Clinical diagnosis and case formulation in the psychotherapy of personality disorders.

Purpose: The article aimed to present a case conceptualization in two stages of therapy for PD patients qualifying for a specific therapy modality and diagnosis, including the conceptualization and monitoring of the process and mechanism of changes under the influence of specific therapeutic interventions. The problem is significant as there is a high level of treatment dropout among patients with various personality disorders. Views: The article discusses the current state of knowledge and Kazdin's methodology of scientific research on the processes and mechanisms of change in patients under the influence of therapeutic interventions. Using the assumptions of this model, the author describes the six steps of a therapeutic procedure which aims at describing and monitoring the process and mechanism of therapeutic interventions, with a special emphasis on the significance of a mediator in the form of the therapeutic alliance. The therapeutic alliance is a significant mediator of changes leading to positive and/or negative therapy outcome and some of its components should be considered as moderators that may significantly modify the influence of the mediator on the strength of the links between a given therapy modality and its effectiveness. Conclusions: Kazdin's model and diagnostic principles seem very useful and promising in clinical practice. At our current stage of knowledge and research, the diagnosing and monitoring of the process and mechanism of change in patients, resulting from specific therapeutic interventions, constitutes a considerable challenge for psychotherapists and clinicians.

Corpus Callosum Atrophy in Alcohol-Dependent Men with Memory Disorders and Visual Attention Difficulties.

BACKGROUND: The earlier research confirm the relationship between structural changes in the corpus callosum and difficulties in attention and memory in the group of patients with alcohol use disorder (AUD). Nevertheless, the image of auditory and visual memory disorders in men with gradual atrophy of the corpus callosum and different alcohol abuse duration, it has not been explained yet. The overriding objective of this study was: (1) to determine whether there are principal and interaction effects of visuospatial and auditory-verbal memory on alcohol consumption and cross-sectional corpus callosum area in men with alcohol use disorder, (2) to assess the impact of callosal changes on the memory and visual attention processes. METHODS: 97 men with alcohol use disorder were examined. T1-weighted scans were used to carry out corpus callosum segmentation and volumetric measurements. The cognition profile included two domains: attention, memory (visuospatial and auditory-verbal). RESULTS: The results showed that participants with visuospatial memory disorder had inferior education background, and were characterized by a longer duration of alcohol abuse, more severe alcohol use disorder, and greater alcohol consumption per day. Second, alcohol-dependent men with auditory and visual memory disorders had a smaller frontal and posterior part of the corpus callosum areas. Additionally, among the alcohol-dependent men with memory disorders the smaller rostral body of corpus callosum was determined by the longer alcohol abuse duration. On the other hand, the smaller rostral body of corpus callosum was predicted by the older age only in alcohol-dependent men with normal memory. Among all examined individuals were observed a statistically significant relationships among visual attention, visuospatial memory and corpus callosum subregions including in particular genu and isthmus. CONCLUSIONS: The smaller corpus callosum cross-sectional area significantly affects visual attention and memory difficulties in alcohol use disorder, especially have differentiated the patients with normal and disordered memory. Longer alcohol abuse duration plays also a significant role in the corpus callosum atrophy in alcohol-dependent men with disordered memory (visuospatial in particular).

Positive and negative life experiences and changes in internal working models of attachment - a comparative study. / Pozytywne i negatywne doswiadczenia zyciowe a zmiany wewnetrznych modeli przywiazania ­ badania porównawcze.

