Carsten Rene Jørgensen

Outcome of mentalization‐based and supportive psychotherapy in patients with borderline personality disorder: a randomized trial

Objective:  This study presents data from a randomized outcome study comparing mentalization‐based and supportive psychotherapy for patients with borderline personality disorder (BPD).

Severity of affective temperament and maladaptive self-schemas differentiate borderline patients, bipolar patients, and controls.

OBJECTIVES There is an unsettled debate on whether borderline personality disorder and bipolar disorder should be considered related or distinct. This study aimed to further the understanding of the similarities and differences between the 2 disorders by comparing borderline patients, bipolar patients, and controls in terms of various affective temperaments and maladaptive self-schemas. METHODS The sample consisted of 85 participants (31 borderline patients, 25 bipolar patients and 29 student controls) who completed 2 questionnaires: The Temperament Evaluation of the Memphis, Pisa, Paris, and San Diego Autoquestionnaire and the Young Schema Questionnaire. All of the patients were in remission from affective episodes. RESULTS Compared to the bipolar patients and the controls, the borderline patients were characterized by significantly higher mean scores on most of the maladaptive self-schemas and affective temperaments. The bipolar patients differed significantly from controls by higher mean scores on the cyclothymic temperament and insufficient self-control. CONCLUSIONS The study suggests that affective temperaments and maladaptive self-schemas are more severe in borderline patients than in bipolar patients. These findings point to phenomenological differences between the 2 disorders and therefore question their degree of kinship.

Mouth-to-mouth ventilation is superior to mouth-to-pocket mask and bag-valve-mask ventilation during lifeguard CPR: A randomized study

AIM The quality of cardiopulmonary resuscitation (CPR) is a crucial determinant of outcome following cardiac arrest. Interruptions in chest compressions are detrimental. We aimed to compare the effect of mouth-to-mouth ventilation (MMV), mouth-to-pocket mask ventilation (MPV) and bag-valve-mask ventilation (BMV) on the quality of CPR. MATERIALS AND METHODS Surf lifeguards in active service were included in the study. Each surf lifeguard was randomized to perform three sessions of single-rescuer CPR using each of the three ventilation techniques (MMV, MPV and BMV) separated by 5 min of rest. Data were obtained from a resuscitation manikin and video recordings. RESULTS A total of 60 surf lifeguards were included (67% male, 33% female, mean age 25 years). Interruptions in chest compressions were significantly reduced by MMV (8.9 ± 1.6 s) when compared to MPV (10.7 ± 3.0 s, P < 0.001) and BMV (12.5 ± 3.5s, P < 0.001). Significantly more effective ventilations (visible chest rise) were delivered using MMV (91%) when compared to MPV (79%, P < 0.001) and BMV (59%, P < 0.001). The inspiratory time was longer during MMV (0.7 ± 0.2 s) and MPV (0.7 ± 0.2s, P < 0.001 for both) compared to BMV (0.5 ± 0.2s). Tidal volumes were significantly lower using BMV (0.4 ± 0.2L) compared to MMV (0.6 ± 0.2L, P < 0.001) and MPV (0.6 ± 0.3 L, P < 0.001), whereas no differences were observed when comparing MMV and MPV. CONCLUSION MMV reduces interruptions in chest compressions and produces a higher proportion of effective ventilations during lifeguard CPR. This suggests that CPR quality is improved using MMV compared to MPV and BMV.

Active ingredients in individual psychotherapy: Searching for common factors

Every serious school of psychotherapy has its own theory—often only vaguely formulated—concerning the active ingredients in psychotherapy. Many of these theories are presented as mutually exclusive. The author presents an overview of some of the important, primarily psychoanalytically founded, theories of the factors in individual psychotherapy that are responsible for inducing change. It is impossible to pinpoint any single factor that is crucial in every therapy. What is needed is a nondogmatic, multiple-factor model that successfully incorporates the knowledge obtained from the many existing theories of psychotherapyinduced change. In practice, it is often difficult to maintain the traditional distinction between specific and nonspecific factors, just as it is difficult to distinguish the roles played by purely therapeutic factors—relating to the technique of the therapist—and by extratherapeutic factors. The author also addresses the epistemological status of the various claims put forward, by the many different theories of psychotherapy, concerning the active ingredients in psychotherapy.

INVITED ESSAY: IDENTITY AND BORDERLINE PERSONALITY DISORDER

The general consensus is that disturbed identity is one of the defining characteristics of borderline personality disorder. So far it has not been possible to reach a generally accepted definition of identity, and the clinical phenomenon of identity disturbance involves inner subjective states that are not directly accessible to observation and reliable assessment. In this article a preliminary definition of identity is suggested and different levels, dimensions, and categories of identity are delineated. Essential elements of identity disturbance or identity diffusion in BPD patients are described and related to other aspects of borderline personality disorder: mentalization failures, disrupted relationships, impulsive or nonvolitional behavior, deficits in memory, dissociation, and dysfunctional self-narratives.

