Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients.

OBJECTIVE: This study reports the efficacy of a cognitive behavioral outpatient treatment on interpersonal outcome variables for patients diagnosed with borderline personality disorder. METHOD: In a 1-year clinical trial, 26 female patients with borderline personality disorder were randomly assigned to either dialectical behavior therapy or a treatment-as-usual comparison condition. All subjects met criteria of DSM-III-R and Diagnostic Interview for Borderline Patients for borderline personality disorder and were chronically suicidal. RESULTS: In both the intent-to-treat and treatment completion groups, dialectical behavior therapy subjects had significantly better scores on measures of anger, interviewer-rated global social adjustment, and the Global Assessment Scale and tended to rate themselves better on overall social adjustment than treatment-as-usual subjects. CONCLUSIONS: These results suggest that dialectical behavior therapy is a promising psychosocial intervention for improving interpersonal functioning among severely dysfunctional patients with borderline personality disorder.

Case manager ratings of the clinical status of dually diagnosed outpatients.

OBJECTIVE: The researchers' aim was to evaluate the construct validity of a rating scale used by case managers to assess the clinical status of clients in a large outpatient treatment program for persons with severe mental illness and concurrent drug or alcohol problems. METHODS: A standardized rating scale for assessing clients' levels of four key clinical problems--psychiatric symptoms, substance use, treatment noncompliance, and overall level of dysfunction--was developed for use by case managers. After being trained in use of the instrument, 20 case managers rated 302 clients along these dimensions. Case manager ratings were compared with data on clients' diagnoses and the level of structure they required in their treatment program. RESULTS: About 42 percent of the clients assessed had schizophrenia, 28 percent had bipolar disorder, 14 percent had major depression, and 11 percent had other psychotic disorders. The case manager ratings were significantly related to clients' diagnosis and the level of structure in their treatment program. The four dimensions were also correlated with each other; strong correlations were found between severity of substance use and noncompliance and between severity of psychiatric disorder and level of dysfunction. CONCLUSIONS: Ratings by case managers can be used to measure individual progress in treatment as well as the status of the entire client population in a treatment program.

Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients.

BACKGROUND: A randomized clinical trial was conducted to evaluate whether the superior performance of dialectical behavior therapy (DBT), a psychosocial treatment for borderline personality disorder, compared with treatment-as-usual in the community, is maintained during a 1-year posttreatment follow-up. METHODS: We analyzed 39 women who met criteria for borderline personality disorder, defined by Gunderson's Diagnostic Interview for Borderline Personality Disorder and DSM-III-R criteria, and who had a history of parasuicidal behavior. Subjects were randomly assigned either to 1 year of DBT, a cognitive behavioral therapy that combines individual psychotherapy with group behavioral skills training, or to treatment-as-usual, which may or may not have included individual psychotherapy. Efficacy was measured on parasuicidal behavior (Parasuicide History Interview), psychiatric inpatient days (Treatment History Interview), anger (State-Trait Anger Scale), global functioning (Global Assessment Scale), and social adjustment (Social Adjustment Scale--Interview and Social Adjustment Scale--Self-Report). Subjects were assessed at 6 and 12 months into the follow-up year. RESULTS: Comparison of the two conditions revealed that throughout the follow-up year, DBT subjects had significantly higher Global Assessment Scale scores. During the initial 6 months of the follow-up, DBT subjects had significantly less parasuicidal behavior, less anger, and better self-reported social adjustment. During the final 6 months, DBT subjects had significantly fewer psychiatric inpatient days and better interviewer-rated social adjustment. CONCLUSION: In general, the superiority of DBT over treatment-as-usual, found in previous studies at the completion of 1 year of treatment, was retained during a 1-year follow-up.

Cognitive-behavioral treatment of chronically parasuicidal borderline patients.

A randomized clinical trial was conducted to evaluate the effectiveness of a cognitive-behavioral therapy, ie, dialectical behavior therapy, for the treatment of chronically parasuicidal women who met criteria for borderline personality disorder. The treatment lasted 1 year, with assessment every 4 months. The control condition was "treatment as usual" in the community. At most assessment points and during the entire year, the subjects who received dialectical behavior therapy had fewer incidences of parasuicide and less medically severe parasuicides, were more likely to stay in individual therapy, and had fewer inpatient psychiatric days. There were no between-group differences on measures of depression, hopelessness, suicide ideation, or reasons for living although scores on all four measures decreased throughout the year.

Prolonged survival of actively enhanced rat renal allografts despite accelerated cellular infiltration and rapid induction of both class I and class II MHC antigens.

