The neglected parental mental health problem? Borderline personality disorder: A preliminary exploration of borderline mothers' attributions of children's behaviour

BACKGROUND: Despite the significant interpersonal difficulties experienced by individuals with borderline personality disorder (“BPD”) and the high family aggregation of BPD, the relationship between borderline parents and their children has been largely neglected. The unstable relationships of borderline individuals are characterised by alternating views of others as alternately ‘malevolent’ and ‘protective’. In experimental studies, the former representation dominates borderline individuals’ view of other adults. However, the preliminary findings of studies of borderline parents indicate that borderline mothers may view the child from an idealised frame of reference. Parental attributions are proposed to play a critical mediating or moderating role in relation to parents’ affect and behaviour. Exploring the nature of borderline parents’ attributions may, therefore, offer valuable insight into the potential pathways underlying the increased psychiatric risk posed to their children.OBJECTIVES: This study aimed to explore the borderline parents’ child-centered attributions in relation to:I.The degree of hostile intent attributed to ambiguous and negative child behaviour.II.The perceived balance of control in negative adult-child interactions.METHOD: Nine mothers with a confirmed diagnosis of BPD and nine mothers with mild to moderate mental health difficulties without a diagnosis of BPD completed a parent report questionnaire, which included measures of parental attributions, maternal depression and children’s emotional and behavioural strengths and difficulties. Screening measures for personality disorder and psychological distress were also included, to exclude participants with potential Cluster B personality disorders or severe mental health difficulties from the control group.RESULTS: Non-parametric Mann-Whitney U-tests indicated that, relative to mothers in the control group, borderline mothers attributed significantly less hostile intent and considered significantly lower levels of punishment in response to ambiguous or negative child behaviour. No significant differences emerged in relation to maternal attributions of the balance of control in negative adult-child interactions. Exploratory analysis clarified the potential role of maternal depression and emotional and behavioural difficulties of participants’ children in mediating or moderating these findings. All significant results were marked by large effect sizes.CONCLUSIONS: The findings in the present study are consistent with the picture that emerges from empirical studies of borderline mothers, where maternal behaviour is characterised as helpless and frightened as opposed to hostile and frightening. The absence of attributions linked to parental abuse or hostile affect potentially call into question the assumptions of hostile and abusive parenting in borderline parents that dominate clinical texts, and may indicate different pathways to abuse in this population. The findings further pointed to the possibility of a permissive parenting styles and an idealised representation of the child in borderline mothers, potentially offering new insights into the possible mechanism underlying the risk to children of borderline parents

Spatial Alliances of Public Transit Operators: Establishing operator preferences for area management contracts with Government

Scheduled transit services in many countries are provided by operators within geographical jurisdictions protected from competition with other public transit operators, although unprotected from competition by other modes, especially the car. This increased competition in many developed economies has led to a loss of market share of urban transit and contributed to the growing crisis in escalating costs of service provision (leading to pressure for increasing subsidy support). The response to this throughout the 1990s has seen governments progressively introducing market reforms centred on competitive tendering and economic deregulation. In more recent years, performance-based contracts have become popular variants, with an increasing number of incentive payment criteria introduced to not only promote cost efficiency but also aimed at growing patronage. Where such reform has involved area wide contracts, the boundaries of the contract areas have been essentially preserved. In recognition of the growing support for bus-based transit systems (variously referred to as bus rapid transit, busways and transitways), which offer increasing promise in growing public transit patronage, the NSW government in Australia has introduced reforms that require existing operators in the Sydney metropolitan area each currently holding an area contract (87 contracts) to work together under fifteen new spatial contracts. These new contracts overlay the existing contract areas and give incumbent operators the first option to participate. In this paper we assess ways in which operators might coalesce to deliver ongoing and new ‘regional’ services within these new trusting partnerships. Operator business preferences and potential barriers to cooperation are identified through stated preference experiments

The effect of a home-based strength training program on type 2 diabetes risk in obese Latino boys

