bluuebunny/crossref_metadata_2025 huggingface dataset:
Age and clinical presentation of patients at onset of borderline personality disorder in a mental health unit
Authors: Garcia Tellez J.M. , Gonzalez Saavedra L. , Sanchez-Moyano Lea J.M.
Published: May 2011

Ojective

Borderline Personality disorder is a well recognised syndrome. These patients show a clear emotional unstability, lack of control impulse, unpredictible auto and heteroaggresive behaviour, poor interpersonal realitionships and self image as well as brief psychotic episodes.The unspecific symtomatology and diagnostic difficulty derived from different nosographic frames makes their diagnosis and treatment a challenge. Through the analysis of their medical records we aim to know the age they sought specialized help, the symptomatology at first consultation, the treatment given and the outcome after years of therapy.

Methodology

Systematic review of all BPD patient's medical records treated in our Unit with a particular reference to age and symptoms at the start of treatment and at present. Medical records from the Childhood and Adolescence Psychiatric Unit were also reviewed to determine the most prominent symptoms at that time.

Results

We found that the vast majority of cases contacted the psychiatric services in their adolescence and early adulthood, probably in relation to demands of daily life at that age. The most relevant symptoms at onset of illness were depressive mood and anxiety. As time went on depressive symptoms were the main complaint. The clinical state remained fairly stable over time.

Conclusions

There is a clear early onset of symptoms, in particular, affective ones (depression and anxiety) being prominent in childhood and preadolescence. Also there is a stable psychopathology over time which keep the patients on long term follow ups. This medical demand seemed to diminish at their fifth decade.
Analysis of the clinical boarding of the BPD in ambulatory treatment
Authors: Garcia Tellez J.M. , Gonzalez Saavedra L. , Sanchez-Moyano Lea J.M.
Published: May 2011

Objective

It has become increasingly clear over the last few years that the most effective treatments for patients with Borderline Personality Disorder (BPD) is a combined psychological and pharmacological approach, aiming to improve the symptoms, feelings and behaviours that are so distressing and damaging to their lives. On this poster we try to show our daily therapeutic practice with these patients through a complete review of the BPD patient's medical records available in our outpatients psychiatric clinic.

Method

Systematic review of all BPD patients medical records, treated in our clinic with a particular reference to pharmacological, psychotherapeutic or both approaches stating the type of intervention in each case.

Results

We found a mostly mixed approach to treating BPD patients in our clinic as clinical guidelines and other literature recommends. Being critical of our practice, we have observed a prolonged use of medication despite evidence suggesting a sometimes limited benefit for acute and chronic symptoms.

Although psychotherapeutic interventions are widely used in our Clinic, it is doubtful that the most accepted psychotherapies mentioned earlier are the ones implemented (Kernberg, Linehan….)

Conclusion

The evidence from the literature and prescribing guidelines, suggests that some of the main approaches to treating BPD patients are specific psychotherapies. However, without belittling the benefit of these psychotherapies, we found that the use of psychopharmacological treatments helps too with alleviating acute and more chronic symptoms; maybe improving the likelihood of psychotherapeutic engagement.
Factitious bereavement with psychotic features in a patient with borderline personality disorder and opium dependence
Authors: Ghaffarinejad A. , Shahriari V.
Published: May 2011

Factitious disorder, whilst uncommon, is not rare in patients referring to clinics and psychiatric hospital.

Concerning high rate of grief reactions in this province after the Bam earthquake in the year 2004, we believe that this condition is Under diagnosed, mainly because of diagnostic difficulties. In current article an unusual case who came with psychotic symptoms accompanied by symptoms of complicated grief is reported. The final diagnosis is supposed to be factitious bereavement.

Reported case is a 27 years old man with approved diagnosis of borderline personality disorder and opium dependence. At the last session of hospitalizing in 2010, his symptoms include : irritability, aggression and emphasis on visiting his relatives and some strange people who died in the Bam earthquake about six years ago, in which the patient took part in finding their corpses in collaboration with safety guards.

From onset of disturbance, patient claimed that those deceased people are continuously present around him, talk to him and blame him because of his insufficient effort to save them. He also believes that the experiences are real and those people are alive at present. Relationship between factitious disorder with bereavement symptoms is not well-described in literatures, so this patient and influences of personality structure and opium dependence on forming patient's symptoms are discussed in this article.
Self disclosure and self criticism in adolescents
Authors: Horesh-Reinman N.
Published: May 2011

Background

The purpose of the study was to examine the relationship between self-disclosure and self-criticis, positive and negative life events, social support, and a number of well-being and distress variables.

Methods

Fifty-one adolescents suffering from emotional difficulties and 47 healthy adolescents participated in the study. The following questionnaires were administered to the subjects: Major Life Events Questionnaire, Minor Life Events Questionnaire, Self-Disclosure Questionnaire, Self-Criticism Questionnaire, Social Support Questionnaire, Depressive symptoms questionnaire, Mood questionnaire and demographic questionnaire.

