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1.
Am J Geriatr Psychiatry ; 28(9): 983-988, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32622730

RESUMO

BACKGROUND: Societal measures in context of the COVID-19 outbreak forced us to transform our schema therapy based day-treatment for older adults with chronic affective disorders and personality problems into an online program. The objective of this paper is to present first impressions of this transformation. METHODS: Using over-the-phone instructions initially, all patients were able to participate with the online therapy program. To reduce screen-time for patients, the nonverbal therapies were shortened. Four patients, aged 64-70 years, started our online program. RESULTS: Therapists were positive about the online capabilities and resilience of patients to adapt to the new situation. Prejudices on limited effectiveness of online psychotherapy were counteracted. Sending homework by email and mail seems to facilitate therapy adherence. Nonverbal therapy could be important to stimulate the online group process. CONCLUSION: We were positively surprised by the online capabilities of our geriatric mental healthcare patients and encourage further formal effectiveness studies.


Assuntos
Infecções por Coronavirus/psicologia , Transtornos da Personalidade/terapia , Pneumonia Viral/psicologia , Psicoterapia de Grupo/métodos , Psicoterapia/métodos , Telemedicina/métodos , Idoso , Betacoronavirus , Surtos de Doenças , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Pandemias
2.
PLoS One ; 15(6): e0234047, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32502161

RESUMO

AIM: Personality Disorders (PD) often share clinical and phenomenological overlap with psychotic disorders, especially at onset. However, there is little research on comorbid PD among people experiencing first episode psychosis. We examined the prevalence of PD recording and its sociodemographic and clinical correlates in people accepted to Early Intervention in Psychosis (EIP) services. METHODS: Participants were aged 16-35, accepted into 6 EIP services for suspected psychosis, as part of the Social Epidemiology of Psychoses in East Anglia (SEPEA) study. PD was recorded by clinicians according to ICD-10. Multilevel logistic regression was performed. RESULTS: Of 798 participants, 76 people (9.5%) received a clinical diagnosis of PD, with emotionally unstable PD (75.0%, N = 57) the most common subtype. In multivariable analysis, risk factors for PD included female sex (odds ratio [OR]: 3.4; 95% CI: 2.0-5.7), absence of psychotic disorder after acceptance to EIP (OR: 3.0; 95% CI: 1.6-5.5), more severe hallucinations (OR: 1.6; 95% CI: 1.2-2.1), and lower parental SES (OR: 1.4; 95% CI: 1.1-1.8). Compared with the white British, black and minority ethnic groups were less likely to receive a PD diagnosis (OR: 0.3; 95% CI: 0.1-0.7). There was no association between PD and neighbourhood-level deprivation or population-density. CONCLUSIONS: Recording of a PD diagnosis was three times more common amongst participants later found not to meet threshold criteria for psychotic disorder, implying phenomenological overlap at referral which highlights difficulties encountered in accurate diagnostic assessment, treatment and onward referral. People with PD experienced more individual-level, but not neighbourhood-level social disadvantage in an already disadvantaged sample.


Assuntos
Intervenção Médica Precoce , Transtornos da Personalidade/diagnóstico , Adulto , Estudos de Coortes , Feminino , Alucinações/complicações , Alucinações/patologia , Humanos , Masculino , Razão de Chances , Transtornos da Personalidade/complicações , Transtornos da Personalidade/etnologia , Transtornos da Personalidade/terapia , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Adulto Jovem
4.
Clín. salud ; 31(1): 47-53, mar. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-191915

RESUMO

The identification of transdiagnostic mediating processes involved in a therapeutic change and their relationship with personality can contribute to a better adjustment of a therapeutic technique, enhancing its effectiveness. In a sample of 158 adults diagnosed with personality disorder who complete an inpatient therapeutic community program for 6 months, the hypothesis of a differential reduction in symptom intensity according to the externalizer/internalizer typology is tested, and cognitive variables mediating change are explored. A pre-post change (p = .000, etap2 = .50) is observed, along with a difference between externalizers and internalizers (p = .002, etap2 = .06), and an interaction effect (p = .037, etap2 = .03). The effect of personality type on symptom change (Beta = .43, p = .009) is no longer significant when negative automatic thoughts and dysfunctional attitudes are considered as mediators (Beta = .06, p = .549). Findings are discussed from the perspective of personality disorder as a vulnerability factor


