An Exploration of the Relationship Between Personality Traits and Cognitive Functioning in Neuropschological Outpatients in Community Based Treatment

This study examined whether behavioral disturbances in obsessive compulsive personality disorder and borderline personality disorder were related to executive functioning. An archival database was used; this consisted of 104 subjects who had been given the Millon Clinical Multiaxial Inventory-III (MCMI-III) and the Wisconsin Card Sorting Test (WCST) at a local neuropsychology practice. Comparisons in executive functioning abilities were made between groups of subjects identified as reporting obsessive compulsive personality disorder traits or borderline personality disorder traits, and also between groups of subjects identified as reporting both obsessive compulsive personality traits and borderline personality traits. Findings concluded that a relationship does not exist between personality traits and executive functioning. Although the study‟s findings revealed no statistically significant results, the study generated significant discussion points pertinent to future research

Cognitive functioning, clinical profile and life events in young adults addicted to drugs. Does being a girl make a difference?

Objective: Gender features play a fundamental role as risk factors in drug addiction, entailing differences in vulnerability, onset, drug use and clinical trajectories. Even if increasing empirical evidence has attested that drug abuse in emerging adulthood is associated with cognitive impairments, personality disorders and psychological distress, limited research has analyzed these aspects from a gender perspective. The present research focuses on gender differences in youths (18–24 years of age) diagnosed with substance use disorders (SUDs), in order to detect possible differences between females and males as regards their neuropsychological functioning, clinical profiles and past life experiences. Method: Neuropsychological functioning (neuropsychological battery Esame Neuropsicologico Breve-2), the severity of the symptomatology (Symptom Checklist-90-Revised), personality profile and disorders (Shedler Westen Assessment Procedure-200) and life history were assessed in two groups of young adults with SUDs, 20 males and 20 females (mean age = 21 years, SD = 2.2). Participants were recruited in a therapeutic community in Venice, Italy. Results: Girls showed less cognitive impairment but higher psychological distress with respect to boys; between the two groups, no differences emerged regarding the personality profiles. The girls’ life histories presented more experiences of abuse and maltreatment; they also moved more quickly from substance use to dependence. Boys, instead, were more involved in criminal activity. Conclusions: Given our results, it seems that gender differences manifest early, at emerging adulthood. Consequently, a gender-oriented treatment for drug addiction should be offered even at an early age, focusing on early adverse experiences and their potential traumatic effect on girls. By contrast, young men seem to rely on compromised cognitive functions, which require a specific treatment approach, since they constitute a crucial factor for individual adjustment and treatment outcomes. Results should be interpreted relative to some limitations (such as the small sample size and the preliminary and cross-sectional nature of the research), and future studies are require

Executive functions and borderline personality features in adolescents with major depressive disorder

BackgroundExecutive functions (EF) consolidate during adolescence and are impaired in various emerging psychiatric disorders, such as pediatric Major Depressive Disorder (pMDD) and Borderline Personality Disorder. Previous studies point to a marked heterogeneity of deficits in EF in pMDD. We examined the hypothesis that deficits in EF in adolescents with pMDD might be related to comorbid Borderline Personality features (BPF).MethodsWe examined a sample of 144 adolescents (15.86 ± 1.32) diagnosed with pMDD. Parents rated their child’s EF in everyday life with the Behavior Rating Inventory of Executive Function (BRIEF) and BPF with the Impulsivity and Emotion Dysregulation Scale (IED-27). The adolescents completed equivalent self-rating measures. Self- and parent-ratings of the BRIEF scores were compared with paired t-Tests. Correlation and parallel mediation analyses, ICC, and multiple regression analyses were used to assess symptom overlap, parent-child agreement, and the influence of depression severity.ResultsOver the whole sample, none of the self- or parent-rated BRIEF scales reached a mean score above T > 65, which would indicate clinically impaired functioning. Adolescents tended to report higher impairment in EF than their parents. Depression severity was the strongest predictor for BPF scores, with Emotional Control predicting parent-rated BPF and Inhibit predicting self-rated BPF. Furthermore, the Behavioral Regulation Index, which includes EF closely related to behavioral control, significantly mediated the relationship between depression severity and IED-27 factors emotional dysregulation and relationship difficulties but not non-suicidal self-injuries.ConclusionOn average, adolescents with depression show only subtle deficits in executive functioning. However, increased EF deficits are associated with the occurrence of comorbid borderline personality features, contributing to a more severe overall psychopathology. Therefore, training of executive functioning might have a positive effect on psychosocial functioning in severely depressed adolescents, as it might also improve comorbid BPF.Clinical trial registrationwww.ClinicalTrials.gov, identifier NCT03167307

Inequalities in Health and Service Use among People with Borderline Intellectual Impairment

This report, produced in collaboration with Professor Angela Hassiotis and others, sets out the extent to which people with borderline intellectual impairment face inequalities in health and use of services compared with the rest of the population, and seeks to improve awareness of these inequalities. Findings - Borderline intellectual impairment is common, affecting at least one adult in ten in England. The term is used here to refer to people with good verbal skills and living in private households, but who may experience cognitive impairments. - The findings in this report are consistent with previous research: people with borderline intellectual impairment are a disadvantaged group and their needs are not well understood. - Such adults face high levels of poor mental health, poorer general health, and many limitations in their daily lives. - Their level of use of mental health treatment and services does not appear to be commensurate with their higher level of need. This indicates that they are underserved compared with the rest of the population. - This may be due to a lack of professional awareness of their needs, to services not adapting enough to meet those needs, or to difficulties the individual faces in seeking treatment and support. - Adults with borderline intellectual impairment constitute key users of primary and secondary health care, and employment, education and welfare support. Improving awareness of the needs of this group should form part of wider plans to reduce inequalities in health and service use in England. Methods Secondary analysis of data from the Adult Psychiatric Morbidity Survey (APMS) was conducted to profile the circumstances of people with borderline intellectual impairment. APMS is one of the most authoritative and comprehensive national household surveys to assess both intellectual functioning and mental health in adults in England