Results

The study group was characterized by a greater number of major negative life events, a lower level of social support, and a higher level of distress indexes. In the whole sample a positive relation was found between life events and the social network size, and also between positive life events and self-disclosure level and between it and satisfaction from social support. We also found a positive relationship between the negative life events and some of the distress indexes. In addition, there were gender differences in self-disclosure: the girls were more willing to disclose themselves to a close friend in comparison to the boys. A negative relationship was found between self-criticism and social network size. Moreover, self-criticism was related positively to suicidal tendency indexes and was negatively related to positive mood. Finally, a negative relationship was found between social support and some of the distress indexes.

Conclusions

The results of the study confirmed most of the research hypotheses. The theoretical and clinical implications of the study are discussed, as well its strengths and limitations.
Alexithymia and interpersonal functioning:an extension of empirical research by using a dimensional approach for interpersonal style and the structured interview for alexithymia
Authors: Inslegers R. , Vanheule S. , Meganck R. , Desmet M.
Published: May 2011

Introduction

The concept of alexithymia refers to problems in experiencing and regulating affects; clinical study as well as empirical research suggests that alexithymia is related to cold and socially inhibited interpersonal functioning. However, empirical studies frequently use only self report questionnaires.

Objectives/aims

This study investigates the relation between alexithymia and self-reported interpersonal problems. By using an interview measure of alexithymia next to a questionnaire, we want to avoid artificially high correlations due to shared method variance and thus get a clearer picture of the link between alexithymia and interpersonal style. We hypothesize that alexithymia will be related to a cold, but not to a dominant or submissive interpersonal style.

Method

The Toronto Structured Interview for Alexithymia (TSIA) was administered by a trained researcher to 74 psychiatric inpatients, who also filled out the Toronto Alexithymia Scale (TAS-20) and the Inventory of Interpersonal Problems (IIP-64). Dimensional affiliation and dominance scores of the IIP-64 were computed and Pearson correlations between TSIA, TAS-20 and IIP-64 dimensional scores were calculated.

Results

As hypothesized, we observed no significant correlation between TSIA, TAS-20 and the dominance dimension of the IIP-64 and a significant correlation between the affiliation dimension and TSIA and TAS-20.

Conclusions

Our results support previous research and confirm that alexithymia is related to a cold interpersonal style. Since our findings converge for both measurements of alexithymia, the link between alexithymia and interpersonal style can not be explained by shared method variance. The measurement of only self-reported interpersonal problems is a limitation of this study.
Prevalence of the metabolic syndrome in patients with borderline personality disorders - results of a cross-sectional study
Authors: Kahl K. , Greggersen W. , Schweiger U. , Correll C. , Balijepalli C. , Lösch C. , Moebus S.
Published: May 2011

Introduction

The metabolic syndrome (MetS) is an important risk factor for the development of type-2 diabetes and coronary artery disease. However, little is known about the prevalence of the MetS in patients with borderline personality disorder (BPD).

Objectives, aims

We aimed to compare the MetS prevalence in patients with borderline personality disorder (BPD) with control subjects followed in primary care from a similar region.

Methods

One-hundred thirty five BPD patients according to DSM-IV diagnostic criteria were compared to 1009 subjects from primary care. We used the American Heart Association/National Heart, Lung and Blood Institute (AHA/NHBLI) criteria to determine the rate of MetS and of each individual MetS criterion. For comparison purposes we calculated age-standardized rates of the MetS and their 95%-confidence intervals (CI).

Results

The age-standardized prevalence of MetS was more than double in patients with BPD compared to control subjects (23.3% vs. 10.6%, p < 0.05).

Within BPD patients, an increased rate of MetS was associated with higher BMI (Wald = 10.2; p = 0.004), age (Wald = 4.7; p = 0.03), treatment with second generation antipsychotics (quetiapine, olanzapine and clozapine) (Wald = 4.6; p = 0.032), dysthymia (Wald = 4.6; p = 0.031), panic disorder (Wald = 4.6; p = 0.032), benzodiazepine dependency (Wald = 5.9; p = 0.015), and binge-eating disorder (Wald = 5.4; p = 0.02).

Conclusions

Our results demonstrate an increased MetS rate, dysregulated glucose and lipid metabolism in patients with BPD. Independent predictors of MetS in BPD patients require further study to inform targeted prevention efforts in this population. Cardiometabolic monitoring and careful screening for physical health conditions among people with BPD is warranted.
Predictors of 18-month outcome for patients with borderline personality disorder
Authors: Karaklic D. , Thuile J. , Granger B. , Secret I. , Bungener C.
Published: May 2011

Introduction

For quite a long time, borderline personality disorder (BPD) has been viewed as a chronic disorder and borderline patients as extremely difficult to treat. However, those views are changing and there is an increasing recognition that the BPD has a far more benign course than previously thought, but predictors of its outcome remain poorly explored.

Objective and aims

The purpose of this study was to determine the most clinically relevant predictors of the outcome of BPD at the 18-month follow-up.

