Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.811
Filtrar
1.
J Med Internet Res ; 23(11): e28874, 2021 11 11.
Artigo em Inglês | MEDLINE | ID: mdl-34762057

RESUMO

BACKGROUND: The cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patients with borderline personality disorder is unknown. OBJECTIVE: This study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cards in DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility. METHODS: This study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants were recruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in a mobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. A cost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years (QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability. All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industry representatives to discuss the potential advantages and disadvantages of using a mobile diary app. RESULTS: A total of 78 participants were included in the analysis. An insignificantly higher number of participants in the paper group dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an average of 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants in the paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, and suicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference -0.054; SE 0.03) and reduction in depression severity (adjusted difference -1.11; SE 1.57). The between-group difference in total costs ranged from US $107.37 to US $322.10 per participant during the 12 months. The use of services in the health care sector was similar across both time points and groups (difference: psychiatric hospitalization <5 and <5; general practice -1.32; SE 3.68 and 2.02; SE 3.19). Overall, the patients showed high acceptability and considered the app as being easy to use. Therapists worried about potential negative influences on the therapist-patient interaction from new work tasks accompanying the introduction of the new technology but pointed at innovation potential from digital database registrations. CONCLUSIONS: This study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT compared with paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness. TRIAL REGISTRATION: ClinicalTrials.gov NCT03191565; http://clinicaltrials.gov/ct2/show/NCT03191565. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/17737.


Assuntos
Transtorno da Personalidade Borderline , Aplicativos Móveis , Ansiedade , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/terapia , Análise Custo-Benefício , Humanos , Ideação Suicida
2.
BMC Psychiatry ; 21(1): 486, 2021 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-34607589

RESUMO

AIM/BACKGROUND: Even though dialectical behavior therapy (DBT) has received substantial empirical support in treating patients with borderline personality disorder (BPD), fewer studies have evaluated whether a brief DBT skills group may be effective in improving clinical outcomes in this population. Further, less is known regarding the feasibility and outcomes of DBT beyond Euro-American contexts. This paper describes outcomes from a pilot study examining the feasibility, acceptability, and clinical outcomes following completion of a shortened, 14-week DBT skills group in a sample of Muslim-majority BPD patients in Malaysia. METHODS: Twenty patients were recruited from a public hospital and attended DBT skills groups in an outpatient clinic. Participants completed measures assessing psychological symptoms, self-harm behaviors, suicidal ideation, emotion regulation difficulties, self-compassion, and well-being pre- and post-intervention. RESULTS: There were significant reductions in depressive symptoms, stress, and emotion regulation difficulties, as well as increases in self-compassion and well-being from pre- to post-intervention. A trend was found for decreases in frequency and types of non-suicidal self-harm behaviors, suicidal ideation, and anxiety symptoms. Qualitative content analyses of participants' feedback indicated that the vast majority of participants perceived a positive impact from the skills group, with mindfulness and distress tolerance being rated frequently as skills that were beneficial. CONCLUSION: These preliminary findings suggest that DBT skills training is feasible and acceptable in a Muslim-majority, low resource clinical setting, and holds promise in improving clinical outcomes among BPD patients in Malaysia.


Assuntos
Transtorno da Personalidade Borderline , Terapia do Comportamento Dialético , Terapia Comportamental , Transtorno da Personalidade Borderline/terapia , Estudos de Viabilidade , Humanos , Malásia , Projetos Piloto , Resultado do Tratamento
3.
J Psychiatr Res ; 143: 445-450, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34656877

RESUMO

Studies on the theory of mind (TOM) and alexithymia in borderline personality disorder (BPD) have yielded inconsistent results. Also, the relationship between TOM abilities and alexithymia facets as two domains of social cognition has not been studied in BPD. This study aimed to fill this gap. Participants were 50 outpatients with BPD and 50 age and gender-matched healthy controls. Assessments performed using Reading the Mind in Eyes Task (RMET), Toronto Alexithymia Scale (TAS-20), Faux Pas Task (FPT), and Digit Span subtest of Wechsler Adult Intelligence Scale. Results showed that BPD patients scored lower on overall FPT (p < .001) and its cognitive (p < .001) and affective TOM (p < .001) subtests but were comparable with healthy controls in emotion recognition ability assessed by RMET (p = .241). The BPD group also scored significantly lower in overall alexithymia (p < .001) and subscales of difficulty identifying feelings (DIF; p < .001) and difficulty describing emotions (DDF; p = .001). However, they performed similarly to the healthy control group in externally oriented thinking (EOT; p = .164). Correlation analysis revealed a significant negative correlation between EOT and RMET in the BPD group (r = -0.33, p < .05). No association, however, was found between FPT and RMET. This study suggests that BPD patients are impaired in the complex TOM abilities and have lower self-awareness of emotions, but their recognition of others' emotions is intact. Also, the results demonstrate that a heightened level of EOT is associated with difficulties in facial emotion recognition in BPD patients.