La identificación de procesos mediadores transdiagnósticos intervinientes en el cambio terapéutico y su relación con la personalidad puede contribuir a un mejor ajuste de la técnica terapéutica, potenciando su eficacia. En una muestra de 158 adultos diagnosticados de trastorno de personalidad inscritos en un programa de comunidad terapéutica hospitalaria durante 6 meses se pone a prueba la hipótesis de una reducción diferencial de laintensidad sintomatológica según la tipología externalizador/internalizador y se exploran las variables cognitivas mediadoras del cambio. Se observa un cambio pre-post (p = .000, Etap2 = .50), la diferencia entre externalizadores e internalizadores (p = .002, Etap2 = .06) y el efecto de interacción (p = .037, Etap2 = .03). El efecto del tipo de personalidad sobre el cambio en los síntomas (Beta = .43, p = .009) deja de ser significativo cuando se consideran los pensamientos automáticos negativos y las actitudes disfuncionales (Beta = .06, p = .549) como mediadores. Se discuten los resultados desde la perspectiva del trastorno de personalidad como factor de vulnerabilidad


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Transtornos da Personalidade/terapia , Psiquiatria Comunitária , Terapia Cognitivo-Comportamental , Avaliação de Resultados em Cuidados de Saúde
7.
Curr Psychiatry Rep ; 22(3): 14, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32025914

RESUMO

PURPOSE OF REVIEW: The aim of the paper is reviewing recent literature on the epidemiology, assessment, and treatment of personality disorders (PDs) among older adults (≥ 60 years). RECENT FINDINGS: Since 2015, 12 primary empirical studies have been published addressing PDs in older adults; 3 addressing epidemiological aspects, 6 on assessment, 2 exploring both epidemiology and assessment, and 1 examining treatment. PD research in older adults is steadily growing and is predominantly focused on assessment. The studies showed that PDs were rather prevalent ranging from 10.6-14.5% in community-dwelling older adults, to 57.8% in nursing home-residing older adults. The Severity Indices of Personality Problems-Short Form, Gerontological Personality disorders Scale, and Assessment of DSM-IV Personality Disorders turned out to be promising instruments for assessing PDs in later life. Furthermore, schema therapy seems to be a feasible and effective intervention. Despite promising findings, there is an urgent need for studies addressing PDs in older adults, especially studies investigating epidemiological aspects and treatment options. Furthermore, new areas of interest arise such as PDs in other settings, and behavioral counseling.


Assuntos
Transtornos da Personalidade/epidemiologia , Transtornos da Personalidade/terapia , Psicoterapia , Idoso , Manual Diagnóstico e Estatístico de Transtornos Mentais , Humanos , Determinação da Personalidade , Transtornos da Personalidade/diagnóstico , Prevalência
10.
Rev. Asoc. Esp. Neuropsiquiatr ; 39(136): 259-280, jul.-dic. 2019. graf
Artigo em Espanhol | IBECS | ID: ibc-192358

RESUMO

En este artículo se ofrece una descripción del modelo de hospital de día que hemos desarrollado en Alcalá de Henares, destinado fundamentalmente a personas diagnosticadas de trastornos de la personalidad y (actualmente) de trauma complejo. Se describen brevemente las teorías en las que se apoya: la Terapia Basada en la Mentalización y la Terapia de Grupo Interpersonal. El hospital de día está focalizado en activar la capacidad de mentalización de los pacientes y en mantener la de los profesionales mientras se interactúa en la compleja red de relaciones interpersonales que se constituye en él. Se explica el contexto en que se ha desarrollado, incluyendo cuestiones como la perspectiva de género, la importancia cada vez mayor que se está reconociendo al trauma en la aparición de la psicopatología, la necesidad de cuidar a los cuidadores o, más concretamente en Alcalá de Henares, el desarrollo de un "Proceso de atención a personas diagnosticadas de trastornos de la personalidad", del que forma parte el hospital de día. Por último, se describe su funcionamiento a lo largo de las diferentes fases de tratamiento y se ofrecen algunos datos de un estudio pre-post tratamiento con datos del periodo comprendido entre 2007 y 2015


This article provides a description of the day hospital model developed in Alcalá de Henares, aimed primarily at people diagnosed with personality disorders and (currently) complex trauma. The theories on which it relies are briefly described: Mentalization-Based Therapy and Interpersonal Group Therapy. The day hospital is focused on activating the mentalization capacity of patients and maintaining that of professionals, while interacting in the complex network of interpersonal relationships developed in it. It explains the context in which it has been developed, including issues such as the gender perspective, the increasingly recognized importance of trauma in the emergence of psychopathology, the need to care for caregivers or, more specifically in Alcalá de Henares, the development of a "Care process for people diagnosed with personality disorders", of which the Day Hospital is part. Finally, its operation throughout the different phases of treatment is described and some data from a pre-post treatment study from the period between 2007 and 2015 are provided