Methods

Borderline patients (n = 75) were compared to patients with other personality disorders (OPD) (n = 40). All subjects were assessed at baseline and 6, 12, and 18 months with a series of semi structured interviews (personality disorders, global functioning, mental disorders, life events, …) and self-report measures (alexithymia and impulsivity). Logistic regression was used to estimate hazard ratios.

Results

At the 18-month follow up, 57 BPD patients and 22 with OPD have been evaluated, 45% of borderline subjects and 50% of the OPD subjects achieved remission. Low impulsivity, low alexithymia, good global functioning, and older age at onset of symptoms were found to be significant predictors of good outcome of BPD. Our clinical data suggest that life events and the quality of current relationships are determinant in the outcome of BPD.

Conclusions

45% of patients with BPD are likely to improve in 18-months. Specific factors, such as impulsivity, alexithymia, life events and quality of current relationships, determine the short-term outcome of this disorder.
Psychodynamic diagnostic manual in clinical practice-case report
Authors: Kecojevic Miljevic S.
Published: May 2011

Psychodynamic diagnostic manual was created by collaborative work of organisatios in the field of mental health and an authorial group with the aim of supplementing currently valid diagnostic systems ICD-10 and DSM-IV-TR. PDM is based on traditional psychoanalytical and psychodynamic concepts of genesis of mental disorders, currently valid diagnostic systems, new insights in the area of neurosciences, as well as on the evaluation of outcomes of different therapeutic approaches. The concept of mental disorders understanding adopted by PDM is bio-psycho-social and it follows a primary course of topical trends dictated by World Psychiatric Association towards personality orientated psychiatry. The purpose of this paper is the usage presentation of the useful guide in clinical practice with the aim of diagnosing mental disorder in the case of the described patient of a type of psychoanalytical approach applied in her treatment. The multi-axis diagnostic system of PDM has been used in the methodology of this paper. Based on this research we conclude that the described patient suffers from somatisation personality disorder, she also possesses the level of mental functioning with the moderate to higher degree of limitation, and symptomatically demonstrates somatiform disorder from the class of gastrointestinal system dysfunction and anxious disorder from a class of phobia.The mind-set of patient, and the limited level of her mental functions which suggests the inclination to a borderline level of type of personality organisations indicate plausible grounds for using supportive expressive psychoanalytical psychoterapeutic approach.
Comparisonal investigation of Rap personality disorder in youngsters
Authors: Khanmohammadi Otaghsara A.
Published: May 2011

Introduction & objectives

Personality disorder, formerly referred to as a Character Disorder, is a class of mental disorders characterized by rigid and on-going patterns of feeling, thinking, and behavior. The underlying belief systems informing these patterns are referred to as fixed fantasies or “dysfunctional schemata” (Cognitive modules). The inflexibility and pervasiveness of these behavioral patterns often cause serious personal and social difficulties, as well as a general functional impairment. So the study examined a new view in personality and mental disorders named “Rap” disorder. In the domain we compare the youngster with and without disorder. The Rap disorder people are known with unusual hair model, nihilistic and anarchistic thinking, unusual and bizarre behavior, reading of meaningfulness poet and sings, doing immoral behavior against society norms and so on.

Methods

Method research is Causative - Comparative (Ex post facto). 200 youngster, 100 with the disorder and 100 without the disorder, were randomly selected and Eysenc's Personality Questionnaire (EPQ) was administered on them.

Results

Findings showed the Rap youngster are high in extroversion and emotional instability than normal youngster.

Conclusions

It is recommended that the appropriate behavior education specially moral and religious education can avoid tendency to this behavior disorder and reduce the bad effects of the behavior in society.
Association between Personality Traits and Work-Family Conflict Among Iranian Teachers
Authors: Koolaee A. Khodabakhshi , Sheykhi G.
Published: May 2011

Objective

This research was carried out to study the association between personality traits and work-family conflict among teachers.

Methods

The method of this research was a correlation study. Participants were 100 teachers that answered to NEO & family-work conflict questioners. For analysis the data were stem from the research applied statistical methods, included; mean, standard deviation, T-Test, correlation and multi variable regression.

Results

The results indicated that there was negative and significant relationship between personality traits (included; extraversion, agreeableness, conscientiousness and openness) with family-work conflict. Furthermore, the results of T test did not showed significant difference in personality traits and family-work conflict in males and females teacher. The regression results indicated that two dimensions of traits, neuroticism and agreeableness could explanation %76 of family-work variation. Also, neuroticism dimension could explanation %48 of family work variation. Moreover, the other two dimensions of trait involving; neuroticism and openness could explain %92 of family-work variation.

Conclusions

The results suggested that family-work conflict characteristics had association with personality traits. In addition, the results showed that there was not significant relationship between personality traits and family-work conflicts in males and females teachers.
How to Diagnose and Manage “Difficult” Patients - Development of a Workshop for Interprofessional Audience
Authors: Kljenak D.
Published: May 2011

Introduction

More than 15% of patients who present to a primary care clinic are considered “difficult” yet interprofessional members of primary care clinics receive little training on how to diagnose and manage these patients.

Objectives

Become familiar with successful method of workshop development on how to diagnose and manage “difficult” patients to interprofessional audience of six community health centers.