Assuntos
Transtorno da Personalidade Borderline , Teoria da Mente , Adulto , Sintomas Afetivos , Estudos Transversais , Emoções , Humanos , Pacientes Ambulatoriais
4.
Transl Psychiatry ; 11(1): 545, 2021 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-34675186

RESUMO

Emotion dysregulation is central to the development and maintenance of psychopathology, and is common across many psychiatric disorders. Neurobiological models of emotion dysregulation involve the fronto-limbic brain network, including in particular the amygdala and prefrontal cortex (PFC). Neural variability has recently been suggested as an index of cognitive flexibility. We hypothesized that within-subject neural variability in the fronto-limbic network would be related to inter-individual variation in emotion dysregulation in the context of low affective control. In a multi-site cohort (N = 166, 93 females) of healthy individuals and individuals with emotional dysregulation (attention deficit/hyperactivity disorder (ADHD), bipolar disorder (BD), and borderline personality disorder (BPD)), we applied partial least squares (PLS), a multivariate data-driven technique, to derive latent components yielding maximal covariance between blood-oxygen level-dependent (BOLD) signal variability at rest and emotion dysregulation, as expressed by affective lability, depression and mania scores. PLS revealed one significant latent component (r = 0.62, p = 0.044), whereby greater emotion dysregulation was associated with increased neural variability in the amygdala, hippocampus, ventromedial, dorsomedial and dorsolateral PFC, insula and motor cortex, and decreased neural variability in occipital regions. This spatial pattern bears a striking resemblance to the fronto-limbic network, which is thought to subserve emotion regulation, and is impaired in individuals with ADHD, BD, and BPD. Our work supports emotion dysregulation as a transdiagnostic dimension with neurobiological underpinnings that transcend diagnostic boundaries, and adds evidence to neural variability being a relevant proxy of neural efficiency.


Assuntos
Transtorno da Personalidade Borderline , Imageamento por Ressonância Magnética , Tonsila do Cerebelo/diagnóstico por imagem , Emoções , Feminino , Hipocampo , Humanos
5.
Scand J Psychol ; 62(6): 878-886, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34523729

RESUMO

According to the literature, avoidant personality disorder (APD) is often overlooked in research on personality disorders. In the present study, patients with APD were compared to patients with borderline personality disorder (BPD) with respect to emotional dysfunction. Emotional dysfunction was operationalized through the Affect Integration Inventory. Sixty-one patients receiving treatment at specialized outpatient hospital facilities for either BPD (n = 25) or APD (n = 36) (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) were included in a cross-sectional study. Supporting our expectations of no difference in the global capacity for affect integration between groups, the estimated difference was 0.00 (95% confidence interval [CI] [-0.53, 0.53]). On the other hand, the expected increased dysfunction in APD regarding Expression could not be confirmed. Furthermore, problems with specific affects distinguished the groups; integration of Interest was worse in APD (p = 0.01), whereas integration of Jealousy was worse in BPD (p = 0.04). In terms of prototypical modes of experiencing affects, APD was characterized by decreased access to the motivational properties of Interest (p < 0.01), while BPD was more driven by Interest (p < 0.01), Anger (p < 0.01), and Jealousy (p = 0.01). In conclusion, even though the two disorders are characterized by similar overall levels of emotional dysfunction, they differ systematically and predictably regarding specific affects and modes of experiencing. These findings carry implications for the understanding of emotional dysfunction in APD and BPD, suggesting specific areas of emotional dysfunction that could be targeted in tailored psychotherapeutic interventions.


