A Randomized Clinical Trial in a Public Health Context: Inclusion of Emotional Techniques in Group Therapy for Anxiety Disorders / Un estudio clínico aleatorizado en un contexto de sanidad pública: inclusión de técnicas emocionales en una terapia grupal para trastornos de ansiedad

Se realizó un ensayo clínico aleatorio con dos grupos de tratamiento: uno que recibió terapia cognitivo-conductual (TCC) y otro con la inclusión de técnicas emocionales (TCCE), ambos de 20 sesiones. La muestra consistió en 237 pacientes, todos ellos con diagnóstico principal de trastornos de ansiedad, y todos remitidos por sus médicos de cabecera. Hubo mejoras significativas en la sintomatología (rasgo de ansiedad, depresión, sintomatología clínica), pero la única diferencia significativa encontrada en la comparación intergrupal fue para la variable "satisfacción vital subjetiva" (p= .017), que fuemayor en el grupo de TCCE. Este grupo también mostró una mayor adherencia al programa de tratamiento (p= .019). Esto refuerza la conveniencia de incluir el tratamiento de terapia de grupo con componentes emocionales en los entornos de atención primaria, destacando la importancia de hacer hincapié en la autoestima.(AU)

A randomized clinical trial was carried out with two treatment groups: one receiving cognitive-behavioral therapy (CBT) and the other with the inclusion of emotional techniques (CEBT), both lasting 20 sessions. The sample consisted of 237 patients, all of them with principal diagnoses of anxiety disorders, and all referred by their general practitioners. There were significant improvements in symptomatology (anxiety trait, depression, clinical symptomatology), but the only significant difference found in the intergroup comparison was for the variable “subjective life satisfaction” (p = .017), which was greater in the CEBT group. This group also displayed better adherence to the treatment program (p = .019). This reinforces the case for including group therapy treatment with emotional components in primary care settings, highlighting the importance of emphasizing self-esteem.(AU)

Trastorno de evitación/restricción de la ingestión de alimentos: análisis descriptivo y comparativo / Avoidant Restrictive Food Intake Disorder: descriptive and comparative analysis / Trastorn d'evitació/restricció de la ingesta d'aliments: anàlisi descriptiva I comparativa

El objetivo del artículo es escribir el perfil sociodemográfico y clínico de un grupo de pacientes con trastorno de evitación/res­tricción de la ingestión de alimentos (ARFID) y comparar los resultados en base a sus tres dimensiones psicopato­lógicas. Se evaluaron 56 niños y adolescentes con una entrevista diagnóstica semiestructurada. El 51,8 % refirieron miedos específicos; el 28,6 %, falta de interés y el 19,6 %, sensibilidad sensorial. La edad media de los pacientes fue de 11 años y la proporción de varones fue mayor. A nivel clínico, el 23,2 % presentaba alguna comorbilidad médi­ca y el 57,1 %, psiquiátrica. Se hallaron diferencias significativas entre grupos (p < 0,05) en las variables género y comorbilidad psiquiátrica

The article aims at writing about the sociodemographic and clinical profile of a group of patients with Avoidant Restrictive Food Intake Di­sorder (ARFID) and to compare the results based on its three psychopathological dimensions. Fifty-six children and adolescents were assessed with a semi-structured diagnostic interview. 51.8 % reported specific fears, 28.6 % reported lack of interest and 19.6 % reported sensory sensitivity. The patients' average age was 11, and the male proportion was higher. At the clinical level, 23.2 % had some medical comorbidity and 57.1 % had psychiatric comorbidity. Significant differences were found between groups (p < 0.05) in the variables gender and psychia­tric comorbidity

L'objectiu de l'article és escriure el perfil social, demogràfic I clínic d'un grup de pacients amb trastorn d'evitació/restricció de la in­gesta d'aliments (ARFID) I comparar els resultats sobre la base de les seves tres dimensions psicopatològiques. Es van avaluar 56 nens I adolescents amb una entrevista diagnòstica semiestructurada. El 51,8 % va referir pors específiques; el 28,6 %, manca d'interès I el 19,6 %, sensibilitat sensorial. L'edat mitjana dels pacients era d'11 anys I la proporció de gènere masculí era major. A nivell clínic, el 23,2 % presentava alguna comorbiditat mèdica I el 57,1 %, psiquiàtrica. Es van trobar diferències significatives entre grups (p < 0,05) en les variables gènere I comorbi­ditat psiquiátrica

B·RIGHT: usability and satisfaction with a mobile app for self-managing emotional crises in patients with borderline personality disorder.

