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1.
Prax Kinderpsychol Kinderpsychiatr ; 69(2): 126-140, 2020 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-32114950

RESUMO

The Association Between Illicit Drug Use, Borderline Personality Disorder and Depression in a Help-Seeking Sample of Adolescents Risk-taking behavior is a common phenomenon in adolescence. Even prevalence rates for illicit drug use are considerably high in youth and associated with a range of psychiatric disorders, especially depression and Borderline Personality Disorder (BPD). However, there is a lack of data investigating differences in psychopathology between different substance user groups. Therefore, aim of the study was to investigate occurrence of depression and BPD symptoms in different drug risk groups (no use vs. occasional use vs. frequent use). Further aim of the study was to examine risk profiles regarding single BPD criteria. Data of n = 347 adolescents (81.7 % female, mean age 14.95, SD = 1.50) presenting at the specialized outpatient clinic for risk-taking and self-harming behavior (AtR!Sk) in Heidelberg were analyzed. Results show that BPD is clearly associated with illicit drug use in adolescence. There is no difference between occasional and frequent users in terms of mean number of BPD criteria. However, frequent users differ from occasional users regarding greater number of impulsivity and anger criteria. After adjusting for sociodemographic variables there was no association between drug use and depression. Since even single events of illicit drug use are associated with higher levels of BPD, clinicians should rapidly target to stop consumption. Further, psychotherapeutic interventions for BPD in high-risk consumers should especially focus on facilitating adaptive emotion regulation skills in regards to impulsivity and anger.


Assuntos
Transtorno da Personalidade Borderline/complicações , Transtorno da Personalidade Borderline/psicologia , Depressão/complicações , Depressão/psicologia , Comportamento de Busca de Ajuda , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Transtorno Depressivo/complicações , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Comportamento Autodestrutivo
2.
Psychiatr Hung ; 35(2): 136-145, 2020.
Artigo em Húngaro | MEDLINE | ID: mdl-32191219

RESUMO

INTRODUCTION: High levels of impulsivity represent a core feature of various psychiatric conditions, such as Attention Deficit Hyperactivity Disorder (ADHD), Borderline Personality Disorder (BPD), Impulse Control and Conduct Disorders, Bulimia Nervosa, Substance Use Disorders, and other maladaptive behaviors, like non-suicidal self-harm and suicidal behavior. The overall aim of our research is to carry out a trans-diagnostic study of impulsivity as a common behavioral risk factor, taking into consideration the different dimensions of impulsivity (motor, attentional, non-planning). The project investigates inhibitory neurocognitive deficits, electrophysiological correlates, childhood adversities and genetic vulnerability factors in the background of impulsivity. METHODS: In this report, we describe the results of our pilot study which aims to compare impulsivity profiles, personality traits, and levels of aggression in patients with adult ADHD (aADHD) and BPD primary diagnoses, and healthy control subjects, based on self report questionnaires (Barratt Impulivity Scale, Cloninger Temperament and Character Inventory). We have also carried out analyses on the role of childhood adverse events in the background of impulsivity. Because of the predominance of female participants in the BPD group, we restrict our analyses to only female subjects (N=111 out of 152 patients overall). RESULTS: Comparing the three groups significant differences were observed in each impulsivity domain: higher levels of attentional and motor impulsivity were present in aADHD, while non-planning impulsivity was more characteristic to BPD (p<0.001). Using the Cloninger Temperament and Character Inventory aADHD patients reached significant higher levels on six subscales (novelty seeking, harm avoidance, reward dependency, perseverance, selfdirection, cooperation) than BPD patients (p<001). Childhood emotional neglect results in higher levels of impulsivity in adulthood (R=0.54, p<0.001) regardless of diagnosis. CONCLUSION: Impulsivity, as a diagnostic criterion of different psychiatric disorders is a heterogenous construct. Different characteristics of impulsivity are pronounced with respect to the condition it is part of. Studying impulsivity can improve our understanding of the etiology of different psychiatric conditions, which can result in more specific and effective therapeutic interventions.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno da Personalidade Borderline/psicologia , Comportamento Impulsivo , Adulto , Caráter , Humanos , Projetos Piloto
3.
Rev Med Suisse ; 16(681): 314-317, 2020 Feb 12.
Artigo em Francês | MEDLINE | ID: mdl-32049453