Assuntos
Humanos , Hospital Dia , Teoria da Mente , Psicoterapia de Grupo , Transtornos da Personalidade/terapia , Relações Interpessoais , Espanha
11.
Int J Law Psychiatry ; 66: 101463, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31706395

RESUMO

BACKGROUND: Offenders with personality disorder experience significant co-morbid mental health problems and present with an increased risk of offending. The evidence for the effectiveness of interventions for personality disordered offenders in the community is limited. This study was a pilot study to determine the feasibility of a randomised controlled trial (RCT) of an intervention known as Resettle for personality disordered offenders and to explore the possible effects of this intervention. METHODS: Potential participants were recruited from referrals of male prisoners to Resettle. Those consenting underwent baseline assessments before being randomised to Resettle or treatment as usual. Officially recorded and self-report offending was assessed over two years following release from custody. Of the 110 eligible participants, 72 (65%) participated in the study of whom 38 were randomised to Resettle and 34 to treatment as usual. The two groups had a similar psychiatric and offending profile. RESULTS: Analysis of officially recorded offences at two years found mixed results, but whether adopting an intent-to-treat approach or including only those who received the intervention there was no clear evidence of an effect of the intervention. A comparison of self-report offending found no effect of Resettle in an intent-to-treat analysis, but there was an effect when the analysis involved only those participating in the intervention. CONCLUSIONS: This study demonstrated that with some adjustments it was possible to carry out an RCT of a complex intervention for personality disordered offenders in a criminal justice setting. Some, but not conclusive, evidence was found in favour of the intervention.


Assuntos
Transtornos da Personalidade/terapia , Prisioneiros/psicologia , Reincidência/prevenção & controle , Reincidência/estatística & dados numéricos , Adulto , Comorbidade , Criminosos , Inglaterra , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/psicologia , Projetos Piloto , Análise de Regressão , Resultado do Tratamento , País de Gales , Adulto Jovem
12.
Turk Psikiyatri Derg ; 30(2): 137-141, 2019.
Artigo em Turco | MEDLINE | ID: mdl-31487379

RESUMO

Narcissism is a recurring topic of psychoanalysis since its beginningand has gained a place in everyday language of modern societies.However, there still exist gaps and limitations in our knowledge ofnarcissistic personality disorder (NPD), which presents the need forbetter integration of already existent theoretical conceptualisations ofthe disorder. In the present paper, we have examined the theories of,Otto Kernberg and Heinz Kohut, the two most influential, howeverdisagreeing, psychoanalytic thinkers on the topic. For the purpose ofthe comparative review, we have examined multiple convergences anddivergences of their theories. We have examined the development ofnormal narcissism of infancy and childhood, which is essential forhealthy development of the individual; characteristics and course ofpathology conceptualisation, in which we also addressed the cause andsource of the pathology; attitudes and behaviours relating to objectrelations; classification of the pathology; and treatment applications.The review indicates that, despite divergences, both theories represent avaluable theoretical perspective of the disorder, which can be observedin the modern application of these theories in different evidence basedpsychoanalytic treatments.


Assuntos
Narcisismo , Transtornos da Personalidade/psicologia , Humanos , Transtornos da Personalidade/terapia , Teoria Psicanalítica , Psicoterapia
13.
J Nerv Ment Dis ; 207(11): 944-950, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31503182

RESUMO

Individuals with personality disorders experience worry and repetitive thoughts regarding interpersonal scenarios. Mainstream mindfulness-based approaches may be insufficient to soothe these individual's distress due to difficulties in letting thoughts go and refocusing attention to the present moment. For this reason, we devised an adapted form of mindfulness-based program called Metacognitive Interpersonal Mindfulness-Based Training (MIMBT) for personality disorders. In this pilot study, 28 individuals attended nine weekly sessions to evaluate the feasibility and acceptability, and to establish preliminary outcomes. All individuals completed the program. Attendance was very high (96%). Significant changes were observed on the primary outcome of reduction in repetitive thinking, measured using the Metacognition Questionnaire-30. We also observed a decrease in depression severity. Despite important limitations, this pilot study suggests that MIMBT has the potential to be a viable and well-accepted option for increasing positive outcomes in the treatment of personality disorders. Clinical considerations and directions for future research are discussed.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Metacognição/fisiologia , Atenção Plena/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Transtornos da Personalidade/psicologia , Transtornos da Personalidade/terapia , Adulto , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Personalidade/diagnóstico , Projetos Piloto , Adulto Jovem
14.
Emerg Nurse ; 27(4): 20-24, 2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31468847