This paper is designed to determine the effects of a home-based strength training (HBST) intervention on insulin sensitivity (SI), compensatory acute insulin response and β-cell function, body composition measures, and maximum strength in obese Latino boys. A total of 26 obese Latino males aged between 14 and 18 years were randomized to either a twice-weekly (n=15) or a control group (C; n=15) for 16 weeks. HBST for 16 weeks, composed of two 1-h sessions per week. Outcome measures were assessed pre-and post-intervention/control condition and included SI, acute insulin response to glucose (AIR) and disposition index (DI), fasting glucose, 2-h glucose, body composition using waist-hip circumferences, body mass index (BMI), dual energy X-ray absorptiometry (DEXA) scan, blood pressure, and strength by 1-repetition maximum. A repeated measures GLM was used to assess differences in changes in outcome measures, between the C and the HBST groups. There were no significant overall intervention effects on any of the outcome variables (p<0.05). These results suggest that an HBST does not improve SI, maximal strength or decrease adiposity in obese Latino boys

The feasibility of brief dog assisted therapy on university students stress levels: The PAwS study.

Background: Pet therapy is becoming increasingly popular and is used in a variety of ways from encouraging communication in older adults to improving wellbeing in those with serious mental illness. Increasingly Universities have been offering pet therapy to students in an effort to reduce stress. However, little evidence currently exists to support the effectiveness of reducing measurable stress levels after a standalone drop-in unstructured session. The University of Sheffield’s Counselling Service works in partnership with Guide Dogs for the Blind to give students access to calm, well-trained animals for informal group stress relief. Aims: To assess the feasibility of implementing and evaluating unstructured group interventions with a Guide Dog in training within the university student population. Methods: One hundred and thirty-one students who attended pet therapy at the University Counselling Service were recruited on a voluntary basis to take part in the research. Stress, measured on the state trait anxiety inventory, and blood pressure were taken before and after a 15-min intervention. Results: All measures showed a statistically significant reduction immediately after the intervention. Conclusion: Short interactions with a Guide Dog in training appear to reduce stress in University students. A controlled study is required to investigate further

Patient-reported outcome measures (PROMs) in paediatric ophthalmology: a systematic review

Aim: To identify patient-reported outcome measures (PROMs) specifically developed and used to assess the impact of ophthalmic disorders in children and to systematically assess their quality as a basis for recommendations about their use in clinical and research settings. Methods: A systematic review of the literature was performed in MEDLINE, EMBASE, PsychINFO, CINAHL and AMED, supplemented by a grey literature search. Papers reporting development and validation of questionnaire instruments for assessing patient-reported outcomes of an ophthalmic disorder in patients aged 2–18 years were included. Quality was assessed by examining the purpose and psychometric properties of the instruments. Strengths and limitations were summarised with recommendations regarding use. Results: Search identified 17 instruments. Of these, 11 were condition-specific and six were intended for a broader population of children and young people with visual impairment regardless of the ophthalmic condition. Three were developed for use in a specific trial and two are still in development. Conclusions: Paediatric ophthalmology PROM development and application is a developing field and new instruments are needed. There is scope for improvement in this area through (a) clarity of definitions of the underlying constructs intended to be measured at the onset of development of new instruments, (b) application of child-centred approaches and (c) adherence to extant guidance and best practice in questionnaire instrument development

Self-Management of Unpleasant Auditory Hallucinations: A Tested Practice Model

Individuals who experience auditory hallucinations (AH) frequently report hearing unpleasant voices saying disturbing things to them, making derogatory remarks about them, or commanding them to do something, including harming themselves or someone else. The Self-Management of Unpleasant Auditory Hallucinations Practice Model was developed to help psychiatric-mental health nurses in both inpatient and outpatient settings implement evidence-based nursing care for voice hearers who are distressed by unpleasant voices. The model\u27s utility extends to nursing education, administration, and research. The model is comprised of three parts: (a) Assessment of Voice Hearer\u27s Experience, (b) Nursing Interventions, and (c) Voice Hearer\u27s Expected Positive Outcomes. These three parts of the model describe nursing assessments conducted with an interview guide and two self-report tools, nursing interventions that teach strategies to manage unpleasant AH in a 10-session course or individually, and evaluation of voice hearer outcomes with two self-report tools