RESUMO

Suicide is a common cause of death in Switzerland. It often occurs during a period of crisis marked by a disruption of the subject's intrapsychic, interpersonal or social balance. The management of this crisis is crucial and essentially psychotherapeutic. Drug therapy may be necessary for the management of acute symptoms or for the prevention of long-term suicidal risk. Benzodiazepines and atypical antipsychotics are often used for acute symptoms such as anxiety or sleep disorders while other molecules are recognized in reducing long-term suicidal risk. Some disorders, such as borderline personality disorder, account for more frequent suicidal behaviors. The pharmacological management of these specific situations is discussed.


Assuntos
Antipsicóticos/farmacologia , Suicídio/prevenção & controle , Suicídio/psicologia , Benzodiazepinas/farmacologia , Transtorno da Personalidade Borderline/psicologia , Humanos , Fatores de Risco , Ideação Suicida , Suíça
4.
Psychiatr Prax ; 47(1): 35-38, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31910459

RESUMO

OBJECTIVE: Borderline Personality Disorder (BPD) appears to be the most stigmatized diagnosis among personality disorders. This study aims to assess attitudes of psychiatric nurses towards patients with BPD compared to patients with depressive disorder. METHOD: 37 psychiatric nurses were randomized to an experimental between-subject design, in form of two questionnaires with different vignettes. The vignettes examined main outcomes such as negative attitudes, social distance and emotional reactions. RESULTS: Significant moderate to large differences in terms of social distance (p = 0.033, d = -0.736) and single emotional reactions towards patients with BPD (p = 0.017, d = 0.82), e. g. "I have compassion with her" were found. CONCLUSION: Patients with BPD have a substantial need for support. Quality and standards of inpatient care of patients with a BPS disorder can only guaranteed by giving adequate information about the causes of the disorder and professional treatment of the patients. Personnel must be trained to be able to cope with the specifics of the symptoms in BPD patients.


Assuntos
Transtorno da Personalidade Borderline , Enfermagem Psiquiátrica , Estigma Social , Transtorno da Personalidade Borderline/psicologia , Feminino , Alemanha , Hospitalização , Humanos , Masculino , Apoio Social , Inquéritos e Questionários
5.
Prax Kinderpsychol Kinderpsychiatr ; 69(1): 60-81, 2020 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-31918648

RESUMO

Alliance Ruptures in the Psychotherapy of Adolescents with Borderline Personality Pathology: Risk or Benefit? Adolescents with subthreshold or full-blown borderline personality disorders (borderline personality pathology (BPP)) are characterized by a pronounced instability in their self-image and their interpersonal relationships. The building of a stable therapeutic relationship is considerably challenged in patients with BPP. The concept of alliance ruptures and resolutions assumes that the resolution of ongoing relationship difficulties contributes to therapeutic change. Resolutions are strategies of the therapist to address ruptures, to explore their meaning with the patient and to enhance the therapeutic collaboration between the patient and the therapist. This article illustrates the use and benefits of alliance ruptures and resolutions among adolescents with BPP treated with the manualized treatment concept Adolescent Identity Treatment (AIT). Ten patients were treated with AIT. Three out of ten patients dropped out of treatment prematurely. A total of 187 therapy sessions were analyzed using the Rupture and Resolution Rating System (3RS; Eubanks, Lubitz, Muran, Safran, 2018). Alliance ruptures and resolutions are illustrated in session transcripts of a qualitative case vignette. Quantitative analyses show that alliance ruptures occur frequently over the complete treatment course in good outcome patients. However, frequent alliance ruptures at the beginning of treatment represent a risk for premature treatment termination. The concept of alliance ruptures and resolutions may help to improve the ongoing therapeutic alliance in the treatment of adolescents with BPP.