Self-esteem in remitted bipolar disorder patients: a meta-analysis

OBJECTIVES Low self-esteem has been found to be a risk factor for depression in major depressive disorder (MDD). In contrast, the role of self-esteem in bipolar disorder (BD) is still uncertain. In order to examine the characteristics of self-esteem in BD, we synthesized studies comparing self-esteem in BD patients with self-esteem in MDD patients and in normal controls. METHODS Database searches and identification of studies were conducted by two of the authors independently. Remission of BD and MDD was a major selection criterion. The results were generated through meta-analyses. RESULTS Random-effects models of 19 between-group comparisons (N= 1,838) suggested that the self-esteem of remitted BD patients was significantly lower than that of normal controls (Cohens d= -0.83), while significantly higher than that of remitted MDD patients (Cohens d= 0.54). Fail-safe numbers and tests for funnel plot asymmetry indicated that the results were robust and unlikely to reflect publication biases. Additional studies indicated that self-esteem may take a fluctuating course during remission of BD. CONCLUSIONS By revealing that BD patients do experience low self-esteem, the findings implicate a need for further understanding the causes and therapeutic impact of such abnormality in BD.

IDENTITY STYLE IN PATIENTS WITH BORDERLINE PERSONALITY DISORDER AND NORMAL CONTROLS

Identity diffusion is one of the essential diagnostic criteria for borderline personality disorder. Diffuse-avoidant identity style (as conceptualized by Berzonsky, 1989), diffuse identity status (as conceptualized by Marcia, 1966) and Structural identity diffusion (as conceptualized by Erikson, 1959; Kernberg, 1984, 2006; and Akhtar, 1992), are theoretically and to some extent empirically related. In this study, identity style in a group of female borderline patients (n = 66), measured by using the Identity Style Inventory (ISI) developed by Berzonsky, was compared with identity style in a control group of female psychology students (n = 65). Findings revealed that the mean score for diffuse-avoidant identity style was significantly higher in the borderline group: more than half the borderline patients (59%) were classified as primarily diffuse-avoidant in identity style, compared with only 12% in the control group. Similarly, ISI-scores for the more mature and more adaptive information-oriented identity style and for the normative identity style were significantly higher in the control group compared with the group of borderline patients. Finally, the level of commitment in identity functioning was significantly lower in the borderline group than in the group of psychology students.

Self-esteem in remitted bipolar disorder patients

OBJECTIVES Low self-esteem has been found to be a risk factor for depression in major depressive disorder (MDD). In contrast, the role of self-esteem in bipolar disorder (BD) is still uncertain. In order to examine the characteristics of self-esteem in BD, we synthesized studies comparing self-esteem in BD patients with self-esteem in MDD patients and in normal controls. METHODS Database searches and identification of studies were conducted by two of the authors independently. Remission of BD and MDD was a major selection criterion. The results were generated through meta-analyses. RESULTS Random-effects models of 19 between-group comparisons (N= 1,838) suggested that the self-esteem of remitted BD patients was significantly lower than that of normal controls (Cohens d= -0.83), while significantly higher than that of remitted MDD patients (Cohens d= 0.54). Fail-safe numbers and tests for funnel plot asymmetry indicated that the results were robust and unlikely to reflect publication biases. Additional studies indicated that self-esteem may take a fluctuating course during remission of BD. CONCLUSIONS By revealing that BD patients do experience low self-esteem, the findings implicate a need for further understanding the causes and therapeutic impact of such abnormality in BD.

Identity-related autobiographical memories and cultural life scripts in patients with Borderline Personality Disorder

Disturbed identity is one of the defining characteristics of Borderline Personality Disorder manifested in a broad spectrum of dysfunctions related to the self, including disturbances in meaning-generating self-narratives. Autobiographical memories are memories of personal events that provide crucial building-blocks in our construction of a life-story, self-concept, and a meaning-generating narrative identity. The cultural life script represents culturally shared expectations as to the order and timing of life events in a prototypical life course within a given culture. It is used to organize ones autobiographical memories. Here, 17 BPD-patients, 14 OCD-patients, and 23 non-clinical controls generated three important autobiographical memories and their conceptions of the cultural life script. BPD-patients reported substantially more negative memories, fewer of their memories were of prototypical life script events, their memory narratives were less coherent and more disoriented, and the overall typicality of their life scripts was lower as compared with the other two groups.

Affective temperaments' relation to functional impairment and affective recurrences in bipolar disorder patients

BACKGROUND The prognostic significance of affective temperaments in bipolar disorder is not yet fully understood. This study therefore examined the relationship between affective temperaments and two major illness outcomes in bipolar disorder: functional impairment and affective recurrences. METHOD At baseline fifty-one remitted bipolar disorder patients were administered the Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Auto-questionnaire (TEMPS-A), and the Work and Social Adjustment Scale (WSAS). The patients were followed for 24 months as part of their routine treatment. At follow-up, data on affective recurrences were obtained through medical records combined with a semi-structured interview that enquired into medication adherence. RESULTS Scores on the cyclothymic temperament correlated significantly with functional impairment overall and with scores in three function domains: home-management, private leisure activities and social leisure activities. High scores on the cyclothymic temperament also significantly predicted the presence of depressive recurrences even when controlling for medication non-adherence. The presence of hypomanic or manic recurrences was not predicted by scores on any of the affective temperaments. LIMITATION Since all of the bipolar patients were newly diagnosed and therefore relatively young, the representativeness of the results may have been reduced. The prospective part of the study used data from medical records that may not be as systematic as data gathered from structured clinical interviews. CONCLUSION By suggesting that the cyclothymic temperament is related to both functional impairment and depressive recurrences the findings highlight a vulnerability area in need of further exploration in terms of its prognostic significance.