The architecture of amyloid-like peptide fibrils revealed by X-ray scattering, diffraction and electron microscopy

Structural analysis of protein fibrillation is inherently challenging. Given the crucial role of fibrils in amyloid diseases, method advancement is urgently needed. A hybrid modelling approach is presented enabling detailed analysis of a highly ordered and hierarchically organized fibril of the GNNQQNY peptide fragment of a yeast prion protein. Data from small-angle X-ray solution scattering, fibre diffraction and electron microscopy are combined with existing high-resolution X-ray crystallographic structures to investigate the fibrillation process and the hierarchical fibril structure of the peptide fragment. The elongation of these fibrils proceeds without the accumulation of any detectable amount of intermediate oligomeric species, as is otherwise reported for, for example, glucagon, insulin and [alpha]-synuclein. Ribbons constituted of linearly arranged protofilaments are formed. An additional hierarchical layer is generated via the pairing of ribbons during fibril maturation. Based on the complementary data, a quasi-atomic resolution model of the protofilament peptide arrangement is suggested. The peptide structure appears in a [beta]-sheet arrangement reminiscent of the [beta]-zipper structures evident from high-resolution crystal structures, with specific differences in the relative peptide orientation. The complexity of protein fibrillation and structure emphasizes the need to use multiple complementary methods

Adjuvant therapy with antidepressants for the management of inflammatory bowel disease (Protocol)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: Primary objectives 1. To assess the efficacy and safety of antidepressants for managing anxiety and depression in IBD 2. To assess the efficacy and safety of antidepressants for managing quality of life in IBD Secondary objectives 1. To assess the efficacy and safety of antidepressants for managing disease activity in IB

Targeted Induction of Endoplasmic Reticulum Stress Induces Cartilage Pathology

Pathologies caused by mutations in extracellular matrix proteins are generally considered to result from the synthesis of extracellular matrices that are defective. Mutations in type X collagen cause metaphyseal chondrodysplasia type Schmid (MCDS), a disorder characterised by dwarfism and an expanded growth plate hypertrophic zone. We generated a knock-in mouse model of an MCDS–causing mutation (COL10A1 p.Asn617Lys) to investigate pathogenic mechanisms linking genotype and phenotype. Mice expressing the collagen X mutation had shortened limbs and an expanded hypertrophic zone. Chondrocytes in the hypertrophic zone exhibited endoplasmic reticulum (ER) stress and a robust unfolded protein response (UPR) due to intracellular retention of mutant protein. Hypertrophic chondrocyte differentiation and osteoclast recruitment were significantly reduced indicating that the hypertrophic zone was expanded due to a decreased rate of VEGF–mediated vascular invasion of the growth plate. To test directly the role of ER stress and UPR in generating the MCDS phenotype, we produced transgenic mouse lines that used the collagen X promoter to drive expression of an ER stress–inducing protein (the cog mutant of thyroglobulin) in hypertrophic chondrocytes. The hypertrophic chondrocytes in this mouse exhibited ER stress with a characteristic UPR response. In addition, the hypertrophic zone was expanded, gene expression patterns were disrupted, osteoclast recruitment to the vascular invasion front was reduced, and long bone growth decreased. Our data demonstrate that triggering ER stress per se in hypertrophic chondrocytes is sufficient to induce the essential features of the cartilage pathology associated with MCDS and confirm that ER stress is a central pathogenic factor in the disease mechanism. These findings support the contention that ER stress may play a direct role in the pathogenesis of many connective tissue disorders associated with the expression of mutant extracellular matrix proteins