Assuntos
Transtorno da Personalidade Borderline , Psicoterapia , Adolescente , Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/cirurgia , Humanos , Relações Interpessoais , Relações Profissional-Paciente , Autoimagem , Comportamento Social
6.
PLoS One ; 14(12): e0226737, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31856211

RESUMO

Previous research has suggested that the short (S)-allele of the 5-HT transporter gene-linked polymorphic region (5-HTTLPR) may confer "differential susceptibility" to environmental impact with regard to the expression of personality traits, depressivity and impulsivity. However, little is known about the role of 5-HTTLPR concerning the association between childhood adversity and empathy. Here, we analyzed samples of 137 healthy participants and 142 individuals diagnosed with borderline personality disorder (BPD) focusing on the 5-HTTLPR genotype (S/L-carrier) and A/G SNP (rs25531), in relation to childhood maltreatment and empathy traits. Whereas no between-group difference in 5-HTTLPR genotype distribution emerged, the S-allele selectively moderated the impact of childhood maltreatment on empathic perspective taking, whereby low scores in childhood trauma were associated with superior perspective taking. In contrast, L-homozygotes seemed to be largely unresponsive to variation in environmental conditions in relation to empathy, suggesting that the S-allele confers "differential susceptibility". Moreover, a moderation analysis and tests for differential susceptibility yielded similar results when transcriptional activity of the serotonin transporter gene was taken into account. In conclusion, our findings suggest that the S-allele of the 5-HTTLPR is responsive to early developmental contingencies for "better and worse", i.e. conferring genetic plasticity, especially with regard to processes involving emotional resonance.


Assuntos
Transtorno da Personalidade Borderline/genética , Maus-Tratos Infantis/psicologia , Empatia/genética , Polimorfismo de Nucleotídeo Único , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Adolescente , Adulto , Transtorno da Personalidade Borderline/psicologia , Empatia/fisiologia , Feminino , Heterozigoto , Humanos , Pessoa de Meia-Idade
8.
Medicine (Baltimore) ; 98(37): e17101, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517840

RESUMO

BACKGROUND: Caregivers encounter serious and substantial challenges in managing hypertension in patients with subclinical or clinical borderline personality disorder (BPD). These challenges include therapeutic conflicts resulting from harmful drug-drug, and drug-disease interactions. Current guidelines provide no recommendations for concurrent psychotropic and antihypertensive treatment of hypertensive BPD patients who are at even greater cardiovascular risk. METHODS: We conducted a systematic literature review to assess the extent of available evidence on prevalence rates, cardiovascular risk factors, therapeutic conflicts, and evidence-based treatment recommendations for patients with co-occurring hypertension and BPD. Search terms were combined for hypertension and BPD in PubMed, MEDLINE, EMBASE, Cochrane, and PsycINFO databases. RESULTS: We included 11 articles for full-text evaluation and found a very high prevalence of hypertension and substantial cardiovascular risk in studies on co-occurring BPD and hypertension. However, we identified neither studies on harmful drug-drug and drug-disease interactions nor studies with treatment recommendations for co-occurring hypertension and BPD. CONCLUSIONS: Increased prevalence of hypertension in BPD patients, and therapeutic conflicts of psychotropic agents strongly suggest careful evaluation of treatment strategies in this patient group. However, no studies or guidelines recommend specific therapies or strategies to resolve therapeutic conflicts in patients with hypertension and BPD. This evidence gap needs attention in this population at high risk for cardiovascular disease.


Assuntos
Transtorno da Personalidade Borderline/complicações , Hipertensão/tratamento farmacológico , Psicotrópicos/efeitos adversos , Transtorno da Personalidade Borderline/tratamento farmacológico , Transtorno da Personalidade Borderline/psicologia , Interações de Medicamentos , Humanos , Hipertensão/psicologia , Prevalência , Psicotrópicos/uso terapêutico
9.
J Consult Clin Psychol ; 87(11): 975-988, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31556655

