the findings highlight potential vulnerabilities in BD, which merit further examination in terms of their underlying causes and potential treatment implications. KEY PRACTITIONER MESSAGE: Early maladaptive schemas are relevant psychological dimensions to consider in remitted phases of major mood disorders. Findings from the current study suggest that early maladaptive schemas are more prevalent in adults with bipolar disorder compared to adults with major depressive disorder when measured during remission. Interventions targeting early maladaptive schemas may be valuable in treatment of bipolar disorder.

Early maladaptive schemas and functional impairment in remitted bipolar disorder patients.

BACKGROUND AND OBJECTIVES: Previous research indicates that low self-esteem is associated with functional impairment in remitted bipolar disorder patients. The present study aimed to elucidate this area further by exploring the relationship between different self-schemas and key functional outcome domains. METHODS: The study consisted of 49 remitted bipolar disorders patients who completed the Young Schema Questionnaire-Short Version (YSQ-S3) and the Work and Social Adjustment Scale (WSAS). RESULTS: A hierarchical regression analysis revealed that the schemas Social Isolation, Failure to Achieve, Dependence, Vulnerability to Harm and Illness, Emotional Inhibition, Insufficient Self-Control, and Pessimism accounted for 28% of the variance in functional impairment when controlling for length of remission and subsyndromal depressive symptoms. LIMITATIONS: The WSAS as a self-report scale measures the patients' perception of own functioning and is therefore not an objective measure of functioning. CONCLUSIONS: The findings delineate specific psychological vulnerabilities which are likely to be implicated in functional impairment in bipolar disorder and as such warrant further examination in terms of their causal mechanisms and therapeutic implications.

Affective temperaments' relation to functional impairment and affective recurrences in bipolar disorder patients.

BACKGROUND: The prognostic significance of affective temperaments in bipolar disorder is not yet fully understood. This study therefore examined the relationship between affective temperaments and two major illness outcomes in bipolar disorder: functional impairment and affective recurrences. METHOD: At baseline fifty-one remitted bipolar disorder patients were administered the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Auto-questionnaire (TEMPS-A), and the Work and Social Adjustment Scale (WSAS). The patients were followed for 24 months as part of their routine treatment. At follow-up, data on affective recurrences were obtained through medical records combined with a semi-structured interview that enquired into medication adherence. RESULTS: Scores on the cyclothymic temperament correlated significantly with functional impairment overall and with scores in three function domains: home-management, private leisure activities and social leisure activities. High scores on the cyclothymic temperament also significantly predicted the presence of depressive recurrences even when controlling for medication non-adherence. The presence of hypomanic or manic recurrences was not predicted by scores on any of the affective temperaments. LIMITATION: Since all of the bipolar patients were newly diagnosed and therefore relatively young, the representativeness of the results may have been reduced. The prospective part of the study used data from medical records that may not be as systematic as data gathered from structured clinical interviews. CONCLUSION: By suggesting that the cyclothymic temperament is related to both functional impairment and depressive recurrences the findings highlight a vulnerability area in need of further exploration in terms of its prognostic significance.

Self-esteem in remitted bipolar disorder patients: a meta-analysis.

OBJECTIVES: Low self-esteem has been found to be a risk factor for depression in major depressive disorder (MDD). In contrast, the role of self-esteem in bipolar disorder (BD) is still uncertain. In order to examine the characteristics of self-esteem in BD, we synthesized studies comparing self-esteem in BD patients with self-esteem in MDD patients and in normal controls. METHODS: Database searches and identification of studies were conducted by two of the authors independently. Remission of BD and MDD was a major selection criterion. The results were generated through meta-analyses. RESULTS: Random-effects models of 19 between-group comparisons (N= 1,838) suggested that the self-esteem of remitted BD patients was significantly lower than that of normal controls (Cohen's d= -0.83), while significantly higher than that of remitted MDD patients (Cohen's d= 0.54). Fail-safe numbers and tests for funnel plot asymmetry indicated that the results were robust and unlikely to reflect publication biases. Additional studies indicated that self-esteem may take a fluctuating course during remission of BD. CONCLUSIONS: By revealing that BD patients do experience low self-esteem, the findings implicate a need for further understanding the causes and therapeutic impact of such abnormality in BD.