[Borderline personality disorder and end of life: a major challenge]. / Trouble de la personnalité borderline et fin de vie : un défi de taille.

The care of patients suffering from a borderline personality disorder confronted with death is a relational and clinical challenge for interdisciplinary teams. In this specific context, the particular psychic vulnerability of these patients highlights multiple issues. Based on the scarce existing literature and our clinical experience, this article presents management strategies in order to best support this population weakened by serious illness as well as the interdisciplinary teams that care for them.

La prise en soins de patients souffrant d'un trouble de la personnalité borderline confrontés à la mort est un défi relationnel et clinique pour les équipes interdisciplinaires. Dans ce contexte particulier, la vulnérabilité psychique de ces patients met en lumière de multiples enjeux. Cet article propose, sur la base de la rare littérature existante et de notre expérience clinique, des stratégies de prise en soins afin d'accompagner au mieux cette population fragilisée par la maladie grave ainsi que les équipes interdisciplinaires qui en prennent soin.

[Adaptations of an outpatient Dialectical Behavioral Therapy during the COVID-19 pandemic and consequences of the confinement on patients with borderline personality disorder]. / Adaptations de la thérapie comportementale dialectique ambulatoire en période de pandémie COVID-19 et conséquences du confinement sur des patients souffrant d'un état-limite.

BACKGROUND: The COVID-19 pandemic impacted the accessibility of psychotherapy for particularly vulnerable patients during the period of confinement in the French-speaking part of Switzerland. We had to adapt our usual therapeutic programs. We illustrate this approach in an outpatient program of dialectical behavioral therapy for patients with borderline personality disorder. Each week the individual therapies took place by videoconference or phone. The skills training group was held individually by videoconference or phone and was supported by an online skills training program. Patients filled out their diary cards online. Intersession contact with the therapist remained available as usual and we could organize team consultation. The aim of this study is to describe how a sample of our patients experienced the period of confinement. METHOD: We compared the experiences of seven patients suffering from borderline personality disorder during two periods: eight weeks prior to confinement, and during the eight weeks of confinement. We analyzed their daily diary cards (n = 426) and their weekly frequency of problem behaviors (n = 69). We performed multilevel analyses to take into account the hierarchical structure of the data and the autocorrelation of observations. RESULTS: The seven patients were predominantly female (85.7 %) and had an average age of 35.1 (11.5) years. Measurements prior to the start of the pandemic indicated on average severe depression (Beck Depression Inventory, m = 30.9 [10.0]) and marked hopelessness (Beck Hopelessness Scale, m = 15.0 [5.0]). Analysis of the daily diary cards indicated that the confinement period significantly predicted a decrease in feelings of shame or guilt, fear and tension. At the same time, however, there was an increase in distress. Weekly monitoring of problem behaviors showed a decrease in binge-eating behaviors and a trend towards a decrease in alcohol consumption during confinement. CONCLUSIONS: Despite the small number of patients included, two types of repeated measurements indicated convergent results, with some improvements during confinement: a decrease of the feelings of fear, shame or guilt, and tension, and a decrease of the frequency of binge-eating behaviors. The decreased pace of daily social and professional life may explain these improvements. The diminution of the above-mentioned feelings as triggers for addictive and compulsive behaviors may also account for the improvements regarding binge-eating. However, they also experienced an increased distress that may reflect the loneliness experienced during this period. The pre-pandemic development of computerized tools that were already familiar to patients greatly facilitated the necessary adaptations to maintain an intensive therapeutic setting during the confinement. This may partly explain why these patients were able to adjust the challenges of this period.

Group intervention for family members of people with borderline personality disorder based on Dialectical Behavior Therapy: Implementation of the Family Connections® program in France and Switzerland.

BACKGROUND: Families and significant others of people with borderline personality disorder (BPD) show increased levels of psychological distress. Family Connections®, a 12-week group intervention based on the principles of Dialectical Behavior Therapy, was designed to provide families with both information about the disorder and emotion regulation skills. It has been progressively implemented in French-speaking European countries. METHODS: We conducted an observational, multicenter study in France and Switzerland. In total, 149 participants of the Family Connections program were included among five centers. Burden, depression, coping, and emotion regulation were assessed before and after the intervention. RESULTS: One-way repeated measures MANOVA showed that the burden, depressive symptoms, emotion regulation and coping all changed significantly after the intervention (p < 0.001, partial η2 = 0.297). T-tests showed that the burden significantly decreased after the intervention (p < 0.0001, d = -0.48), as did depressive symptoms (p < 0.0001, d = -0.36) and difficulties in emotion regulation (p < 0.0001, d =-0.32) whereas coping improved (p < 0.0001, d = 0.53). Two-way mixed ANOVA showed that burden reduction was stronger among female than male participants (p = 0.048, η2 = 0.027). Before the intervention, the burden was higher for female than male participants (p < 0.001). An initial linear regression showed the burden reduction to be associated with a decrease in the resignation of the participants (ß = 0.19, p = 0.047). A second linear regression showed the burden reduction to be associated with the intensity of the relatives' symptoms at baseline (ß = 0.22, p = 0.008) and improvement of emotional clarity of the participants (ß = 0.25, p = 0.006). CONCLUSION: This Dialectical Behavior Therapy-Based psychoeducational intervention is an appropriate way to support French-speaking European families of people with BPD.