RESUMO

OBJECTIVE: To examine conformity to prototypical therapeutic principles and its relation with change in reflective functioning in 3 treatments for borderline personality disorder (BPD). METHOD: Early phase videotaped sessions from a randomized-controlled trial of year-long transference-focused psychotherapy (TFP; n = 27), dialectical behavior therapy (DBT; n = 26), and supportive psychodynamic therapy (SPT; n = 29) were coded using the Psychotherapy Q-sort (Jones, 1985). Ratings were compared to experts' ratings of ideal TFP, DBT, and mentalizing-enhancing principles to quantify conformity to ideal treatments. Reflective functioning was assessed at pre- and posttreatment. Differences among treatments in conformity and its relation with change in reflective functioning were examined. RESULTS: Conformity to TFP and mentalizing-enhancing principles was highest in TFP (ps < .01) while conformity to DBT principles was high in DBT and SPT (DBT vs. SPT: p > .40), but lower in TFP (ps < .01). Larger improvements in reflective functioning were predicted by higher conformity to TFP principles during TFP (p = .04) and higher conformity to mentalizing-enhancing principles during SPT (p = .02). CONCLUSIONS: Treatments for BPD differ in conformity to unique principles of specific modalities. Treatments also differ in the processes that predict increase in reflective functioning. The findings point to specificity and multiple pathways in increasing reflective functioning in the treatment of BPD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Fidelidade a Diretrizes , Psicoterapia/métodos , Adulto , Terapia Comportamental/métodos , Feminino , Humanos , Masculino , Mentalização , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
10.
Psychiatr Danub ; 31(Suppl 3): 282-289, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488741

RESUMO

Emotionally Unstable Personality Disorder (EUPD) causes significantly impaired personality functioning to include feeling of emptiness, lack of identity, unstable mood and relationships, intense fear of abandonment and dangerous impulsive behaviour including severe episodes of self-harm. The vast majority of EUPD patients are managed in the community, and have less contact with specialist psychiatric services when compared to patients with other mental illnesses. Despite the burden of this condition on primary care, the academic literature focuses on EUPD in psychiatric inpatients. This paper therefore aims to redress this balance through, first, establishing the key themes present in the available body of work on EUPD in the community, and second, highlighting areas for future research. Further, in the spirit of reducing stigma surrounding mental illness, the authors present a novel and non-pejorative toolkit for the recognition of EUPD in primary care.


Assuntos
Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Atenção Primária à Saúde , Sintomas Afetivos , Humanos , Características de Residência , Comportamento Autodestrutivo , Estigma Social
11.
Psychiatr Danub ; 31(Suppl 3): 490-496, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488778

RESUMO

BACKGROUND: Differentiating Borderline Personality Disorder (BPD) from Bipolar Disorder (BD) represents a very difficult challenge for clinicians. Dysphoria could be a possible key to differentiate these disorders. We currently define dysphoria as a complex and disorganized emotional state with proteiform phenomenology, characterized by a multitude of symptoms. Among them irritability, discontent, interpersonal resentment and surrender prevail. These dimensions can be detected using the Neapen Dysphoria Scale - Italian version (NDS-I). Dysphoria role in BPD has been highlighted by the recent theorization of the Interpersonal Dysphoria Model, according to which dysphoria could represent the "psychopathological organizer" of the BPD. On the other side, dysphoria role in BD has not yet been established. This is simply considered as an aspect, and not fundamental, of the symptomatology characterizing BD, especially in mixed states patients. The phenomenological analysis of the dimensional spectrum of dysphoria within BPD and DB could provide a valuable aid in the differential diagnosis between BPD and BD. AIMS: The aim of this paper is to verify if the dimensional spectrum of dysphoria differs between Borderline Personality Disorder (BPD) and Bipolar Disorder Spectrum (BD) through an observational comparative study SUBJECTS AND METHODS: In this study, 65 adult patients, males and females between the ages of 18 and 65, were enrolled from the Psychiatric Service of the Santa Maria della Misericordia Hospital in Perugia (PG), Italy, from January 1st 2018 to April 30th 2019. We have formed 2 groups. A BPD group composed of 33 patients (19 female patients, representing approximately 57.6% of the sample) and a BD group composed of 32 patients (18 Female patients, representing approximately 56.2% of the sample). Patient's comorbid with BD and BPD have been excluded from the study. After a preliminary assessment to exclude organic and psychiatric comorbidity, and after at least 72 hours from hospitalization, we administered them the Neapen Dysphoria Scale - Italian Version (NDS-I), a specific dimensional test for dysphoria. Starting from the dataset, with the aid of the statistical program SPSS 20, we have carried out a comparison between disorders groups selected and their NDS-I total score and subscales (irritability, discontent, interpersonal resentment, surrender); For this we have used the Mann-Whitney U test, a nonparametric test with 2 independent samples, by setting a significance level p<0.05. CONCLUSIONS: This study allowed us to explore and analyze dysphoria dimensions expressions in BPD and BD. Despite the small sample analyzed, the results show a significant different dimensional spectrum expression of the dysphoria between the two disorders. In particular, Irritability and Interpersonal Resentment dimensions show greater interest in BPD than BD spectrum. Further studies with a larger and stratified sample are needed to confirm these results.


