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.

A transcultural study of hoarding disorder: Insights from the United Kingdom, Spain, Japan, and Brazil.

Though problematic hoarding is believed to be a universal human behavior, investigations of clinically-defined hoarding disorder (HD) have been confined almost exclusively to Western countries. The current investigation sought to describe and directly compare the features of individuals meeting diagnostic criteria for HD across four distinct cultural settings. Participants were 82 individuals meeting DSM-5 diagnostic criteria for HD, recruited and assessed by trained clinicians at one of four project sites: London, Barcelona, Fukuoka, and Rio de Janeiro. A series of semi-structured interviews and self-report scales were administered, including assessments of socio-demographic characteristics, psychiatric comorbidity, and severity of hoarding and related features. Results indicate that the severity and core features of HD, as well as the cognitions and behaviors commonly associated with this condition, are largely stable across cultures. However, some differences in patient demographics-in particular age, marital status, and clinical expression-as well as comorbid psychiatric features also emerged. These findings confirm that HD, as defined in DSM-5, exists and presents with similar phenomenology across the studied cultures. Future, more fine-grained, research will be needed to study the features of the disorder in additional cultures (e.g., non-industrialized nations) and to evaluate the impact of these cultural aspects on the design of interventions for the disorder.

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.

Evaluación y tratamiento ambulatorio de la acumulación compulsiva en un paciente con patología del espectro psicótico / Evaluation and outpatient treatment of compulsive hoarding in a patient with psychotic spectrum disorder

Introducción: los pacientes con acumulación compulsiva primaria tienden a presentar escasa adherencia y respuesta al tratamiento conductual ambulatorio, desconociéndose el papel que la patología comórbida del espectro psicótico pudiera ejercer en su abordaje terapéutico. Así mismo, la valoración de su gravedad y evolución clínica suele hallarse limitada a autoinformes. Caso clínico: se expone el caso de un varón de mediana edad, con antecedentes de acumulación compulsiva de 30 años de evolución, que desarrolló posteriormente un trastorno esquizoafectivo. Tras la implementación de psicoterapia conductual monitorizada en el domicilio por la pareja, se objetivó una remisión parcial de la acumulación compulsiva al cabo de 12 meses de tratamiento ambulatorio. Conclusiones: el uso de fotografías constituye una herramienta evaluativa que permite determinar con mayor precisión el diagnóstico clínico y la evolución de los sujetos con acumulación compulsiva. La presencia de sintomatología negativa comórbida debe estimular la supervisión de las pautas psicoterapéuticas en el propio domicilio del paciente (AU)

Introduction: patients with primary compulsive hoarding normally have a poor adherence and response to outpatient behavioral treatment, not knowing the role that comorbid psychotic spectrum psychopathology could exercise in its therapeutic approach. Likewise, the assessment of its severity and clinical course is usually limited to self-reports. Case report: we describe the case of a middle-aged male with a 30 years evolution of compulsive hoarding, which subsequently developed schizoaffective disorder. After implementing behavioral therapy monitored at home by the couple, a partial remission of compulsive hoarding was obtained during 12 months of outpatient treatment. Discussion: the use of photographs is an assessment tool for determining more accurately the clinical diagnosis and the evolution of patients with compulsive hoarding. The presence of comorbid negative symptoms should stimulate psychotherapeutic supervision in patient’s home (AU)