Aims

The aim of the workshop was to enhance primary care providers’ capacity to diagnose and manage “difficult” patients as well as serve as a pilot program for a larger conference on managing “difficult” patients.

Methods

A half-day workshop was designed to fill this perceived need of community health providers to learn how to diagnose and manage “difficult” patients. The workshop consisted of didactic presentation and case based small group learning.

This workshop served as a pilot program for the development of larger conference for community providers on managing “difficult” patients.

Results

The workshop was evaluated by participants. 100% of respondents agreed that the workshop was relevant to their work and 87.5% of respondents reported that the workshop will alter their clinical practice.

Conclusion

The workshop has met participants’ perceived learning needs as well as served as a pilot program for a larger conference on managing difficult patients.
Systematic review of psychotherapeutic treatments for “minor” personality disorders
Authors: Lieb K. , Staffers J. , Völlm B.
Published: May 2011

Introduction

Among personality disorders (PDs), antisocial and borderline personality disorder are well-studied. However, the remaining PDs (in the following called “minor PDs”) pose major problems in everyday-health care settings. People affected often present with additional axis-l disorders such as substance-related, mood or anxiety disorders, and are among those most difficult to treat.

Objectives

To systematically review the current evidence of psychotherapeutic treatments for “minor” personality disorders

Methods

In the context of Cochrane Collaboration reviews for Cluster A, B and C PDs, exhaustive literature searches were done to identify the current RCT evidence for PD treatments. The electronic search strategies were extended to identify also non-RCT evidence for minor PD treatments. Retrievals were assessed and evaluated by two reviewers independently.

Results

The current evidence for psychotherapeutic treatments of minor PDs is sparse and based on mixed PD samples with co-morbid axis-l disorders in the majority of cases. Reported outcomes focus on specific axis-l disorders or general measures such as overall functioning.

Conclusions

The current evidence is scarce and does not allow for distinct treatment recommendations but undermines the importance of meeting special demands of PD patients by PD-specific treatments. Possible reasons for the paucity of research in this regard will be discussed, also in the light of future developments after DSM-V.
To Explore the Relationship Between Moral Judgement and Psychopathic Traits in a Healthy Population
Authors: Mistry J.K. , Reniers R. , Völlm B.
Published: May 2011

Introduction

Psychopathy comprises affective (eg lack of empathy, superficial charm, shallow emotions) and antisocial lifestyle features (eg criminal behaviour, impulsivity). The nature of the deficits in empathie responding remain poorly understood but recently authors have claimed that psychopaths know right from wrong but do not care.

Aims & Objectives

To explore the relationship between moral judgement and psychopathic traits in a healthy population (n = 198 females and n = 103 males).

Methods

We used a number of online questionnaires to assess key features of psychopathy including primary and secondary psychopathy (Levenson's Psychopathy Scale), moral judgement (Moral Judgement Test), impulsivity (Barratt Impulsivity Scale), life history of aggression (Life History of Aggression questionnaire), and cognitive and affective empathy (Questionnaire of Cognitive and Affective Empathy) in a healthy student population. We explored relationships between moral judgement scores and the other constructs using correlational analysis and comparisons between upper and lower quartiles.

We found correlations that were consistent with current literature for example, total BIS scores correlated strongly with Secondary Psychopathy scores (r = 0.57, p < 0.01). Primary psychopathy correlated with cognitive empathy (r = 0.3, p < 0.01). However, we did not observe any significant correlations between moral judgement scores and psychopathy scores.

Conclusions

In this healthy control population moral judgment scores do not show a significant relationship with psychopathy scores. Low empathy and high impulsivity scores observed in individuals with high psychopathy scores may not be related to a lack of understanding of moral concepts. These findings will have to be confirmed in a clinical population.
Personality Disorders in a Sample of Inpatients Alcoholics Entering Detoxification Treatment in Italy: Prevalence and Gender Differences
Authors: Oliva F. , Picci R. , Vigna-Taglianti F. , Mathis F. , Salmaso S. , Stumpo D. , Ostacoli L. , Sodano A. Iaretti , Furlan P.M.
Published: May 2011

Introduction

Alcohol abuse and dependence are frequently associated with psychiatric disorders and Personality Disorders, with differences among genders. However, only few studies investigated gender differences in personality disorders among alcoholics.

Aims

The aim of our study is to investigate personality disorders in a sample of inpatient alcoholics applying Millon Clinical Multiaxial Inventory - III, and to describe gender differences in prevalence and comorbidity of personality disorders.

Methods

The study population consist of 206 alcohol dependent patients entering detoxification treatment in a specialized clinic in Italy. At enrollment, patients filled in the Millon Clinical Multiaxial Inventory - III for the assessment of personality disorders and the AUDIT Test for the evaluation of alcohol consumption.