Assuntos
Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/psicologia , Pacientes Internados/psicologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Psychiatr Danub ; 31(Suppl 3): 626-631, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488804

RESUMO

BACKGROUND: Springbank Ward, Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, is a Borderline Personality Disorder (BPD) unit employing positive risk-taking, allowing for relevant psychological therapies to be carried out. The aim of this survey was to identify staff and patient attitudes to Springbank Ward. Previous research has not addressed the question of patient and staff perception of these therapeutic approaches. SUBJECTS AND METHODS: We used a qualitative open-ended semi-structured survey of staff and patients (n=2+4, respectively). We gathered information on the perception of the unit, staff, safety and the positive and negative aspects of the ward. Interview transcripts and participation notes were coded and categorised for emerging themes. RESULTS: The four main themes were: views on the unit: 'safe space', 'opportunity', 'community'; views on the programme: 'successful', 'skills-based', involving patients in their own recovery; views on staff: important part of the therapeutic process by delivering elements of dialectical behaviour therapy (DBT); views on safety: patients and staff feel safe in the context of positive risk-taking. CONCLUSIONS: The long-term therapeutic programme offered at Springbank is perceived positively by both patients and staff. Involving patients actively in their recovery remains a powerful tool. The delivery of DBT by nursing staff contributes significantly to the positive perception of the unit. Positive risk-taking is perceived to be a good and safe strategy.


Assuntos
Atitude do Pessoal de Saúde , Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Unidades Hospitalares , Satisfação do Paciente , Pesquisa Qualitativa , Inquéritos e Questionários , Terapia do Comportamento Dialético , Unidades Hospitalares/normas , Humanos
13.
Nord J Psychiatry ; 73(8): 509-514, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31453750

RESUMO

Objective: To identify personality disorders comorbid with borderline personality disorder (BPD) that may confer greater risk for the presence of severe dissociative experiences. Method: Three hundred and one outpatients with a primary diagnosis of BPD were evaluated using the Structured Clinical Interview for DSM-IV Axis II personality disorders, the Borderline Evaluation of Severity Over Time (BEST) and the Dissociative Experiences Scale (DES). Results: The most frequent personality disorders comorbid to BPD were paranoid (83.2%, n = 263) and depressive (81.3%, n = 257). The mean BEST and DES total score were 43.3 (SD = 11.4, range 15-69) and 28.6 (SD = 19.8, range 0-98), respectively. We categorized the sample into patients with and without severe dissociative experiences (41% were positive). A logistic regression model revealed that Schizotypal, Obsessive-compulsive and Antisocial personality disorders conferred greater risk for the presence of severe dissociative experiences. Discussion: Our results suggest that a large proportion of patients with BPD present a high rate of severe dissociative experiences and that some clinical factors such as personality comorbidity confer greater risk for severe dissociation, which is related to greater dysfunction and suffering, as well as a worse progression of the BPD.