Assuntos
Transtorno da Personalidade Borderline , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Transtornos da Personalidade
6.
J Consult Clin Psychol ; 89(9): 751-761, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34591548

RESUMO

OBJECTIVE: The capacity for understanding mental states (reflective functioning; RF) is considered essential for self-growth, social learning, and emotion regulation. Impaired RF is thought to play a central role in borderline personality disorder (BPD). We examined whether asking patients to consider mental states in-session has a down-regulatory effect on emotional arousal in treatments for BPD. METHOD: Early-, middle- and late-phase videotaped sessions from a randomized-controlled trial of transference-focused psychotherapy (TFP; n = 30), dialectical behavior therapy (DBT; n = 29), and supportive psychodynamic therapy (SPT; n = 29) were segmented to therapist and patient talk-turns. Therapist talk-turns were rated as asking patients to consider mental state (bids for RF) or not. Patient talk-turns were rated for RF and acoustically encoded for arousal. RESULTS: Bids were twice as common in TFP compared to DBT and SPT. Across treatments, therapist bids for RF predicted better RF, which, in turn, predicted lower emotional arousal. CONCLUSIONS: Asking patients to consider mental states has a down-regulatory effect on patients' arousal in psychotherapies for BPD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Transtorno da Personalidade Borderline , Terapia do Comportamento Dialético , Regulação Emocional , Transtorno da Personalidade Borderline/terapia , Emoções , Humanos , Psicoterapia
7.
Eur Psychiatry ; 64(1): e56, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34465401

RESUMO

BACKGROUND: One common denominator to the clinical phenotypes of borderline personality disorder (BPD) and major depressive disorder (MDD) is emotion regulation impairment. Although these two conditions have been extensively studied separately, it remains unclear whether their emotion regulation impairments are underpinned by shared or distinct neurobiological alterations. METHODS: We contrasted the neural correlates of negative emotion regulation across an adult sample of BPD patients (n = 19), MDD patients (n = 20), and healthy controls (HCs; n = 19). Emotion regulation was assessed using an established functional magnetic resonance imaging cognitive reappraisal paradigm. We assessed both task-related activations and modulations of interregional connectivity. RESULTS: When compared to HCs, patients with BPD and MDD displayed homologous decreased activation in the right ventrolateral prefrontal cortex (vlPFC) during cognitive reappraisal. In addition, the MDD group presented decreased activations in other prefrontal areas (i.e., left dorsolateral and bilateral orbitofrontal cortices), while the BPD group was characterized by a more extended pattern of alteration in the connectivity between the vlPFC and cortices of the visual ventral stream during reappraisal. CONCLUSIONS: This study identified, for the first time, a shared neurobiological contributor to emotion regulation deficits in MDD and BPD characterized by decreased vlPFC activity, although we also observed disorder-specific alterations. In MDD, results suggest a primary deficit in the strength of prefrontal activations, while BPD is better defined by connectivity disruptions between the vlPFC and temporal emotion processing regions. These findings substantiate, in neurobiological terms, the different profiles of emotion regulation alterations observed in these disorders.


Assuntos
Transtorno da Personalidade Borderline , Transtorno Depressivo Maior , Transtorno da Personalidade Borderline/diagnóstico por imagem , Cognição , Transtorno Depressivo Maior/diagnóstico por imagem , Emoções , Humanos , Imageamento por Ressonância Magnética
8.
Tijdschr Psychiatr ; 63(7): 543-549, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34523706

RESUMO

BACKGROUND: Parenting an adolescent with borderline personality disorder (BPD) features can be challenging due to, for example, emotional dysregulation, impulsivity and/or self-destructive behavior. Parents confronted with challenging behavior of their child, may experience less parental-self-efficacy (PSE). Subsequently this lower PSE might strengthen the relationship between low parental support and BPD features. AIM: To increase our understanding of the association between parenting related factors and features of BPD in adolescents. METHOD: The sample consisted of 81 adolescents, in the age of 13-21, from a clinical population and their parents. Parents completed (online) questionnaires on parental self-efficacy and adolescents reported on parental support and BPD features. RESULTS: Adolescents who experienced lower parental support reported more BPD features. Lower parental self-efficacy was not related to BPD features in adolescence, but (more) self-efficacy was related to (older) age. Subsequently no evidence was found for a combined effect of perceived parental support and parental self-efficacy on adolescent BPD features. CONCLUSION: Adolescents in a clinical population with higher levels of BPD perceived lower levels of parental support. Parental self-efficacy was not related to levels of BPD. This research is a first step in understanding parenting related factors and BPD features. Longitudinal research is needed to gain more insight in transactions between parenting related factors and symptoms of adolescent BPD.