Clinical and service implications of a cognitive analytic therapy model of psychosis

Cognitive analytic therapy (CAT) is an integrative, interpersonal model of therapy predicated on a radically social concept of self, developed over recent years in the UK by Anthony Ryle. A CAT-based model of psychotic disorder has been developed much more recently based on encouraging early experience in this area. The model describes and accounts for many psychotic experiences and symptoms in terms of distorted, amplified or muddled enactments of normal or ‘neurotic’ reciprocal role procedures (RRPs) and of damage at a meta-procedural level to the structures of the self. Reciprocal role procedures are understood in CAT to represent the outcome of the process of internalization of early, sign-mediated, interpersonal experience and to constitute the basis for all mental activity, normal or otherwise. Enactments of maladaptive RRPs generated by early interpersonal stress are seen in this model to constitute a form of ‘internal expressed emotion’. Joint description of these RRPs and their enactments (both internally and externally) and their subsequent revision is central to the practice of CAT during which they are mapped out through written and diagrammatic reformulations. This model may usefully complement and extend existing approaches, notably recent CBT-based interventions, particularly with ‘difficult’ patients, and generate meaningful and helpful understandings of these disorders for both patients and their treating teams. We suggest that use of a coherent and robust model such as CAT could have important clinical and service implications in terms of developing and researching models of these disorders as well as for the training of multidisciplinary teams in their effective treatment

Developing a rating scale for projected stories

The 6-Part Story Method (6PSM) is a projective tool in wide use by dramatherapists in the UK, USA and Israel (Lahad & Ayalon, 1993). In contrast to projective tests used by psychotherapists and psychologists, the 6PSM has never been the subject of any validation or reliability studies. This paper reports on the identification of scale items to describe the manifest content of 6-part stories. 26 statements with acceptable inter-rater reliability have been identified. These statements were used to rate stories produced by clinicians (n=24), mainstream community mental health patients (n=21) and patients with a Borderline Personality Disorder (n=19). Some features that were expected to be indicators of an author with a BPD diagnosis proved to be as common in stories from other authors. However a scale of eight items was identified that differentiated well between authors with a BPD diagnosis and others, with adequate test-retest and inter-rater reliability. Concurrent validity was tested against the Structured Clinical Interview for DSM-IV Axis II (SCID-II), the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) and the Inventory of Interpersonal Problems short form (IIP-32)

Clinical Associations of Deliberate Self-Injury and Its Impact on the Outcome of Community-Based and Long-Term Inpatient Treatment for Personality Disorder

Background: Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). There are gaps in our knowledge of DSI as an indicator of severity of psychopathology, as moderator of outcome and with regard to its response to different treatment programs and settings. Methods: We compare 2 samples of PD with (n = 59) and without (n = 64) DSI in terms of clinical presentation, response to psychosocial treatment and relative outcome when treated with specialist long-term residential and community-based programs. We test the assumption that DSI is an appropriate indicator for long-term inpatient care by contrasting the outcomes (symptom severity and DSI recidivism) of the 2 DSI sub-groups treated in the 2 different approaches. Results: PD with DSI had greater severity of presentation on a number of variables (early maternal separation, sexual abuse, axis-I comorbidities, suicidality and inpatient episodes) than PD without DSI. With regard to treatment response, we found a significant 3-way interaction between DSI, treatment model and outcome at 24-month follow-up. PD with DSI treated in a community-based program have significantly greater chances of improving on symptom severity and recidivism of self-injurious behaviour compared to PD with DSI treated in a long-term residential program. Conclusions: Although limitations in the study design invite caution in interpreting the results, the poor outcome of the inpatient DSI group suggests that explicit protocols for the management of DSI in inpatient settings may be beneficial and that the clinical indications for long-term inpatient treatment for severe and non-severe PD may require updating. Copyright (C) 2010 S. Karger AG, Base

Borderline personality features possibly related to cingulate and orbitofrontal cortices dysfunction due to schizencephaly.

Prefrontal cortex dysfunction has been associated with a series of behavioral symptoms, such as impulsivity and affective instability, which are the defining features of several personality disorders, notably, borderline personality disorder. We report on a 27-year-old patient with schizencephaly in the right frontal lobe (cingulate cortex lesion and secondary orbitofrontal cortex dysfunction) presenting with prominent borderline features and compromise of executive functions, decision-making and attention. We hypothesize that the personality disorder of our patient could be related to cingulate cortex lesion and secondary orbitofrontal cortex dysfunction associated with schizencephaly

Mental Health and Wellbeing in England: the Adult Psychiatric Morbidity Survey 2014

This report presents findings of a survey of mental illness and wellbeing among people aged 16 and over living in private households in England. The survey was commissioned by NHS Digital and funded by the Department of Health, and is the fourth in a series of surveys of adult mental health