OBJECTIVE: Borderline personality disorder (BPD) is a severe mental disorder characterized by emotional crises. To date, crisis interventions for BPD have been conducted via telephone calls and emergency units, which are associated with an extra amount of resources. The aim of this research was to test the usability and satisfaction with a psychotherapeutic mobile app for self-managing crises in BPD. METHOD: The B·RIGHT app was designed based on Artificial Intelligence psychotherapeutic algorithms. Usability and satisfaction with the app were assessed in 25 outpatients diagnosed with BPD (84% female, mean age = 35.80 years) using the System Usability Scale (SUS) and other questionnaires. Clinical features were assessed using the Borderline Symptom List, the Difficulties in Emotion Regulation Scale and Beck's Depression Inventory. RESULTS: Patients with BPD considered the app user-friendly (mean total score = 4.03) and highly satisfactory (mean total score = 4.02), resulting in a positive user experience (mean total score = 4.09). Total usability was negatively associated with age (r = -.44), positively associated with educational level (rho = .47) and with overall emotion dysregulation (r = .51), and negatively associated with depression severity (r = -.47). CONCLUSIONS: The usability and satisfaction testing of the B·RIGHT app showed promising findings, which warrant further research in order to validate its effectiveness.

Avoidant/restrictive food intake disorder: Psychopathological similarities and differences in comparison to anorexia nervosa and the general population.

INTRODUCTION: Avoidant/restrictive food intake disorder (ARFID) categorises patients with selective and/or restrictive eating patterns in the absence of distorted cognition concerning weight, food, and body image. OBJECTIVE: To examine the sociodemographic and clinical profile of patients with ARFID in comparison to those with anorexia nervosa (AN) and to a non-clinical group (NCG). METHOD: A descriptive, observational, comparative study made up of three groups (ARFID, AN and NCG). Ninety-nine children and adolescents were analyzed by means of a semi-structured diagnostic interview and questionnaires on depression, anxiety, clinical fears and general psychopathology. RESULTS: The ARFID group was significantly younger (10.8 vs. 14.1 years of age), with a greater proportion of males (60.6% vs. 6.1%), an earlier onset of illness (6.2 vs. 13.4 years of age), and a longer period of evolution of the illness (61.2 vs. 8.4 months) compared to the AN group. Clinically, patients with ARFID showed greater medical (42.4% vs. 12.1%) and psychiatric (81.8% vs. 33.3%) comorbidity-assessed with a semi-structured diagnostic interview-greater clinical fear (p < 0.005), more attention problems (p < 0.005) and fewer symptoms of anxiety and depression (p < 0.005)-measured with self-report questionnaires. CONCLUSIONS: ARFID is a serious disorder with a significant impact on the physical and mental health of the pediatric population. Likewise, some of these physical and mental conditions may be a risk factor in developing ARFID. Attention problems and clinical fears in ARFID, and the greater presence of internalised symptoms in AN, were the main differences found in the psychopathological profiles.

Technology-Based Psychosocial Interventions for People with Borderline Personality Disorder: A Scoping Review of the Literature.