Assuntos
Transtorno da Personalidade Borderline , Adolescente , Criança , Emoções , Humanos , Poder Familiar , Pais , Autoeficácia
9.
BMJ Open ; 11(9): e047771, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34497078

RESUMO

IMPORTANCE: Borderline personality disorder (BPD) is a severe mental disorder that is often inadequately treated. OBJECTIVE: To determine if adding a self-management intervention to care as usual (CAU) is effective and safe. DESIGN: Randomised, controlled, rater-blind trial. Duration of treatment and assessments: 12 months. SETTING: Secondary care, recruited mainly via the internet. PARTICIPANTS: Patients with BPD and BPD Severity Index (BPDSI) of at least 15. INTERVENTIONS: CAU by treating psychiatrist and/or psychotherapist alone or adjunctive use of an internet-based self-management intervention that is based on schema therapy (priovi). MAIN OUTCOME MEASURE: Outcomes were assessed by trained raters. The primary outcome was change in BPDSI. The safety outcome was the number of serious adverse events (SAEs). The primary outcome time point was 12 months after randomisation. RESULTS: Of 383 participants assessed for eligibility, 204 were included (91.7% female, mean age: 32.4 years; 74% were in psychotherapy and 26% were in psychiatric treatment). The slope of BPDSI change did not differ significantly between groups from baseline to 12 months (F3,248= 1.857, p=0.14). At 12 months, the within-group effect sizes were d=1.38 (95% CI 1.07 to 1.68) for the intervention group and d=1.02 (95% CI 0.73 to 1.31) for the control group. The between-group effect size was d=0.27 (95% CI 0.00 to 0.55) in the intention-to-treat sample and d=0.39 (95% CI 0.09 to 0.68) for those who used the intervention for at least 3 hours (per-protocol sample). We found no significant differences in SAEs. CONCLUSIONS: We have not found a significant effect in favour of the intervention. This might be due to the unexpectedly large effect in the group receiving CAU by a psychiatrist and/or psychotherapist alone. TRIAL REGISTRATION: NCT03418142.


Assuntos
Transtorno da Personalidade Borderline , Autogestão , Adulto , Transtorno da Personalidade Borderline/terapia , Análise Custo-Benefício , Feminino , Humanos , Internet , Masculino , Psicoterapia , Resultado do Tratamento
10.
Psychiatry Res Neuroimaging ; 316: 111357, 2021 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-34488007

RESUMO

Positron emission tomography (PET) and single photon emission computed tomography (SPECT) are two neuroimaging techniques that have led to important insights into the pathophysiology of borderline personality disorder (BPD) and its symptom clusters. This paper provides the most up-to-date review of PET and SPECT studies targeting BPD. A systematic search of PET and SPECT studies using the databases PsycINFO, PubMed, and Embase was implemented, which yielded 30 articles in the end. Earlier PET studies largely reported decreased glucose metabolism in prefrontal brain regions. More recent PET research has pointed to alterations in monoaminergic systems, greater activation of the opioid system during sadness induction, as well as abnormalities of the brain endocannabinoid system in BPD. SPECT studies of BPD mainly identified changes in regional cerebral blood flow and alterations of the serotonergic system. Such PET and SPECT study abnormalities have been suggested to relate to the symptomatology of BPD, including impulsivity, aggression, and mood changes. The implications of these neuroimaging studies in terms of shedding new light on the pathophysiology of BPD and providing new avenues for drug development are discussed.


Assuntos
Transtorno da Personalidade Borderline , Transtorno da Personalidade Borderline/diagnóstico por imagem , Humanos , Comportamento Impulsivo , Tomografia por Emissão de Pósitrons , Síndrome , Tomografia Computadorizada de Emissão de Fóton Único
11.
Actas Esp Psiquiatr ; 49(5): 199-204, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34533202

RESUMO

Suicidal behavior (SB) spectrum is nuclear in the clinic and management of Borderline Personality Dis- order (BPD). Although in recent research papers non-suicidal self-injury behavior (NSSI) and suicidal behavior (SB) differ in intentionality, frequency and lethality; these two behaviors have been described concurrently with a controversial distinction. Few works talk about the reason for the co-occurrence between both entities in the psychiatric population in general and in BPD in particular. The aim of the report is to analyze the link between SB and NSSI in BPD.