Assuntos
Transtorno da Personalidade Borderline/epidemiologia , Transtorno da Personalidade Borderline/psicologia , Transtornos Dissociativos/epidemiologia , Transtornos Dissociativos/psicologia , Índice de Gravidade de Doença , Adolescente , Adulto , Idoso , Transtorno da Personalidade Borderline/diagnóstico , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Dissociativos/diagnóstico , Feminino , Humanos , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/epidemiologia , Transtornos da Personalidade/psicologia , Estudos Retrospectivos , Autorrelato , Adulto Jovem
14.
J Abnorm Psychol ; 128(6): 610-621, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31318241

RESUMO

Borderline personality disorder (BPD) is a complex and debilitating psychiatric illness. Prior research in adults has shown that neurophysiological deficits in feedback processing and learning from rewards may be central to the development of BPD; however, little research has examined these markers in adolescents and young adults with BPD. The present study used event-related potentials and time-frequency decomposition analysis to probe neural responses to wins and losses in a guessing task among 68 females (13 to 23 years old) either with BPD (n = 35) or no history of mental disorders (healthy control [HC]; n = 33). Participants completed a guessing task wherein they won and lost money at equal frequencies while electroencephalogram (EEG) data were acquired. Adolescents and young adults with BPD showed a smaller differentiation between wins and losses in the reward positivity (RewP) relative to HCs. Using time-frequency decomposition, we isolated distinct frequency bands sensitive to wins (delta = < 3Hz) and losses (theta = 4 Hz to 7 Hz). Compared with BPD participants, HCs showed significantly larger delta power to wins, specifically. The groups did not differ in delta power to losses, nor theta power to wins or losses. Collectively, findings implicate altered reward processing in the pathophysiology of BPD and may inform early identification and targeted intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtorno da Personalidade Borderline/fisiopatologia , Ondas Encefálicas/fisiologia , Potenciais Evocados/fisiologia , Recompensa , Adolescente , Adulto , Transtorno da Personalidade Borderline/psicologia , Feminino , Humanos , Adulto Jovem
15.
PLoS One ; 14(7): e0220233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31335909

RESUMO

BACKGROUND: Borderline personality disorder (BPD) is associated with unemployment and impaired functioning. However, a comprehensive understanding of barriers and facilitators to employment from a multidisciplinary perspective is currently lacking. Therefore, the aim of this qualitative study was to explore barriers and facilitators in gaining and maintaining employment in BPD from the perspectives of patients, mental health practitioners (MHPs) and insurance physicians (IPs). METHODS: Fifteen semi-structured interviews were conducted in patients with BPD and two focus groups were carried out among MHPs (n = 7) and IPs (n = 6) following a thematic content analysis approach. RESULTS: All participants described barriers and facilitators relating to three overall themes: characteristics of BPD, stigma, and support to employment. Barriers to employment mainly related to characteristics of BPD, such as low self-image, difficulty posing personal boundaries, difficulty regulating emotions, and lack of structure. MHPs and IPs additionally mentioned externalization and overestimation of competencies on the part of patients. Enhancing emotion regulation and self-reflection by successful treatment was suggested as a facilitator to enhance employment. Increasing collaboration between mental health and vocational rehabilitation services, and increasing knowledge about BPD, were suggested to increase sustainable employment and decrease stigma. CONCLUSIONS: The present findings revealed that both facilitators and barriers are important in gaining and maintaining employment in BPD in which diminishing symptoms, examining stigma and increasing support to employment are key. As a next step, supported employment strategies that follow patient preferences and integrate employment and mental health services, should be studied in the context of BPD.


Assuntos
Transtorno da Personalidade Borderline/psicologia , Emprego/psicologia , Pessoal de Saúde/psicologia , Pacientes/psicologia , Adulto , Transtorno da Personalidade Borderline/epidemiologia , Transtorno da Personalidade Borderline/reabilitação , Emprego/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Serviço Social em Psiquiatria/estatística & dados numéricos
16.
Trials ; 20(1): 347, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31182143