Evidence-based psychosocial interventions for borderline personality disorder (BPD) still face multiple challenges regarding treatment accessibility, adherence, duration, and economic costs. Over the last decade, technology has addressed these concerns from different disciplines. The current scoping review aimed to delineate novel and ongoing clinical research on technology-based psychosocial interventions for patients with BPD. Online databases (PubMed, Cochrane Library, EMBASE, Web of Science, PsycInfo, and Google Scholar) were searched up to June 2020. Technology-based psychosocial treatments included innovative communication (eHealth) and computational (e.g., artificial intelligence), computing (e.g., computer-based), or medical (e.g., functional magnetic resonance imaging [fMRI]) software. Clinical research encompassed any testing stage (e.g., feasibility, efficacy). Fifteen studies met the inclusion criteria. The main findings were the following: almost two-thirds of the studies (9/15) tested software explicitly conceived as adjunctive interventions to conventional therapy; nearly half of the studies (7/15) were referred to as dialectical behavior therapy-based software; most studies (13/15) were focused on the initial stage of the clinical research cycle (feasibility/acceptance/usability testing), reporting good results at this point; more than one-third of the studies (6/15) tested mobile apps; there is emerging evidence for Internet-based interventions and real-time fMRI biofeedback but only little evidence for mHealth interventions, virtual and augmented reality, and computer-based interventions; there was no computational technology-based clinical research; and there was no satisfaction/preference, security/safety, or efficiency testing for any software. Taken together, the results suggest that there is a growing but still incipient amount of technology-based psychosocial interventions for BPD supported by some kind of clinical evidence. The limitations and directions for future research are discussed.

Parenting attitudes in people with obsessive-compulsive disorder and emotional symptoms in their children / Las actitudes parentales de personas con trastorno obsesivo-compulsivo y los síntomas emocionales de sus hijos

This study sought to delineate distinctive parenting attitudes in people with obsessive-compulsive disorder (OCD), specific emotional symptoms in their children, and the association between them. Forty OCD parents and their children were compared with 37 parents with adjustment disorders and their children by using standardized clinical questionnaires. Children of OCD parents exhibited significantly greater (subclinical) emotional symptoms when compared with children of non-OCD parents. After controlling for parents' and children's depression and anxiety symptoms, OCD parents reported significantly poorer parenting attitudes overall relative to non-OCD parents. The presence of sexual/somatic obsessions in OCD parents predicted anxiety symptom severity among their children, but both relationships were mediated by parental involvement. These findings indicate the importance of addressing and treating the distinctive parenting attitudes among people with OCD and its influence on their children's emotional symptoms

Este estudio pretende delimitar las actitudes parentales distintivas en personas con trastorno obsesivo-compulsivo (TOC), los síntomas emocionales específicos en sus hijos y la asociación entre ambos. Cuarenta padres con TOC y sus hijos fueron comparados con 37 padres con trastornos adaptativos y sus hijos mediante el uso de cuestionarios clínicos estandarizados. Los hijos de padres con TOC manifestaron significativamente más síntomas emocionales (nivel subclínico) en comparación con los hijos de padres con trastornos adaptativos. Tras controlar el efecto de los síntomas de depresión y ansiedad de los padres y los niños, los padres con TOC indicaban actitudes parentales significativamente peores que las de los padres con trastornos adaptativos. La presencia de obsesiones sexuales/somáticas en los padres con TOC predecía la severidad de los síntomas de ansiedad en sus hijos, si bien dichas relaciones estaban mediadas por el nivel de implicación parental. Estos hallazgos indican la importancia de abordar y tratar las actitudes parentales distintivas de las personas con TOC y su influencia en la sintomatología emocional de sus hijos

Relación entre el maltrato infantil y las habilidades de regulación emocional en adolescentes: una revisión sistemática / Relationship between child maltreatment and emotional regulation skills in adolescents: a systematic review

Las habilidades de regulación emocional constituyen un factor transdiagnóstico de psicopatologías y pueden verse especialmente afectadas en individuos con historia de maltrato, y la adolescencia es una etapa crítica para su desarrollo y prevención. Sin embargo, la heterogeneidad conceptual y metodológica en la evaluación de las habilidades de regulación emocional y las formas de maltrato dificultan comprender su relación. La presente revisión analizó la relación entre el maltrato infantil y las habilidades de regulación emocional de los adolescentes entre 12 y 18 años a través de los estudios que la exploraron, incidiendo en la relación diferencial entre las distintas tipologías de maltrato (maltrato físico, abuso sexual, maltrato emocional y negligencia) y las habilidades de regulación emocional (regulación o disregulación emocional e inteligencia emocional), así como en el papel que estas últimas ejercen sobre las problemáticas asociadas al maltrato. Se realizaron búsquedas en PsycINFO, MedLine y PsicoDoc. De los 191 estudios encontrados, 28 cumplieron los criterios de inclusión. Se hallaron relaciones significativas y consistentes entre las medidas globales de maltrato y de disregulación emocional. Sin embargo, cuando se analizan tipos de maltrato o estrategias específicas, los resultados son dispares. Asimismo, las habilidades de regulación emocional influyen en la aparición de problemáticas asociadas al maltrato, siendo la sintomatología internalizada y las autolesiones las más exploradas. La heterogeneidad conceptual y metodológica de los estudios revisados dificultó la extracción de conclusiones sólidas respecto a las tendencias identificadas, por lo que se debe continuar explorando en esta relación