Results

The sample consisted of 150 men and 56 women. According to Millon assessment, 25% percent of men vs 12% of women had one PDs, 16% vs 23% had two PDs, and 46% vs 48% had more than three PDs. A statistically significant higher proportion of women got high scores on Avoidant (21.4% vs 9.3%, p = 0.020), Self-Defeating (50.0% vs 24.0%, p < 0.001), and Borderline scale (42.9% vs 25.3%, p = 0.015). Associations among PD are sporadic among men whilst are very frequent among women. Depressive, Self-Defeating and Borderline PDs are frequently associated both to other PDs and among each other, suggesting a possible female pattern.

Conclusions

Borderline PD is confirmed to be more frequent among alcoholic women than among men. More studies are needed to clarify prevalence and associations of PDs, prognosis, and gender differences in alcoholics patients.
Correlational Study on Frequency of Lies and Personality Profile
Authors: Papari A.C. , Cozaru C.G. , Papari A.
Published: May 2011

The research refers to the relationship between lies and personality. In the present study, we started from the following assumption: the superego of persons of the same culture and same generation tends to be constant regarding content and strength. That is, the superego of 21 years romanian people tends to follow a certain pattern. This assumption is motivated by the fact that in Romania, the middle class is by far the majority; among the middle class, social perceptions tend not to vary too much, those of 21 years were born in the communist period and their superego formed before the revolution, which generated a strong similarity in shaping their superego, the kind of education both formal and informal resembles very much for Romania (see Romanian proverbs), etc.

This assumption leads us to the following statement: given that the superego is similar for most Romanians of the same age, it tends to refer similarly to lying as social value as well as internalized prohibition, and its censorship. So, the lie will have substantially the same value and interpretation for all young people in this category, which will tend to refer to it similarly.

This leads to a very simple conclusion: given that in the Romanian culture, as in other cultures, the lie is disapproved, people who lie will experience a conflict between the censorship of the superego and the desire of the ego, which is reflected in the sense of guilt.
A Controlled Randomized Study on the Efficacy of Short-Term Dinamic Psychotherapy in Borderline Personality Disorders (BPD). Preliminary Results
Authors: Reneses B. , Figuera D. , Salcedo G. , Trujillo M. , López-Ibor J.J. , Galián M. , Fernández del Moral A. , Serrano R.
Published: May 2011

Introduction

Four psychotherapies have been recognized as effective with scientific evidence for the treatment of BPD, but are long term techniques. It is necessary to explore new time limited psychotherapies in order to be more accessible.

We have developed a specific manualized psychotherapy for BPD named Psychic Representation focused Psychotherapy (PRFP)

Objectives

To assess the efficacy of the PRFP in BPD in an outpatient care setting compared to a control group receiving psychiatric treatment “as usual” in several specific symptoms and in diminishing the disability due to the illness.

Methods

60 subjects with BPD were randomized to one of the two treatment groups. The study group has received PRFP with 20 sessions on a weekly basis; the control group has received treatment “as usual”. Both groups may receive psychopharmacological treatment. The assessment is done in four time-points: at baseline, after the psychotherapy or conventional treatment (six months), and at a six and twelve month's follow-up period.

Results

Preliminary results of the first 30 patients (control group 17, experimental group 13, without significant differences, Age 18–35 years; 70% women) assessed at the baseline and at the end of the intervention (six months). Experimental group reached a statistically significant clinical improvement over the controls in all measured variables: Scales: SCL-90; Zanarini ; MDRS; Barrat; STAI anxiety state; Rosemberg self-esteem and SASS social adaptation.

Conclusion

The preliminary results are encouraging and reveal that this method could be effective. This study state the interest in develop more studies about time limited psychotherapy for BPD.
Comparisonal Investigation of Personality Traits and Mental Health in Artistic People and Normal People
Authors: Rezanezhadamirdehi A.
Published: May 2011

Introduction & objectives

The aim of research was comparisonal investigation of personality traits and mental health in people with artistic jobs and without artistic jobs.

Method

The research sample was comprised by 70 people with artistic experiences and jobs such as musician, theatre player, poet, actors, local singer, and 70 people without artistic jobs and experiences. The sample's characteristics were measured by Revised NEO Personality Inventory (FFM PI-R) and Goldberg's general health questionnaire (GHQ). Data were analyzed with T independent test.

Results

Findings showed significant differences between variables. People with artistic experiences and jobs were more extroverted, agreeable and conscientiousness in personality traits and were low in components of mental illness than people without artistic jobs and experiences.

Conclusion

Based on results it is concluded that art and its fields such as music, theatre, poem and singing have positive effect on mental health and well-being.
Borderline Personality Disorder: Vicissitudes Related to Hospitalization Based on a Case Report
Authors: Scherer E.A. , Scherer Z.A.P. , Mori C.M.N.
Published: May 2011

Introduction

Borderline personality disorder (BPD) patients present a diffuse pattern of unstable interpersonal relations, self-image, affection and considerable impulsiveness.

Objective

Describe the circumstances related to prolonged hospitalization of a BPD patient; denote doubts, difficulties, polemics and feelings generated in the care team when managing this situation; and seeking scientific literature support on BPD.

Aims

Understand the circumstances related to prolonged hospitalization of a BPD patient and the effects of this situation on the care team.