RESUMO

BACKGROUND: Impulsivity is a core feature of borderline personality disorder (BPD) and is closely related to suicide risk and destructive and aggressive behaviors. Although transcranial direct current stimulation (tDCS) has shown its promising effects as an intervention to modulate impulsivity, no study has explored its potential regarding BPD. METHODS/DESIGN: This is a multicenter, crossover, double-blind study comparing active versus sham tDCS (2 mA, 30 min), applied over the dorsolateral prefrontal cortex for five consecutive days in 50 BPD patients. Participants will be assessed for impulsivity, depressive symptoms, and suicide risk. The main efficacy criteria on reduction of impulsivity will be the amplitude variation of one specific evoked potential detected by electroencephalography (EEG) during the balloon analogue risk task. Baseline measures will be compared to scores obtained immediately after sessions, then 12 and 30 days later. DISCUSSION: This study investigates the safety and effects of tDCS, which may have a significant impact on impulsivity in patients with BPD and may be useful to reduce risky behaviors. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03498937 . Registered on 17 April 2018.


Assuntos
Transtorno da Personalidade Borderline/terapia , Comportamento Impulsivo , Ensaios Clínicos Controlados Aleatórios como Assunto , Estimulação Transcraniana por Corrente Contínua/métodos , Transtorno da Personalidade Borderline/psicologia , Estudos Cross-Over , Método Duplo-Cego , Humanos , Estudos Multicêntricos como Assunto
17.
Psychiatry Res ; 273: 712-718, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31207857

RESUMO

According to Linehan (1993), emotion dysregulation is a central feature of borderline personality disorder (BPD). We hypothesized that patients with BPD are emotionally hyperresponsive. For BPD treatment, it is important to evaluate this hypothesis, because, if it is supported, therapeutic interventions could be designed to help patients to better manage hyperemotional reactions. We investigated the subjective reactions (in terms of valence and arousal) of patients with BPD to visual emotional stimuli of the International Affective Picture System (IAPS). We hypothesized that, compared to patients with Cluster-C personality disorders and non-patients, BPD patients would show higher scores on the arousal dimension and higher negative scores on the valence dimension when rating IAPS pictures with varying degrees of arousal and valence. Ratings of valence and arousal for 40 IAPS pictures were collected from 39 borderline personality disorder (BPD), 36 patients diagnosed with Cluster-C personality disorders (PD), and a group of 226 non-patients. Contrary to expectations, BPD patients did not differ from the non-patients. This indicates that their self-report scores do not reflect hypersensitivity. We found that patients with BPD showed lower scores on arousal than Cluster-C PD patients. The scores on valence suggested that Cluster-C PD patients also experienced more positive emotions than BPD patients.


Assuntos
Nível de Alerta/fisiologia , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/psicologia , Emoções/fisiologia , Estimulação Luminosa/métodos , Adulto , Afeto/fisiologia , Condicionamento Clássico/fisiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade
18.
Psychopharmacology (Berl) ; 236(8): 2485-2500, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31201478

RESUMO

BACKGROUND: Borderline personality disorder (BPD) is a pervasive psychiatric disorder characterized by emotion dysregulation, impulsivity, impaired self-perceptions, and interpersonal relationships and currently affects 1-3% of the US population as reported by Torgersen et al. (Arch Gen Psychiatry 58:590-596, Torgersen et al. 2001), Lenzenweger et al. (Biol Psychiatry 62:553-564, Lenzenweger et al. 2007), and Tomko et al. (J Personal Disord 28:734-750, Tomko et al. 2014). One major obstacle to our understanding of the neural underpinnings of BPD is a lack of valid animal models that translate the key known features of the disorder to a system that is amenable to study. OBJECTIVE: To summarize the etiology, major symptoms, and symptom triggers of BPD and then propose a blueprint for building an animal model of BPD by choosing key components of the disorder that can be implemented in rodents. RESULTS: We identify the role of early life stress and subsequent mild stress in adulthood as contributing etiological factors and the potential use of altered communication between frontal cortices and the amygdala in extinction and habituation, increased impulsivity, dysregulation of the hypothalamic pituitary axis (HPA), and increased neuroinflammation as biological markers of BPD. Building upon these features of BPD, we propose a two-hit animal model that uses maternal abandonment to alter maturation of the HPA axis and mild secondary adult stress to evoke behavioral symptoms such as increased impulsivity and impaired extinction, habituation, and social interactions. CONCLUSION: Through exploration of the etiology, symptom presentation, and altered neurological function, we propose an animal model of BPD. We believe that a number of existing animal paradigms that model other mental health disorders should be combined in a unique way to reflect the etiology, symptom presentation, and altered neurological function that is evident in BPD. These model, when compared with available human data, will inform research and treatment in humans for better understanding of systems from the micro-molecular level to more global physiology underlying BPD.