Emotion regulation skills are a robust transdiagnostic factor of psychopathologies and can be especially affected in individuals with a history of maltreatment, and adolescence is a critical period for their development and prevention. However, conceptual and methodological heterogeneity in evaluating emotion regulation skills and different forms of maltreatment make it difficult to understand their relationship. This review delved into the relationship between childhood maltreatment and the emotional skills of adolescents between 12 and 18 years of age through the studies that examining it, focusing on unique relationships between the different types of maltreatment (physical abuse, sexual abuse, emotional abuse and neglect) and emotion regulation skills (emotion regulation or dysregulation and emotional intelligence), as well as the role of the latter on maltreatment-related outcomes. Searches were carried out in the PsycINFO, MedLine and PsicoDoc databases. Of the 191 studies found, 28 met the inclusion criteria. The studies reviewed re-vealed significant and consistent relationships between global measures of child maltreatment and emotion dysregulation in adolescents. However, when specific types of maltreatment or strategies were analyzed, results are disparate. Moreover, emotion regulation skills influence the appearance of problems associated with maltreatment, with internalized symptoms and self-harm being the most explored. The conceptual and methodological heterogeneity of the studies reviewed made it difficult to draw robust conclusions regarding the trends identified, hence the need to continue to explore this relationship

Effectiveness of emotional intelligence therapy on suicide risk among adolescents in residential care

This study aimed to apply Emotional Intelligence Therapy (EIT) in a sample of adolescents in residential care and to examine its impact on three outcomes: suicide risk, perceived emotional intelligence (PEI), and basic psychological needs (BPN). Treatment consisted of 16 group sessions held on a weekly basis to develop the emotional skills of perception, facilitation of thinking, understanding and management. A clinical trial of repeated measures was conducted in which the study variables were evaluated at three time points: between three and four months prior to treatment, pre-treatment and post-treatment. Of the initial 65 participants, only 19 (73.68% were boys; Mage= 13.74) completed the three evaluations. The results showed a significant decrease in suicide risk after EIT, especially regarding levels of hopelessness and suicidal ideation. Participants also improved their perception of emotional clarity and of competence. No significant changes were noted in any of the variables when on the waiting list. EIT could be a good tool to prevent the emergence of factors that entail suicide risk among adolescents in residential care

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Riesgo de suicidio, inteligencia emocional y necesidades psicológicas básicas en adolescentes tutelados en centros residenciales / Suicide risk, emotional intelligence and basic psychological needs in adolescents in residential care

Durante décadas la literatura ha evidenciado las múltiples repercusiones psicológicas y emocionales que conlleva el maltrato en la infancia. El presente estudio tiene como objetivo describir y analizar la relación entre el riesgo de suicidio, la inteligencia emocional percibida (IEP) y las necesidades psicológicas básicas (NPB) de los adolescentes tutelados en centros. La muestra se compuso por 61 adolescentes tutelados (el 50.82% eran varones) de entre 12 y 17 años (M = 14.61; DT = 1.61) acogidos en centros residenciales de la provincia de Barcelona. Se administró una batería de cuestionarios que incluía datos demográficos y escalas de inteligencia emocional, riesgo de suicidio y grado de satisfacción de las necesidades psicológicas básicas. Veintiséis adolescentes (42.6%) presentaron altos niveles de riesgo suicida. Se objetivaron correlaciones significativas entre el riesgo de suicidio, la inteligencia emocional percibida (Atención, Claridad y Reparación) y las necesidades psicológicas básicas (Autonomía, Competencia y Relación). Su principal necesidad psicológica fue la de Competencia que, al mismo tiempo, demostró ser la que mantiene una relación inversa más estrecha con el suicidio. Los adolescentes tutelados en centros residenciales presentan indicadores de riesgo de suicidio que deben ser abordados, entre los que destaca una marcada dificultad para afrontar las emociones. La inteligencia emocional podría ser un factor protector ante el riesgo de suicidio en este colectivo

