Multiple integrated treatment of borderline personality disorders

This paper describes a pilot study of the effectiveness of a specific outpatient programme for Cluster B Personality Disorder. According to this model, the patient is offered a pathway of two-year duration, which includes once a week supportive individual psychotherapy combined with fortnightly group psychotherapy (Dialectical Behavioural Therapy), as well as general psychiatric management. We present the results of a prospective research study based on data collected on a first group of six patients treated in the programme. The sample, screened by using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID II), for presence of a Cluster B disorder, was evaluated at regular intervals using the Symptom Check List-90 (SCL-90), for the affective symptoms, the Barratt Impulsiveness Scale, version 11 (BIS-11) and the Aggression Questionnaire (AQ), for the dimensions of Impulsiveness and Aggression. The level of disability perceived has been measured by the Dissociative Disorders Interview Schedule (DISS). Finally, the referring psychiatrist filled in the Global Assessment of Functioning (GAF) and Brief Psychiatric Rating Scale (BPRS). At the end of treatment improvement was found in all measures. The results, based on a limited sample, suggest that improvements in the dimensions of impulsiveness, affectivity, degree of disability and readmission to hospital can be achieved with Cluster B patients in an outpatient setting by utilizing different concurrent psychotherapeutic approaches. This is encouraging concerning the intensive outpatient psychotherapeutic treatment with severe personality disorder

Personality traits in chronic daily headache patients with and without psychiatric comorbidity: an observational study in a tertiary care headache center

BACKGROUND: Previous studies suggest that patients with Chronic Daily Headache (CDH) have higher levels of anxiety and depressive disorders than patients with episodic migraine or tension-type headache. However, no study has considered the presence of psychiatric comorbidity in the analysis of personality traits. The aim of this study is to investigate the prevalence of psychiatric comorbidity and specific personality traits in CDH patients, exploring if specific personality traits are associated to headache itself or to the psychiatric comorbidity associated with headache. METHODS: An observational, cross-sectional study. Ninety-four CDH patients with and without medication overuse were included in the study and assessed by clinical psychiatric interview and Mini International Neuropsychiatric Interview (M.I.N.I.) as diagnostic tools. Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Hamilton Depression Rating Scale (HAM-D) were afterwards administered. Patients with and without psychiatric comorbidity were compared. Further analyses were made by splitting the whole group according to the headache diagnosis and the presence or not of medication overuse. RESULTS: Psychiatric comorbidity was detected in 44 patients (46.8%) (group A) and was absent in the remaining 50 patients (53.2%) (group B). Mood and anxiety disorders were the most frequently diagnosed (43.6%). In the overall group, mean scores of MMPI-2 showed a high level in the so-called neurotic triad; in particular the mean score in the Hypochondriasis subscale was in the pathologic area (73.55 ± 13.59), while Depression and Hysteria scores were moderate but not severe (62.53 and 61.61, respectively). In content scales, score in Health Concern was also high (66.73). Group A presented higher scores compared to Group B in the following MMPI-2 subscales: Hypochondriasis (p = .036), Depression (p = .032), Hysteria (p < .0001), Hypomania (p = .030). Group B had a high score only in the Hypochondriasis subscale. No significant differences were found between chronic migraine (CM)-probable CM (pCM) plus probable medication overuse headache (pMOH) and chronic tension-type headache (CTTH)-probable CTTH (pCTTH) plus pMOH patients or between patients with and without drug overuse. CONCLUSIONS: The so-called “Neurotic Profile” reached clinical level only in CDH patients with psychiatric comorbidity while a high concern about their general health status was a common feature in all CDH patients