Method

An exploratory and descriptive research was carried out at the Psychiatric Ward at Ribeirão Preto Medical School Hospital of the University of São Paulo, Brazil. Interviews with five professionals were submitted to thematic content analysis and data from the patient's file were presented as a case report.

Results

Two categories emerged from the interviews. “Team management in conducting the case”: divergencees in case conduction, bad feelings and counter-transference; the patient made demands and wanted to break rules. “Family abandonment”: although ready for discharge, the patient remained hospitalized due to lack of family and economic support. The only alternative was her transfer to a psychiatric hospital. Despite the difficulties, the team considered the experience gained in conducting the case was positive.

Conclusion

Investments are needed in programs aimed at better preparing the family to understand and welcome the patient after discharge from hospital. Moreover, greater cooperation is needed among the social structures of health care, patients and family members.
Association Between Peptic Ulcer and Personality Disorders in a Nationally Representative us Sample
Authors: Schuster J.-P. , Limosin F. , Levenstein S. , Le Strat Y.
Published: May 2011

Introduction

The peptic ulcer disease (PUD) is a paradigm of the mind body interaction. This model has been a source of much research until the rise of an infectious etiologic model and improvement in pharmacotherapy. To the best of our knowledge, there is no epidemiological data investigating the co-occurrence of PUD with personality disorders based on DSM-IV criteria.

Objective

To assess the association between peptic ulcer and a wide range of personality disorders in a large sample representative of the general population in the United States.

Methods

Data were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, on the basis of a face-to-face interview of more than 43,000 adults. Univariate and multivariate logistic regression were used to examine the relationship between self-reported “stomach ulcer” and personality disorders.

Results

All seven personality disorders assessed in the National Epidemiologic Survey on Alcohol and Related Conditions (i.e., avoidant, dependent, obsessive-compulsive, paranoid, schizoid, histrionic, and antisocial personality disorders) were associated with stomach ulcer, with odds ratio ranging from 2.26 (obsessive compulsive personality disorder) to 5.54 (dependent personality disorder). Participants with ulcer were five times more likely to have more than three personality disorders than participants without ulcer. The relationship between ulcer and personality disorders was only slightly attenuated after adjusting for sociodemographic conditions, physical and psychiatric disorders, and addictions.

Conclusions

Self-reported peptic ulcer is associated with increased rates of personality disorders, beyond the influence of psychiatric disorders or addictions.

Psychosom Med. 2010 Aug 17. [Epub ahead of print]
Borderline Personality and Quality of Life
Authors: Touhami M. , Ouriaghli F. , Manoudi F. , Asri F.
Published: May 2011

Introduction

The borderline personality disorder is the most frequent personality disorder in psychiatry.

It causes significant changes in social, family and professional functioning, wish can sometimes be severe enough to cause an alteration of quality of life for this patients.

Objective

To assess the quality of life among people with borderline personality in order to improve patients care.

Methods

A retrospective study on 25 patients hospitalized in our hospital during the period between 2006 and 2008.

Results

In 92% of our sample, there is a social impact, represented by social and family isolation (64% of cases), separations, divorces (28%). 40% of patients are in a good economical level. 56% of the sample had no education beyond high school, only 36% were able to attend college. In 96% of cases, the symptoms have affected the education and occupation with dropout in 56% fragile employability in 28% and job loss in 12%.

Conclusion

BPD sounds significantly on the social and professional integration of patients, so consequently on the quality of life. Pharmacological treatment alone is not enough. Individual psychotherapy and group rehabilitation activities can contribute on improving the quality of life of borderline subjects.
Are they Different? a Comparison of Risk in Dangerous and Severe Personality Disordered and Personality Disordered Hospitalized Populations
Authors: Sheldon K. , Tetley A. , Vollm B. , Thompson C. , Krishnan G.
Published: May 2011

Introduction

There has been considerable interest internationally in the assessment and treatment of individuals who have a severe personality disorder and who might pose a high-risk of future recidivism. In the United Kingdom, the ‘Dangerous and Severe Personality Disorder’ (DSPD) programme was initiated to deal with just this group. It is important, however, that the DSPD service is filling a treatment void and not competing with already well-established and effective services for (non-DPSD) personality disordered patients. Objective: To establish whether those admitted to innovative DSPD services are different from those admitted to conventional personality disorder (PD) services.

Aim

To compare patients admitted to DSPD services with those admitted to personality disordered (non-DPSD) services.

Method

Sixty patients admitted to DSPD services, under DSPD criteria, were compared with 44 patients admitted to personality disordered (non-DSPD) services within the same high secure psychiatric hospital, on risk measures, including

(1)

an index of predicted future violence

(2)

previous offending behaviour and

(3)

pre-treatment levels of institutional risk-related behaviour.

Results

DSPD patients do pose a greater clinical and management risk, have a higher number of pre-treatment risk-related behaviour, and have a greater number of convictions and imprisonments after age 18, relative to PD patients.