For decades the literature has demonstrated multiple psychological and emotional implications resulting from maltreatment in childhood. The present study aims to describe and analyze the relationship between suicide risk, perceived emotional intelligence (PEI) and the basic psychological needs (BPN) of adolescents in residential care. The sample was consisted of 61 adolescents (50.82% were boys) aged between 12 and 17 years (M = 14.61; DT = 1.61) living in residential care centers in the province of Barcelona. A series of questionnaires was administered that included demographic data and PEI, suicide risk and BPN's satisfaction scales. Twenty-six adolescents (42.6%) reported high levels of suicide risk. Significant correlations were found between suicide risk, PEI (Attention, Clarity and Repair) and BPN (Autonomy, Competence and Relatedness). Competence was their main psychological need, which proved to be the one with the closest inverse relationship with suicide risk. Adolescents in residential care present suicide risk indicators that must be addressed, notably their marked difficulty in dealing with emotions. Emotional intelligence may be a protective factor against suicide risk in this group

La Intervención Familiar Domiciliaria en Psicosis: Análisis Cualitativo de los Cambios Observados tras la Psicoterapia / Domiciliary family intervention in psychosis: Qualitative analysis of changes noticed after psychotherapy

El objetivo del estudio actual es evaluar los cambios en la estructura, la dinámica familiar y la comunicación durante una intervención familiar domiciliaria con pacientes diagnosticados de trastornos del espectro psicótico que muestran resistencia al tratamiento. Se incluyeron en el estudio un total de 12 familias (36 participantes) con descendencia diagnosticada de trastorno psicótico. Para la recopilación de datos se utilizaron diferentes técnicas cualitativas con el fin de triangular la información que proviene de cada una de ellas: un cuestionario de preguntas abiertas y un cuestionario más profundo para los observadores. Los dos ejes que explican la dinámica relacional más estrechamente ligada a la resistencia al tratamiento de estos pacientes fueron el "clima de confianza-desconfianza" y la "ambiguedad claridad-comunicación". Estos indicadores pueden cambiar dinámicamente e interactuar entre sí con el fin de mejorar el clima familiar y la comunicación

The aim of the current study is to assess the changes in the structure, family dynamics, and communication during a domiciliary family intervention with patients diagnosed with psychotic spectrum disorders showing resistance to treatment. A total of 12 families (36 participants) with offspring diagnosed with psychotic disorder were included. For data collection, different qualitative techniques were used in order to triangulate information coming from each of them: a questionnaire of open questions and a deepening questionnaire for the observers. The two axes that explain the relational dynamics most closely linked to the treatment resistance of these patients were "trust-distrust climate" and "clarity-communicational ambiguity". These indicators can dynamically change and interact with each other for the benefit of improving family climate and communication

Considerations of psychotic symptomatology in anti-NMDA encephalitis: Similarity to cycloid psychosis.

Most patients with anti-NMDA receptor (NMDAR) encephalitis present with acute psychosis which is difficult to differentiate from psychotic episodes related to a primarily psychiatric disease. A precise description of the psychiatric phenotype of this disease would greatly facilitate the early diagnosis of these patients. We provide here a detailed description of three of these patients and the similarity of the clinical features with cycloid psychosis. All three patients met Perris and Brockington's criteria for cycloid psychosis in the initial phase of the autoimmune process, including among other an acute and polysymptomatic onset, polymorphous psychotic symptomatology, mood swings, and changes in psychomotricity. In addition, none of the patients had experienced an extended psychiatric prodromal phase. External stress factors preceded symptom onset in the three patients, who also showed common base personality traits and intolerance to a range of antipsychotic treatments. Complementary studies disclosed that the three patients had ovarian teratoma as well as abnormal EEG, and CSF antibodies against NMDAR. Patients with anti-NMDAR encephalitis may present with clinical features that resemble cycloid psychosis. In addition, our patients did not have prodromal history of psychiatric symptoms and showed intolerance to antipsychotic medication, which all should raise concern for anti-NMDAR encephalitis, prompting CSF antibody testing.