Assuntos
Transtorno da Personalidade Borderline , Comportamento Autodestrutivo , Transtorno da Personalidade Borderline/complicações , Humanos , Estudos Retrospectivos , Comportamento Autodestrutivo/complicações , Ideação Suicida
12.
Ir J Psychol Med ; 38(3): 169-176, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34465404

RESUMO

OBJECTIVES: Borderline personality disorder (BPD) is characterised by recurring crises, hospitalisations, self-harm, suicide attempts, addictions, episodes of depression, anxiety and aggression and lost productivity. The objective of this study is to determine the use of direct health care resources by persons with BPD in Ireland and the corresponding costs. METHODS: This prevalence-based micro-costing study was undertaken on a sample of 196 individuals with BPD attending publicly funded mental health services in Ireland. All health care costs were assessed using a resource utilisation questionnaire completed by mental health practitioners. A probabilistic sensitivity analysis, using a Monte Carlo simulation, was performed to examine uncertainty. RESULTS: Total direct healthcare cost per individual was €10 844 annually (ranging from 5228 to 20 609). Based on a prevalence of 1% and an adult population (18-65 years) of 2.87 million, we derived that there were 28 725 individuals with BPD in Ireland. Total yearly cost of illness was calculated to be up to €311.5 million. CONCLUSIONS: There is a dearth of data on health care resource use and costs of community mental health services in Ireland. The absence of this data is a considerable constraint to research and decision-making in the area of community mental health services. This paper contributes to the limited literature on resource use and costs in community mental health services in Ireland. The absence of productivity loss data (e.g. absenteeism and presenteeism), non-health care costs (e.g. addiction treatment), and indirect costs (e.g. informal care) from study participants is a limitation of this study.


Assuntos
Transtorno da Personalidade Borderline , Absenteísmo , Adulto , Transtornos de Ansiedade , Transtorno da Personalidade Borderline/epidemiologia , Transtorno da Personalidade Borderline/terapia , Custos de Cuidados de Saúde , Humanos , Irlanda
13.
J Affect Disord ; 295: 781-787, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34517252

RESUMO

BACKGROUND: Borderline Personality Disorder (BPD) is a severe and disabling psychiatric syndrome, frequently associated with self-injurious behaviours (SIB). In recent years, functional magnetic resonance imaging (fMRI) investigations have tried to identify alterations associated with SIB amongst BPD patients, in order to better delineate possible neurobiological underpinnings of these manifestations. In this mini-review, we aimed at summarizing fMRI studies exploring patterns of neural activation associated with SIB in BPD patients. METHODS: Literature searches on PubMed, Psych-Info and Embase databases were performed for all fMRI studies including adult patients with BPD and SIB undergoing different tasks, including painful or thermic stimulation, affective stimulation through the presentation of picturesor the recollection of personal memories as well as tasks that evaluate sustained attention and impulsivity, and reward processing. Thirteen relevant papers were considered eligible for the present review. RESULTS: Patients with BPD and SIB, compared to HC, showed prefrontal, nucleus accumbens overactivation and amygdala deactivation during pain stimulation. During negative affective stimulation, BPD patients showed a hyperactivation of the amygdala and a hypoactivation of the orbitofrontal cortex (OFC), which was also found to be enhanced during a gambling task and during a recalling of aversive memories. In contrast, during cognitive tasks with negative affective interference, BPD patients showed hypoactivation of OFC, anterior cingulated cortex, and basal ganglia. LIMITATIONS: The limited number of studies and the heterogeneity regarding the fMRI tasks employed allowed only suggestive conclusions. CONCLUSIONS: The reviewed fMRI studies highlighted that BPD patients with a history of SIB showed altered brain activity, compared to HC, in regions involved in inhibitory cognitive processes and affect regulation, which may in turn, explain the overwhelming emotional experiences eliciting SIB in these patients.


Assuntos
Transtorno da Personalidade Borderline , Comportamento Autodestrutivo , Adulto , Tonsila do Cerebelo , Transtorno da Personalidade Borderline/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Emoções , Humanos , Imageamento por Ressonância Magnética , Comportamento Autodestrutivo/diagnóstico por imagem
14.
J Psychiatr Ment Health Nurs ; 28(6): 1128-1139, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34519138