Conclusion

The findings broadly confirm the hypotheses as to the higher risk in DSPD patients and thus offer support for the main purpose of DSPD services: to provide treatment for those who represent the highest priority in terms of treatment need and risk to public protection. Implications are discussed.
Pharmacoepidemiologic studies on psychiatric drugs use in Serbia
Authors: Divac N. , Prostran M. , Todorović Z. , Jašović Gašić M. , Lečić Toševski D. , Stojanović R.
Published: May 2011

High rate of prescribing of psychiatric drugs causes medical, social and economic consequences.

This research was performed by collecting and analysing all the papers published on this matter in Serbia.

In former Yugoslavia (of which Serbia was a constitutive republic), during the eighties, a study of benzodiazepines use showed a trend of the increase of their use (17,9 defined daily doses - DDDs in 1983 - 22,3 DDDs in 1988) (Macolic V et al. Benzodiazepines utilization in Yugoslavia 1983–1988. Pharmaca 1990;217–97). Similar trends continued in the nineties. In 1994 diazepam was at the first position on the list of most prescribed drugs (Miljković M. et al. Analysis of Drug Utilization in Serbia During the Years 1996 and 1997. Pharmacoepidemiol Drug Saf 2000;9:59–64.). The analysis of the trend of prescribing of psychiatric drugs in Serbia (2000–2004) shows the increase, with the emphasis on the use of benzodiazepines and antidepressants (Divac N. et al. Trends in consumption of psychiatric drugs in Serbia and Montenegro 2000–2004. Pharmacoepidemiol Drug Saf. 2006;15:835–8.). There are also positive, qualitative changes in the prescribing practice: the increase of the use of SSRI antidepressants and atypical antipsychotics. Specific prescribing habits were noticed: the common practice of polypharmacy in the treatment of psychoses (Divac N. et al. Antipsychotic polypharmacy at the University Psychiatric Hospital in Serbia. Pharmacoepidemiol Drug Saf. 2007;16:1250–1.).

Pharmacoepidemiologic methods have found its place in Serbian science. The methodology used in these studies is mostly up-to-date. Main limitation of these studies is the lack of databases.
Comparison of risperidone response rate between different CYP2D6 metabolisers
Authors: Barteček R. , Juřica J. , Zrůstová J. , Kašpárek T. , Žourková A.
Published: May 2011

Introduction

Risperidone is an antipsychotic used as the first-line treatment of schizophrenia. Risperidone is metabolised by enzyme CYP2D6. Activity of this enzyme can be predicted by genotypization.

Objectives

To explore the possibility of different response rate to risperidone in first-episode schizophrenia patients with different CYP2D6 genotype.

Aim

To asses the utility of CYP2D6 pharmacogenetic testing in patients with schizophrenia treated with risperidone.

Methods

CYP2D6 genotype was assessed in 22 first-episode schizophrenic patients by use of automatic sequencing of DNA isolated from peripheral leukocytes. PANSS score was assessed every week of treatment until the change in medication or patient release.

Response was defined as at least 30% reduction in total PANSS. Differences in response rate between groups were tested by Fisher's exact test.

Results

10 CYP2D6 extensive metabolisers (EM), 8 intermediate metabolisers (IM) and 4 poor metabolisers (PM) were identified. Criteria for response met 4 EM, 4 IM and 1 PM. Differences in response rate between groups were not statistically significant.

Conclusions

Although group of IM had higher response rate than EM and PM, differences in response rate did not reach statistical significance. Further differences may be found by extending the sample size. An useful approach would be also to examine differences in occurrence of adverse effects and subjective tolerance of the treatment.

Acknowledgement

The study was supported by the grant of Czech Ministry of Health No. NS 9676-4/2008.
Dystonia and acute psychotic episode complicated by neuroleptic malignant syndrome in an adolescent with CYP2D6 deficiency
Authors: Wolańczyk T. , Butwicka A. , Szymańska K. , Retka W.
Published: May 2011

Introduction

CYP2D6 gene encodes an isozyme of the P450 cytochrome mono-oxygenase family, responsible for hepatic metabolism of the majority of neuroleptics. Phenotypes of CYP2D6 activity are ultrarapid, extensive, intermediate, and poor metabolizers. Prevalence of poor metabolizers is relatively high in European Caucasian population and ranges between 5–10%. The subjects with such phenotype are more likely to manifest adverse reactions and toxicity following administration of drugs in standard doses.

Objective

We describe a case report of a 16 year old male patient with dystonia and acute psychotic episode who developed neuroleptic malignant syndrome (NMS) associated with antipsychotic medication and a non-functional CYP2D6*4 allele.

Methods

The patient's clinical course is a case report.

Results

The patient developed NMS after treatment with standard doses of antipsychotics. Genotyping revealed that this patient was homozygous for non-functional CYP2D6*4 allele. Ziprasidone was used for a follow-up treatment after recovery from the NMS. Persistent neuropsychiatric impairment was noted after 9-months.