Early maladaptive schemas associated with dimensional and categorical psychopathology in patients with borderline personality disorder.

OBJECTIVE: To ascertain the foundations for a schema-focused therapy model for the treatment of borderline personality disorder. METHODS: The sample consisted of 102 borderline personality disorder outpatients. Dimensional psychopathology was assessed using the Scale for Suicidal Ideation, the Aggression Questionnaire, and the Symptom CheckList Revised. Categorical psychopathology was measured using the structured clinical interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Axis I Disorders, Patient Edition. Stepwise linear/logistic multiple regression analyses were used to determine the predictive role of the schema domains tested by the Young Schema Questionnaire on both types of psychopathology. Receiver operating characteristic curves were calculated for those binary outcomes. RESULTS: Regarding dimensional psychopathology, disconnection/rejection predicted greater suicidal ideation (ß = .39, p = .002), physical/overt aggressiveness (ß = .27, p = .05), and psychotic-like symptoms, such as paranoid ideation (ß = .35, p = .003). Other-directedness predicted greater anger/inner aggressiveness (ß = .22, p = .05) and internalizing symptoms, such as phobic anxiety (ß = .39, p = .001). Regarding categorical psychopathology, disconnection/rejection significantly predicted the presence of lifetime comorbidities with eating disorders (adjusted odds ratio [AOR] = 1.12, 95% CI = 0.99-1.24) and posttraumatic stress disorder (AOR = 1.2, 95% CI = 1.04-1.3), resulting in a good balance of sensitivity/specificity, respectively (.97/.96 and .88/.89). Other-directedness significantly predicted the absence of lifetime comorbidity with substance-use disorders (AOR = .74, 95% CI = 0.57-0.95). These relationships remained significant after controlling for confounders (e.g., comorbidity with other personality disorders, clinical global severity). CONCLUSIONS: Two schema domains, disconnection/rejection and other-directedness, were directly associated with dimensional and categorical psychopathology among borderline personality disorder patients. These findings provide further information about the foundations and target interventions when implementing schema-focused therapy on this population.

Domiciliary intervention in psychosis: a systematic review.

BACKGROUND: This theoretical study reviews the main findings and research on home-based treatment for psychosis. The principal purpose was to analyze the various types of home-based service and make recommendations for a service that would meet the needs of both first-episode and resistant patients. We compare the Early Intervention Service, which aims to reduce the range of untreated psychosis (DUP) with other types of home-care and similar interventions that have already been implemented: crisis resolution home teams (CRHTs), Open Dialogue Approach (ODA), social skills training (SST) and foster homes. METHOD: We searched electronic bibliographic databases including PubMed, PsycINFO, and Discovery for relevant publications appearing between 2005 and 2015. Ninetythree publications were deemed eligible for inclusion; 9 of these were systematic reviews and the rest were scientific papers or books. DISCUSSION: We describe in this review the most widely used home-based interventions, including individual and family therapy. Multidisciplinary teams carry out all the interventions discussed. There does not appear to be a form of psychotherapy, which is effective in treating resistant patients. CONCLUSIONS: Home-based interventions improve adherence to treatment, everyday living and social skills and also have a beneficial impact on family conflicts and other social conflicts. As a whole result, the number of incomes is reduced, patients’ quality of life and autonomy are increased and inclusion and community living are improved.