RESUMO

Emergency departments (EDs) may already be invalidating environments for patients diagnosed with a personality disorder, with negative attitudes from staff perpetuating patients' feelings of dismissal and rejection. Despite a higher prevalence of patients with personality disorder in health services, including EDs, than the general population, there is a lack of literature on how achieving ED targets may affect this patient group. This article expands on Harden's concept of destructive goal pursuit in relation to the four-hour target and uses the literature to illustrate how pressures to meet the target may distort clinical priorities and result in adverse clinical outcomes for patients. It makes recommendations for practice including using short-stay units in which patients can be treated outside of the target wait time and introducing mental health triage in EDs to improve delivery of psychosocial assessments.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Transtornos da Personalidade/psicologia , Listas de Espera , Inglaterra , Humanos , Satisfação do Paciente , Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/terapia , Qualidade da Assistência à Saúde , Triagem , Carga de Trabalho
15.
BMC Psychiatry ; 19(1): 228, 2019 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340791

RESUMO

BACKGROUND: An adequate frequency of treatment might be a prerequisite for a favorable outcome. Unfortunately, there is a diversity of factors that interfere with an adequate frequency of sessions. This occurs especially in the first phase of treatment, while the first phase seems vital for the rest of treatment. The aim of this naturalistic study was to explore the impact of the initial frequency of treatment sessions on treatment outcome in a diverse mental health care population. METHODS: Anonymized data were analyzed from 2,634 patients allocated for anxiety disorders, depressive disorders, and personality disorders to outpatient treatment programs in a large general mental health care facility. Patients' treatment outcome was routinely monitored with the Outcome Questionnaire-45 (OQ-45.2), every 12 weeks. Frequency of sessions was assessed for the first three months of treatment. Using Cox-proportional-hazard models, we explored the associations between initial frequency and improvement (reliable significant change) and recovery (reliable and clinically significant change). RESULTS: Improvement and recovery were associated with symptom severity and functional impairment at start of treatment, the year the treatment started, number of measurements, the treatment program (anxiety disorders, depressive disorders, and personality disorders) and receiving group therapy other than psychotherapy. In all diagnostic groups, both improvement and recovery were associated with a higher frequency of sessions during the first three months of treatment. For improvement, this effect diminished after three years in treatment; however, for recovery this association was sustained. CONCLUSIONS: In addition to severity at start of treatment and other predictors of outcome, a low frequency of initial treatment sessions might lead to a less favorable outcome and a more chronic course of the mental disorder. This association seems not to be limited to a specific diagnostic group, but was found in a large group of patients with common mental disorders (depression and anxiety disorders) and patients with a personality disorder. Despite organizational obstacles, more effort should be made to start treatment quickly by an effective frequency of session.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Transtornos Mentais/terapia , Serviços de Saúde Mental/estatística & dados numéricos , Psicoterapia/estatística & dados numéricos , Adulto , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Doença Crônica , Estudos de Coortes , Transtorno Depressivo/psicologia , Transtorno Depressivo/terapia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Transtornos da Personalidade/psicologia , Transtornos da Personalidade/terapia , Fatores de Risco , Inquéritos e Questionários , Resultado do Tratamento
16.
Int J Ment Health Nurs ; 28(5): 1173-1182, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31286646

RESUMO

Individuals with a diagnosis of personality disorder (PD) face negative attitudes and are often deemed harder to care for than individuals with other diagnoses. To improve care and engagement with services, it is essential to understand the ways general psychiatric nursing staff approach this client group. This research aims to examine the ways inpatient psychiatric nursing staff therapeutically engage with individuals with a diagnosis of PD. Focus groups were conducted with Registered Mental Health Nurses (n = 7) and Health Care Assistants (formally known as nursing assistants; n = 12) who care for individuals with a diagnosis of PD in a general psychiatric inpatient setting. A thematic analysis indicated six themes: the right frame of mind, knowing the service user, knowing when to engage, service user input, a unified approach, and structured admissions. The findings highlight what non-PD specialist inpatient nursing staff do in order to engage therapeutically with this group of service users and areas that require improvement. Supporting good practice could improve staff confidence when caring for this client group, lower stigma around the diagnosis, and promote a more positive experience of care for individuals with a diagnosis of PD who are using general inpatient mental health services.