RESUMO

INTRODUCTION: Dialectical behaviour therapy(DBT) has been widely used for borderline personality disorder(BPD). Existing studies are limited to behaviours such as self-harm, and the results for reducing self-harm were controversial. Few have systematically evaluated the effect of DBT on self-harming behaviours and negative emotions. AIM: This study aims to evaluate the effects of DBT on self-harming behaviours and negative emotions in patients with BPD. METHODS: RCTs on DBT for BPD were searched from PubMed, Embase, etc., and the results were performed by RevMan 5.3. RESULTS: The meta-analysis demonstrated that DBT reduced self-harming behaviours, and alleviated depression, but had a negligible effect on suicidal ideation and anger. One subgroup revealed that standard DBT improved depression significantly, but DBT skills training improved poorly. Another subgroup revealed that there was a significant reduction in depression among patients receiving DBT for 4 months to 14 months, but not at 4 months. DISCUSSION AND IMPLICATIONS FOR PRACTICE: Findings indicate that DBT can reduce self-harming behaviours and improve depression, but effects on suicidal ideation and anger are insignificant. Subgroup analysis suggests that standard DBT and DBT-ST lasting beyond 4 months benefits on BPD. Given the quality and quantity restrictions of RCTs, more high-quality RCTs need to verify these effects.


Assuntos
Transtorno da Personalidade Borderline , Terapia do Comportamento Dialético , Comportamento Autodestrutivo , Ira , Terapia Comportamental , Transtorno da Personalidade Borderline/terapia , Humanos , Comportamento Autodestrutivo/terapia , Resultado do Tratamento
15.
Sci Rep ; 11(1): 16628, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404887

RESUMO

This study was aimed to investigate whether BPD patients showed impaired impulse inhibition of emotional and non-emotional stimuli and to explore relevant neuroelectrophysiological mechanisms. A total of 32 BPD patients and 32 matched healthy controls were recruited. Self-reported scales were used to measure psychiatric symptoms. The event-related potentials (ERPs) were recorded when subjects were performing neutral and emotional Stop Signal Task (SST). Group differences in self-reported scores, behavioral variables and ERPs were compared. The BPD group scored significantly higher on impulsivity, severity of BPD symptoms, levels of depression and anxiety than the control group. In neutral SST, no significant group differences were detected in the amplitude and latency of ERPs components induced. In emotional SST, the P2 amplitude of negative emotion was significantly larger than that of neutral emotion in Go trials. In Stop trials, the P2 amplitude of BPD group was significantly smaller than that of control group, and the N2 amplitude of BPD group was significantly greater than that of control group. BPD patients showed impaired inhibition of emotional stimuli rather than non-emotional stimuli. The deficits of emotional impulse control mainly exhibit at the early attention, stimulus evaluation and conflict detection stages.


Assuntos
Transtorno da Personalidade Borderline/psicologia , Emoções , Comportamento Impulsivo , Adulto , Estudos de Casos e Controles , Potenciais Evocados , Feminino , Humanos , Masculino
16.
J Neural Transm (Vienna) ; 128(9): 1425-1432, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34390395

RESUMO

Patients with borderline personality disorder (BPD) often display increased stress vulnerability, which may be linked to altered hypothalamus-pituitary-adrenal (HPA) axis functioning. Corresponding deviations of the cortisol awakening response (CAR) are presumed to mirror maladaptive neuroendocrine processes, which may explain why CARs are increased compared to healthy controls (HC). Prior research speculated that these alterations may be caused by early life stress and/or chronic stress related to the ongoing burden of the disorder. Yet, it remains to be investigated how BPD influences CAR in the course of development. Therefore, the current study examined CAR in female adolescents and adults with BPD compared to HC with a particular focus on associations with age. These potential associations were especially focused, as it was hypothesized that the CAR would be even more elevated (i.e., higher) in older individuals with BPD. CAR was assessed in 54 female individuals with BPD (aged 15-40 years) and 54 sex-, age-, and intelligence-matched HC (aged 15-48 years). Group differences were investigated and analyses of covariance using age as continuous predictor were performed to analyze potential developmental associations with CAR alongside BPD-specific effects. Pearson's correlations were calculated to examine associations between CAR and age. Analyses were repeated with potential confounders as control factors. Results not only demonstrated increased CARs in female individuals with BPD compared to HC but demonstrated elevated CARs with increasing age in BPD individuals exclusively. Effects remained stable after controlling for potential confounders. Thereby, findings suggest that endocrine alterations in BPD may reinforce with increasing age and BPD chronicity.