Intervención domiciliaria en psicosis: una revisión sistemática / Domiciliary intervention in psychosis: a systematic review

Introducción. En el presente estudio teórico se revisan las principales investigaciones sobre las intervenciones domiciliarias en psicosis. El objetivo principal es analizar los diferentes tipos de servicios domiciliarios y proponer recomendaciones para la creación de un servicio que satisfaga las necesidades tanto para pacientes con un primer episodio psicótico como para pacientes resistentes a tratamiento psicológico y farmacológico. Se compara la intervención precoz de la psicosis (Early Intervention Services) con otras tipologías de intervención domiciliaria o semejantes y los beneficios de éstas: Intervenciones en crisis (CRHTs: Crisis Resolution Home Teams), Open Dialogue Approach (ODA), Entrenamiento de Habilidades Sociales (EHS) y Foster Homes (o Boarding Homes). Método. Se han realizado búsquedas en bases de datos electrónicas incluyendo PubMed, PsycINFO y Discovery de publicaciones relevantes que aparecen entre 2005 y 2015. Noventa y tres publicaciones se consideraron elegibles para su inclusión; 9 de ellas eran revisiones sistemáticas y el resto eran trabajos científicos o libros. Discusión. En esta revisión se describen las intervenciones domiciliarias más ampliamente utilizadas, incluyendo la terapia individual y familiar, realizadas desde una perspectiva multidisciplinar. Además, se discute la inexistencia del abordaje de pacientes resistentes a tratamiento psicoterapéutico. Conclusiones. Las intervenciones domiciliarias mejoran la adherencia al tratamiento, las actividades de la vida diaria, las habilidades sociales y tienen un efecto beneficioso sobre los conflictos familiares y sociales. Consecuentemente, el número de ingresos se reduce, la calidad de vida y la autonomía de los pacientes incrementan y la inclusión y la vida en comunidad mejoran (AU)

Background. This theoretical study reviews the main findings and research on home-based treatment for psychosis. The principal purpose was to analyze the various types of home-based service and make recommendations for a service that would meet the needs of both first-episode and resistant patients. We compare the Early Intervention Service, which aims to reduce the range of untreated psychosis (DUP) with other types of home-care and similar interventions that have already been implemented: crisis resolution home teams (CRHTs), Open Dialogue Approach (ODA), social skills training (SST) and foster homes. Method. We searched electronic bibliographic databases including PubMed, PsycINFO, and Discovery for relevant publications appearing between 2005 and 2015. Ninetythree publications were deemed eligible for inclusion; 9 of these were systematic reviews and the rest were scientific papers or books. Discussion. We describe in this review the most widely used home-based interventions, including individual and family therapy. Multidisciplinary teams carry out all the interventions discussed. There does not appear to be a form of psychotherapy, which is effective in treating resistant patients. Conclusions. Home-based interventions improve adherence to treatment, everyday living and social skills and also have a beneficial impact on family conflicts and other social conflicts. As a whole result, the number of incomes is reduced, patients' quality of life and autonomy are increased and inclusion and community living are improved (AU)

Differential symptomatology and functioning in borderline personality disorder across age groups.

There is increasing research aimed at addressing whether patients with borderline personality disorder (BPD) may exhibit variations in symptomatology and functioning according to their chronological age. The current study consisted of 169 outpatients diagnosed with BPD, who were divided into four age groups as follows: 16-25 years (n = 41), 26-35 years (n = 43), 36-45 years (n = 45), and 46 and more years (n = 40). Age groups were compared for symptomatology, normal personality traits, psychiatric comorbidities, functioning, and treatment-related features. The younger group had significantly higher levels of physical/verbal aggression and suicide attempts relative to the older group. Conversely, the older group had significantly greater severity of somatization, depression, and anxiety symptoms. In addition, the older group showed significantly greater functional impairment overall and across physical/psychological domains, specifically when compared to the younger group. Overall, these findings may suggest that age-related symptoms should be considered when diagnosing BPD. Also, functional impairments should be the target interventions for older BPD patients.

Romantic Relationships of People with Borderline Personality: A Narrative Review.