Conclusions

Initial symptoms developed by this patient may be explained by overuse OTC cough medication. This case suggest that as in adult population, non-functional CYP2D6 allele could be associated with NMS in pediatric population. This means that screening for CYP2D6*4 allele in pediatric patients with NMS and history of adverse drug reactions could be helpful in the treatment of residual state after NMS.
DRD4 polymorphism predicts the effect of L-DOPA on gambling behaviour
Authors: Eisenegger C. , Knoch D. , Ebstein R.P. , Gianotti L.R.R. , Sándor P.S. , Fehr E.
Published: May 2011

A challenging question in the fields of neuroscience and addiction research is why some individuals are more vulnerable than others to addictive disorders. Pharmacogenetic studies investigating how genetic variation leads to differential drug response offer a way to unravel this mystery.

In recent years, impulse control disorders, in particular pathological gambling, have been described in Parkinson's patients; these problems are most likely associated with dopaminergic treatment. Interestingly, only a subgroup of Parkinson's patients develops pathological gambling, raising the question whether there might be an interaction between genetic predisposition and dopaminergic drug administration. By applying a pharmacogenetic approach in 200 healthy subjects, we observed a differential effect of dopaminergic stimulation using 300 mg of L-DOPA on gambling behaviour, depending on variation in the dopamine D4 receptor gene. Carriers of the 7 repeats allele of the DRD4 exon III variable number tandem repeat polymorphism show an increased propensity to gamble after dopamine modulation. These findings may have implications for the dopaminergic treatment of Parkinson's disease patients by offering a genotype approach for determining individual susceptibilities for pathological gambling. They may also afford insights into the vulnerability mechanisms underlying addictive behaviour.
Seborrheic dermatitis: Could be a rare side effect of nortriptyline?
Authors: Anari A. Mehdizadeh Zare , Ghaffarinejad A.
Published: May 2011

In Iran, although new antidepressants are available, nortriptyline is widely used because of being economical and accessible.

Physicians prescribe it for psychiatric disorders, especially in hospitalized or outpatients with depression.

Clinicians know its common side effects, for example anticholinergic effects, but such as other drugs it has rare adverse effects.

Here, we present a 27 years old woman with major depression disorder who has been treated with nortriptyline/75 mg/day. After a week she came back with seborrheic dermatitis, the diagnosis was confirmed by a dermatologist. Lesions disappear when she discontinued the drug. In her past psychiatric history we found similar lesions in previous depressive episode and using same drug 5 years ago Which are treated only after stop using nortriptylin. She has no lesions in episode intervals.

Although, uncommon skin effects such as uriticaria and angioedema had been reported but this is the first patient with confirmed seborrehic dermatitis.
Venlafaxine and CYP2D6 in clinical practice: An observational study
Authors: Zeppegno P. , Rolla R. , Dalo V. , Ressico F. , Parafioriti A. , Prosperini P. , Bellomo G. , Torre E.
Published: May 2011

Introduction

Venlafaxine is a serotonin-norepinephrine inhibitor, mainly metabolized by CYP2D6 to its active metabolite ODV. Depending on CYP2D6 activity, patients may be identified as Poor, Intermediate, Extensive or Ultrarapid Metabolizers. There is some evidence that a PM phenotype is associated with poor tolerance more often than an EM; while a UM patient would only respond to a greater dose of Venlafaxine1.

Objectives

To evaluate the impact of CYP2D6 phenotype on the efficacy of Venlafaxine XR in depressed patients.

Methods

This observational study evaluated 27 Caucasian adult patients (F = 18, M = 9), satisfying DSM-IV criteria for Major Depressive, Bipolar Disorder or Personality Disorder receiving treatment with Venlafaxine 75–300 mg/die.

CYP2D6 alleles were evaluated with INFINITI CYP2D6 assay, which employs AutoGenomics proprietary film-based microarray technology.

Results

Most patients were identified as EMs, 4 as PMs, while only one was identified as UM. The only statistically significant difference between Extensive and Poor Metabolizers was, in contrast with current literature, the need of a greater mean dose of Venlafaxine in the second group (225 mg/die vs 159.38 mg/die, t student: p = 0.01).

Likewise, in contrast with literature, the UM patient was responsive to average doses of Venlafaxine.

On the contrary, we found no statistically significant differences as far as efficacy, adverse events or duration of treatment are concerned.

Conclusions

In our sample, CYP2D6 metabolizer status does not seem to affect treatment response nor adverse events related to Venlafaxine.
Does suicide allways have to be pathologic?: Contemplating rational suicide
Authors: Lucas R.M. Freire
Published: May 2011

While nothing is more universal and inevitable than death, nothing is more private and avoidable than suicide. Patterns of suicide and attitudes towards suicide exhibit wide variations between societies and between different ages in the same society. Thus, the study of suicide gives us the opportunity to investigate about one of the most perplexing and important aspects of human culture, namely, the malleability of moral attitudes.

With this presentation it is aimed to review the concept of rational suicide, meaning the cases where there is no conditioning mental illness. Given the wide scope of the topic, it will be addressed here, though superficially, from various viewpoints: literary, philosophical, sociological, moral, medical- psychiatric, among others.

It is concluded that suicide should not be regarded as a sine qua non condition of mental illness and that this may constitute a “strategic” answer, congruent with a certain philosophical perspective, in personal crisis situations.