Assuntos
Transtorno da Personalidade Borderline , Hidrocortisona , Adolescente , Adulto , Idoso , Feminino , Humanos , Sistema Hipotálamo-Hipofisário , Sistema Hipófise-Suprarrenal , Saliva
18.
Int J Health Plann Manage ; 36(6): 2366-2375, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34460966

RESUMO

Clinical pathways are known to be key in managing chronic conditions in an effective and sustainable way. This is particularly true in psychiatry, characterized by chronicity and managerial challenges. In particular, the borderline personality disorder is a highly complicated disorder to manage. Although numerous international guidelines converge on the urge of defining clinical pathways and a stepped-care model for its effective treatment, it is unknown to what extent these guidelines have been implemented into concrete changes in the provision of care. The objective of this study is to pursue a preliminary assessment of whether there exists coherence between the provision of formal health dispositions or guidelines and end-users' perception of the change they should imply. A pilot study investigating the perception of parents of patients with borderline disorder on continuity of care has been conducted in three Italian regions. Results suggest that pathways do exist and are partially able to reach their intended effects, although concrete accessibility is still a major issue. Future studies should build on these preliminary results through quantitative investigation and further explore their causes.


Assuntos
Transtorno da Personalidade Borderline , Prestação Integrada de Cuidados de Saúde , Transtorno da Personalidade Borderline/terapia , Humanos , Pais , Percepção , Projetos Piloto
19.
BMC Psychiatry ; 21(1): 393, 2021 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-34372810

RESUMO

BACKGROUND: Emotional dysregulation seems to be a core feature of Borderline Personality Disorders (BPD). In addition, recent research in the adolescent population has shown that suicidal behaviours have been associated with maladaptive strategies of emotion regulation. METHODS: This study examined the relative contributions of emotional dysregulation to suicide attempt history in a clinical sample of borderline adolescents. Data were analyzed from 85 participants of the Collaborative European Research Network on Borderline Personality Disorder. Participants completed measures of BPD traits and symptoms, suicide behaviours, emotional dysregulation, attachment styles and lifetime depressive disorders. RESULTS: In an SEM model, lifetime depressive disorders and insecure attachment styles have a significant direct effect on lifetime suicide attempt, but only lifetime depressive disorders have an indirect effect through emotion dysregulation. The results suggest that emotional dysregulation has a mediating role in suicide attempts among BPD adolescents. CONCLUSIONS: These findings call for the development of interventions targeting the role of emotion dysregulation in effectively predicting and preventing suicidality in borderline adolescents.


Assuntos
Transtorno da Personalidade Borderline , Tentativa de Suicídio , Adolescente , Emoções , Humanos , Ideação Suicida
20.
Behav Ther ; 52(5): 1067-1079, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34452662

RESUMO

Fears of pain, injury, and death may represent key barriers to acting on suicidal thoughts. Dissociation, which involves a disconnection from one's body, may reduce fears and sensations of pain associated with harming the body, in turn facilitating suicide attempts. This study examined whether dissociation differentiated individuals with a history of suicide attempts from those with a history of suicide ideation, and investigated whether other relevant constructs explain this relationship. Sample 1 included 754 undergraduates (Mage = 21, 79% female) who completed a battery of self-report measures. Sample 2 included 247 undergraduates (Mage = 19, 74% female) who completed a self-report measure of dissociation, a clinical interview regarding suicide history, and four counterbalanced behavioral pain tolerance tasks. In both samples, dissociation was elevated in lifetime attempters compared to ideators (d = 0.28; d = 0.46; ps = 0.01) and slightly elevated in lifetime ideators compared to nonsuicidal individuals (d = 0.19, p = .02; d = 0.24, p = .47), though this effect was non-significant in the latter sample. In Sample 1, dissociation no longer differentiated attempters from ideators after controlling for clinical covariates. In Sample 2, dissociation was unrelated to behavioral pain tolerance tasks, and these tasks did not account for the association between dissociation and attempts. Overall, dissociation differentiated individuals with a history of suicide attempts from those with ideation alone in both samples. Pain tolerance did not explain this association; instead, it is possible that the relationship of dissociation to suicide attempts is due to "third variables" associated with both phenomena, such as symptoms of borderline personality disorder or posttraumatic stress disorder.


Assuntos
Transtorno da Personalidade Borderline , Ideação Suicida , Adulto , Transtornos Dissociativos , Feminino , Humanos , Masculino , Limiar da Dor , Fatores de Risco , Tentativa de Suicídio , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...