Assuntos
Transtorno da Personalidade Borderline/psicologia , Modelos Animais de Doenças , Comportamento Impulsivo/fisiologia , Relações Interpessoais , Tonsila do Cerebelo/metabolismo , Animais , Transtorno da Personalidade Borderline/genética , Transtorno da Personalidade Borderline/metabolismo , Emoções/fisiologia , Humanos , Sistema Hipotálamo-Hipofisário/metabolismo , Sistema Hipófise-Suprarrenal/metabolismo , Estresse Psicológico/genética , Estresse Psicológico/metabolismo , Estresse Psicológico/psicologia , Transtornos Relacionados ao Uso de Substâncias/genética , Transtornos Relacionados ao Uso de Substâncias/metabolismo , Transtornos Relacionados ao Uso de Substâncias/psicologia
19.
Dev Psychopathol ; 31(3): 1143-1156, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31169118

RESUMO

Borderline personality disorder (BPD) is a severe and complex disorder characterized by instability across many life domains, including interpersonal relations, behavior, and emotions. A core feature and contributor to BPD, emotion dysegulation (ED), consists of deficits in the ability to regulate emotions in a manner that allows the individual to pursue important goals or behave effectively in various contexts. Biosocial developmental models of BPD have emphasized a transaction of environmental conditions (e.g., invalidating environments and adverse childhood experiences) with key genetically linked vulnerabilities (e.g., impulsivity and emotional vulnerability) in the development of ED and BPD. Emerging evidence has begun to highlight the complex, heterotypic pathways to the development of BPD, with key heritable vulnerability factors possibly interacting with aspects of the rearing environment to produce worsening ED and an adolescent trajectory consisting of self-damaging behaviors and eventual BPD. Adults with BPD have shown evidence of a variety of cognitive, physiological, and behavioral characteristics of ED. As the precursors to the development of ED and BPD have become clearer, prevention and treatment efforts hold great promise for reducing the long-term suffering, functional impairment, and considerable societal costs associated with BPD.


Assuntos
Transtorno da Personalidade Borderline/psicologia , Emoções/fisiologia , Comportamento Impulsivo/fisiologia , Relações Interpessoais , Humanos
20.
Dev Psychopathol ; 31(3): 1157-1171, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31156081

RESUMO

One generation's experience of childhood maltreatment is associated with that of the next. However, whether this intergenerational transmission is specific to distinct forms of maltreatment and what factors may contribute to its continuity remains unclear. Borderline personality pathology is predicted by childhood maltreatment and characterized by features (e.g., dysregulated emotion, relationship instability, impulsivity, and inconsistent appraisals of others) that may contribute to its propagation. Among 364 older adults and 573 of their adult children (total n = 937), self-reported exposure to distinct forms of childhood maltreatment (i.e., emotional, physical, and sexual abuse, and emotional and physical neglect as assessed by the Childhood Trauma Questionnaire) showed homotypic and heterotypic associations across generations with little evidence that latent factors unique to specific forms of maltreatment show generational continuity. General nonspecific indices of childhood maltreatment showed evidence of intergenerational transmission after accounting for demographic factors and parent socioeconomic status (b = 0.126, p = 9.21 × 10-4). This continuity was partially mediated by parental borderline personality pathology (assessed longitudinally through a variety of measures and sources, indirect effect: b = 0.031, 95% confidence interval [0.003, 0.060]). The intergenerational continuity of childhood maltreatment may largely represent general risk for nonspecific maltreatment that may, in part, be propagated by borderline personality pathology and/or shared risk factors.


Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis/psicologia , Transtorno da Personalidade Borderline/psicologia , Emoções/fisiologia , Personalidade/fisiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários
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