Administration of 1 ml of donor whole blood 7 d before renal transplantation produces long-term (greater than 100 d) graft survival in the DA (RT1a) into PVG (RT1c) rat strain combination. Using this model, the pattern and phenotype of infiltrating leukocytes were examined in rejecting and enhanced renal allografts, at days 1, 3, 5, and 7 after transplantation, by immunohistologic techniques. Paradoxically, enhanced grafts showed a more rapid and substantial leukocyte infiltrate, the phenotype of which was similar to that in rejecting grafts except for a reduced number of MRC OX-8+ cells and MRC OX-39+ cells. Graft infiltrating cells and splenocytes from transfused animals showed similar, although modest, levels of both nonspecific cytotoxicity and alloantigen-specific cytotoxicity. Immunohistologic analysis of MHC antigen distribution within the allograft revealed, unexpectedly, that enhanced grafts underwent an accelerated and extensive induction of both donor class I and class II MHC antigens. These findings were confirmed by allospecific quantitative absorption analysis, which showed severalfold increases in class I and class II MHC antigens by day 3 in enhanced grafts but not until day 5 in rejecting grafts. An additional observation was the more rapid disappearance of donor interstitial cells from enhanced grafts. These findings emphasize the overwhelming suppressive effect induced by an organ allograft after preoperative blood transfusion despite the associated induction of large numbers of potential effector cells and increased target antigen density within the graft.

Phenotypic analysis of graft infiltrating cells and major histocompatibility complex expression in actively enhanced rat renal allografts.

In this study donor specific blood transfusion of PVG recipients prevented rejection of DA strain kidneys but, paradoxically, failed to prevent the rapid and progressive accumulation of large numbers of mononuclear cells within enhanced grafts. Morphometric analysis showed that the percentage cellular infiltrate at day 3 was significantly greater in enhanced than in rejecting grafts but a notable feature in the phenotypic analysis of day 5 infiltrates was a markedly reduced number of MRC OX8 positive cells (Tc/s and NK cells) in enhanced grafts. Both rejecting and enhanced allografts showed a marked induction not only of class I but also of class II MHC antigens, and quantitative absorption analysis of donor class I MHC antigens indicated that induction occurred more rapidly in enhanced grafts. Taken together, these findings suggest that blood transfusion sensitizes the recipient, resulting in a more rapid allograft response, but that even in the presence of massive MHC/antigen induction and large numbers of infiltrating cells, immunoregulatory mechanisms are able to suppress the rejection response.

Cognitive-behavioral treatment of depressed affect among epileptics: preliminary findings.

Controlled study showed skills training for the management of depression in an epilepsy population to be effective. Cognitive-behavioral methods were utilized in a structured learning format with 13 clinically depressed epileptic "students." Significantly greater reductions in dysphoria/depression as measured by the Depression Adjective Checklist and the Generalized Contentment Scale occurred among Ss in the treatment group than among control group Ss. Significant decreases in anger and anxiety/stress and increases in social activities were noted on the Community Adjustment Questionnaire (CAQ). Similar trends were evident on the Beck Depression Inventory and the CAQ depression scale.

Service utilization by black and white clientele in an urban community mental health center: revised assessment of an old problem.

Results of a four-year evaluation project by Harborview Community Mental Health Center to assess equity of service to its black constituency are reported. Demographic, service, and psychometric data were gathered on black and white groups which were compared with each other. It was anticipated that service delivery would be proportionate to the social and psychiatric functioning of patients regardless of race or sex. The expectation was partially confirmed. Black patients were found to be somewhat less impaired than whites, yet were referred to treatment modalities and units with apparent equity. Patterns of service at one year were significantly different, reflecting earlier termination for blacks than for whites. This finding is discussed in the context of equal socio-economic class and diagnostic grouping between ethnic groups, but differing indexes of impairment.

Behavioural self-analysis in the medical curriculum: a comparison of Malaysian and American experiences.

Behavioural self-analysis projects were introduced into the second year medical curriculum in behavioural sciences at the University of Malaya. Students performance and evaluation of the experience were compared with those of American medical students. It was concluded that receptivity of medical students to principles of behaviour therapy is relatively similar in the two societies.

Behavioral self-analysis in the medical curriculum.

Medical students in a first-year behavioral science course were required to conduct a behavior change project in accordance with a model based upon behavioristic principles. Most students conducted projects designed to alter their own behaviors, such as studying, eating, sleeping, and exercising. Student feedback, as well as formal evaluation of the projects that were conducted, provided a basis for the view that such procedures can make a significant contribution to the teaching of behavioral change technology in the medical curriculum.

The adult development program: an educational approach to the delivery of mental health services.

The adult development program is an intensive, shortterm program for individuals who want to change their behavior. It is based on an educational model; participants, who are called students, set their own behavior-change goals, and a multidisciplinary staff teach them techniques for reaching those goals. The program curriculum consists of about 20 seminars and workshops, which give the students an opportunity to learn and to practice new behaviors. Students pay fees that vary from $40 to $500 per month depending on the number of classes they take. Approximately 1750 students have participated in the program since it began six years ago.

Mental Illness in the Orang Asli (Aborigines) of West Malaysia.

No abstract available.