Assuntos
Relações Enfermeiro-Paciente , Participação do Paciente/psicologia , Transtornos da Personalidade/terapia , Enfermagem Psiquiátrica , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Transtornos da Personalidade/psicologia , Inquéritos e Questionários
17.
Personal Ment Health ; 13(3): 168-179, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31237109

RESUMO

A high prevalence of people present to 'Improving Access to Psychological Therapies' (IAPT) in England with common mental health disorders and co-morbid personality disorder. This group have suboptimal treatment outcomes in IAPT. Whilst new short-term treatment approaches are advocated, no solutions or guidance have been provided. This qualitative study explored IAPT health-care professional (N = 28) perspectives of working with people who present to IAPT with co-morbid personality disorder. Individual semi-structured interviews were digitally recorded, transcribed verbatim and analysed using a framework analysis approach. Results identified a lack of skills and confidence in working with this patient group, restrictive service constraints and a treatment gap between the interface of primary and secondary services. Insight into acceptable adaptions to practice are identified that have transferable utility to a wider international audience who can identify people outside of specialist mental health services with common mental health disorders and co-morbid personality disorder traits. © 2019 John Wiley & Sons, Ltd.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde Mental , Transtornos da Personalidade/complicações , Psicoterapia , Atitude do Pessoal de Saúde , Inglaterra , Humanos , Transtornos da Personalidade/psicologia , Transtornos da Personalidade/terapia , Pesquisa Qualitativa
18.
Law Hum Behav ; 43(4): 319-328, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31204832

RESUMO

The objective was to evaluate the relative efficacy of dialectical behavior therapy modified for stalking offenders (DBT-S) versus a cognitive-behavioral anger management intervention for the treatment of stalking offenders. We expected DBT to result in significantly lower rates of renewed stalking behavior and significantly greater improvements in impulsivity, aggression, anger, and empathy. We randomly assigned individuals charged with stalking-related offences (N = 109) to one of two study interventions: DBT-S and anger management. Recidivism (renewed stalking, violence, and other offences) was monitored for 1 year following the baseline assessment, and participants completed a battery of self-report questionnaires before and after treatment and at a 1-year follow-up assessment. We found relatively low rates of reoffence when compared to past studies of untreated stalking offenders in the U.S., but type of treatment had no impact on the likelihood of reoffence, nor did completion of the treatment program. Likewise, there was no between-groups difference in rates of treatment completion, or on changes in self-report measures. Intensive treatment focused on reducing problematic behaviors in stalking offenders may be effective regardless of treatment modality, but the mechanism by which treatment impacts criminal behavior is not yet clear. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia de Controle da Ira , Terapia do Comportamento Dialético , Reincidência/estatística & dados numéricos , Perseguição/terapia , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Transtornos da Personalidade/terapia , Autorrelato , Inquéritos e Questionários , Adulto Jovem
20.
Psychotherapy (Chic) ; 56(2): 285-296, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31144852

RESUMO

Different forms of psychotherapy are effective for cluster C personality disorders, but we know less about what in-session processes promote change. Contrasting successful and unsuccessful cases may elucidate processes that facilitate or impede outcome and offer suggestions for clinical practice and future research. In this exploratory outcome-process study, 10 successful and 10 unsuccessful cases were selected from a randomized trial comparing cognitive therapy and short-term psychodynamic psychotherapy for cluster C personality disorders. Videotaped sessions were rated with the Psychotherapy Process Q-Set (PQS). The treatments were compared in terms of which PQS items differentiated successful and unsuccessful cases, as well as their resemblance with PQS prototypes of "ideal treatments." Therapists' behavior in early sessions was also explored. Results indicate that successful cases in our sample were characterized by a more active and engaged patient. In contrast, unsuccessful cases were characterized by a more directive or "controlling" therapist stance. Correlations with PQS prototypes were moderate to strong in both successful and unsuccessful cases, suggesting that optimal and suboptimal interpersonal processes may be independent of adherence to particular treatments. Exploration of therapist behaviors in early sessions indicated that therapists were more likely to adjust their way of working in the successful cases. Our result suggests that patient engagement and therapists' early efforts to improve the therapy relationship may be pivotal for successful outcome, whereas therapist controlling behavior may obstruct the treatment process, regardless of therapy model used. The impact of these in-session processes should be examined more closely in larger samples in future studies. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtornos da Personalidade/psicologia , Transtornos da Personalidade/terapia , Processos Psicoterapêuticos , Psicoterapia Breve/métodos , Psicoterapia Psicodinâmica/métodos , Adulto , Feminino , Humanos , Masculino , Psicoterapia/métodos , Resultado do Tratamento
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