Psychometric properties of the French borderline symptom list, short form (BSL-23).

BACKGROUND: The short form of the Borderline Symptom List (BSL-23) is a self-rating instrument used to assess specific symptoms of borderline personality disorder (BPD). The original German version has shown good psychometric proprieties. The BSL-23 can also be used to measure the effects of therapy on patients with BPD. The aim of this study was to assess the psychometric properties of the French version of the BSL-23. METHODS: The French version of the BSL-23 was given to 265 subjects with BPD. Factor structure, reliability, test-retest stability, convergent validity, divergent validity, and sensitivity to change were analysed. Forty-five subjects suffering from attention-deficit hyperactivity disorder (ADHD) were used as controls to evaluate the specificity of BSL-23. RESULTS: A one-factor structure was obtained in the French version of the BSL-23, showing high internal consistency (Cronbach's alpha = .94) and test-retest reliability (r = .841). The French version of the BSL-23 was highly correlated with depression severity, hopelessness, anger, motor impulsiveness, and BPD diagnosis. It was an efficient tool to discriminate between BPD patients and ADHD patients, and showed good sensitivity to change in a group of BPD patients who took part in a one-month DBT intervention. CONCLUSIONS: The French version of the BSL-23 shows similar psychometric properties as the original German version. This study therefore provides clinicians and researchers with a French instrument to measure BPD symptomatology.

Intensive dialectical behavior therapy for outpatients with borderline personality disorder who are in crisis.

OBJECTIVE: This study examined the effectiveness of an intensive version of dialectical behavior therapy for patients in an outpatient setting who met criteria for borderline personality disorder and who were in crisis. METHODS: Over the two-year study period, 127 patients (103 women) between the ages of 18 and 52 years were referred to the program; 87 were admitted, and because of a limited number of places, 40 were referred elsewhere. Patients were admitted after recent suicidal or parasuicidal behavior, and the most suicidal patients were given priority. The treatment was a three-week intensive version of dialectical behavior therapy consisting of individual therapy sessions; an emphasis on skills training provided in groups, including mindfulness skills; and team consultation. A diagnostic interview was administered, and patients were screened with the International Personality Disorder Examination Screening Questionnaire, the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS), and the Social Adaptation Self-Evaluation Scale. RESULTS: The only significant difference at intake between patients admitted to the program and those referred elsewhere was a slighter higher incidence of antisocial traits in the latter group. Of the 87 patients admitted, 71 (82 percent) completed the program and 16 (18 percent) dropped out. Pre-post analysis showed significant improvement in scores on the BDI and BHS. CONCLUSIONS: The three-week, intensive version of dialectical behavior therapy was found to be an effective treatment. Treatment completion was high, and patients showed statistically significant improvements in depression and hopelessness measures. This approach allowed therapists to treat a large number of patients in a short time.

Monoclonal antibodies specific for the IL-18 receptor.

Interleukin-18, a pleiotropic cytokine is a member of the IL-1 family and has multiple immunoregulatory functions. IL-18 action leads to IFNgamma production by NK or T cells, induces Th1 differentiation and suppresses IgE synthesis by B cells when acting on responding cells in association with IL-12. At present two subunits of the IL-18R have been characterized: IL-18 Ralpha and IL-18 Rbeta. Both receptors belong to the IL-1R family. IL-18 Ralpha has been described as the ligand-binding chain and IL-18 Rbeta as the signal-transduction chain. Three monoclonal antibodies (mAbs) submitted to the HLDA8 workshop, designated H44 (80438), B-B46 (80228), and B-E43 (80232) were evaluated. The mAb specificity was determined by ELISA using coated recombinant IL-18 Ralpha or IL-18 Rbeta. Cell staining was analyzed by flow cytometry. A positive staining with the mAb B-E43 or H44 demonstrated that IL-18 Ralpha is expressed on several myeloid cell lines. No positive cell staining was observed with the anti IL-18 Rbeta mAb B-B46. The mAb biological activity was studied using the cell line KG1. A downmodulation of IFNgamma production was observed with the mAbs B-B46 (80228) and B-E43 (80232).