BACKGROUND: Romantic relationships are one of the most interesting areas of interpersonal functioning in people with borderline personality. The aim of this narrative review was to synthesise empirical findings on this issue. SAMPLING AND METHODS: The PubMed and PsycINFO databases were searched for pertinent materials published between 1980 and March 2016. Thirty articles met the inclusion criteria. RESULTS: Several longitudinal and cross-sectional studies showed that people with borderline personality disorder (BPD) or BPD traits had more - but less prolonged - romantic relationships than people without BPD. The stable relationships of people with BPD or with BPD traits were also less satisfying and more hostile than those of people without BPD. People with BPD or BPD traits had relationships characterised by insecure attachment and passive-aggressive communications. Personality disorders and anxious attachment were more prevalent among the partners of people with BPD or with BPD traits when compared with partners of people without BPD. CONCLUSION: Unstable and chaotic romantic relationships are at the core of interpersonal dysfunction in BPD. More longitudinal research is needed to delineate the relationship between BPD symptoms and romantic relationship dysfunction, including the modulating role of the partner's clinical features in such an association.

Is There a Relationship Between Borderline Personality Disorder and Sexual Masochism in Women?

Sexual masochism disorder is considered the most prevalent paraphilia among women. However, little is known about the etiology and clinical correlates involved in this disorder. We aimed at addressing this issue through a potentially high-risk clinical cohort. This case-control study consisted of 60 women who met DSM-IV criteria for borderline personality disorder (BPD) and 60 women with other personality disorders. For both groups, sexual masochism disorder comorbidity was assessed through the Structured Clinical Interview, Sexual Disorders Module. Several etiological, psychosexual, and personality features were measured. Sexual masochism disorder was 10 times higher in BPD women than in women with other personality disorders (10 vs. 0 %). Among BPD women, those with sexual masochism disorder reported more child sexual abuse, more hostile/dismissing attachments, higher sensation seeking, and more frequently exploratory/impersonal sexual fantasies than BPD without sexual masochism. Correlation analysis confirmed a significant positive relationship between disinhibition and sexual masochism severity for BPD women. Our findings point out that BPD women may represent a high-risk cohort, especially those with higher disinhibition and detached attachment. Childhood sexual abuse may also play a predispositional role on this comorbidity. Further research may help to elucidate the intriguing relationship between both disorders.

Anxious adult attachment may mediate the relationship between childhood emotional abuse and borderline personality disorder.

BACKGROUND: Childhood trauma has been associated with borderline personality disorder (BPD). However, research has not yet provided conclusive evidence concerning the mediating mechanisms. METHODS: Seventy women diagnosed with BPD were compared with other 60 women who met DSM-IV criteria for other personality disorders on measures of childhood trauma and attachment. RESULTS: Patients with BPD reported higher severity of emotional, physical and sexual abuse than patients with other personality disorders. Moreover, BPD patients also showed greater preoccupied-anxious adult attachment. At model 1, logistic regression analysis revealed that only childhood emotional abuse predicted the occurrence of BPD. At model 2, this association was no longer significant, and the addition of preoccupied-anxious adult attachment was significantly associated with a greater likelihood of BPD diagnosis. CONCLUSIONS: These findings support a specific relationship between childhood emotional abuse and the occurrence of BPD, which may be accounted for by preoccupied-anxious adult attachment. Copyright © 2016 John Wiley & Sons, Ltd.

Sexuality-related issues in borderline personality disorder: A comprehensive review.

OBJECTIVE: Sexuality is somewhat neglected in clinical research on borderline personality disorder (BPD). METHOD: We performed a systematic review from 1980 to November 2014 through PubMed and PsycINFO. RESULTS: Empirical evidence underscores that childhood sexual trauma may be considered a non-specific risk factor for BPD. Furthermore, individuals with BPD also display higher sexual identity disturbances and homosexual relationships than non-BPD individuals. Moreover, patients with BPD also exhibit higher sexual impulsivity than non-BPD. In addition, sexual risk behaviours among individuals with BPD are related to increased rates of sexually transmitted diseases, unwanted pregnancies, rape and commercial sexual relationships, especially among drug abusers. Although psychotherapy is widely recommended for BPD, there has been little systematic research on the effect of these treatments with respect to co-morbid post-traumatic symptoms related to childhood sexual trauma. CONCLUSIONS: Sexuality-related issues represent a major clinical topic within this population. Findings are discussed concerning their methodological limitations and clinical implications. Copyright © 2016 John Wiley & Sons, Ltd.