OBJECTIVES: One of the most important questions in personality psychology and psychopathology is whether working models of attachment change during lifetime. It is assumed that early childhood experiences influence the formation of secure or insecure internal working models of attachment The belief that attachment representations formed in childhood are relatively stable is no longer so obvious: new reports have appeared, according to which important life experiences may lead to a change in attachment style from insecure to secure or the other way around. The main aim of the present project was to investigate whether and in what manner positive and negative life experiences lead to changes in internal working models of attachment. METHODS: The specific style of attachment to mother, father, partner, and friend was measured with the ECR-RS, while global attachment was assessed based on the SAAM and ECR-RS G. The number and intensity of positive and negative life experiences was assessed by means of the LES-M. We analyzed the results for a sample of 156 adults. RESULTS: The study revealed significant relations between the level of positive life experiences and global and specific styles of attachment to a friend and partner. However, no significant relationships were observed between the intensity of negative life events and attachment style. Between-group comparisons showed that in the group in which a change of attachment style from insecure to secure had taken place the experience of positive events was significantly stronger than in the group in which there had been no such change. The compared groups did not differ in the level of negative life experiences. CONCLUSIONS: The study supports the hypothesis about a change of global attachment style and selected specific aspects of insecure attachment to a secure style as a result of experiencing positive life events.

Timeliness of the developmental tasks in adulthood among children of mothers suffering from schizophrenia.

BACKGROUND: Being raised by a mother suffering from schizophrenia may affect the fulfilment of developmental tasks. The aim of the study was to determine which psychological factors (attachment, emotion regulation) and social factors (parental care and social support) determine the implementation of developmental tasks, taking into account the age of the child at the time that schizophrenia was diagnosed in the mother (before 10 vs. over 10 years of age; B10y vs. O10y). PARTICIPANTS AND PROCEDURE: The sample consisted of 47 (34 women) highly functioning adult offspring of mothers suffering from schizophrenia. They responded to self-report measures about their current functioning and gave retrospective information about their childhood. RESULTS: The results show that the timeliness, inconsistency and excessive demands of the mother are higher in the O10y group than in the B10y group. The lack of awareness of experienced emotions, the need for support, inconsistency in the mother's parental attitude and diagnosis O10y were predictors of punctuality, while the available instrumental support, the need for support and the inconsistency of the parental style were found to be predictors of the acceleration of developmental tasks. CONCLUSIONS: The results suggest that the group is heterogenous in terms of psychosocial functioning and developmental characteristics, so the type of support should also be diverse.

Level of personality integration in psychopathy. / Poziom integracji osobowosci w psychopatii.

OBJECTIVES: Aim of this research was to determine whether differences in clinical picture of psychopathy (on the basis of which subtypes of psychopathy are identified) reflect differences in pathology of personality organization (integration) according to O. Kernberg. METHODS: The research was conducted on 417 subjects, of whom 88.5% were criminals, 11.5% - non-criminals. Psychopathic Personality Inventory-Revised (PPI-R), developed by S.O. Lilienfeld, was used to assess level of psychopathy while personality organization level was assessed by Borderline Personality Inventory (BPI) developed by F. Leichsenring. K-means cluster analysis was supported by AUC. RESULTS: Cluster analysis allowed for differentiation of two groups: cluster 1 - fearlessly dominating psychopaths and cluster 2 - egocentrically-impulsive psychopaths. Egocentrically-impulsive psychopaths are significantly more frequently characterized by borderline personality organization than psychopaths from cluster 1. In addition to symptoms of psychopathy they show evidence of deeper identity disorders, apply primitive defense mechanisms more frequently, experience fear of fusion and severe problems in reality testing. CONCLUSIONS: Differences in picture of psychopathy reflect different pathology of personality organization. Results confirm the thesis of distinctive nature of coldheartedness and its invariant presence in picture of psychopathy regardless of configuration of other traits in both subtypes.

In psoriasis, levels of hope and quality of life are linked.

Psychological resources such as hope have been suggested to positively influence quality of life (QoL) in chronic disorders. Here, we determined hope levels of psoriasis vulgaris in-patients and analyzed their relation to QoL. A total of 60 (29 male) patients were assessed for their QoL with a generic tool (WHOQOL-BREF) and a skin disease-specific instrument, the Dermatology Life Quality Index (DLQI). Hope levels were determined by use of the Basic Hope Inventory. We found a positive correlation between hope and all domains of WHOQOL-BREF (physical: r = 0.446, p = 0.000; psychological r = 0.464, p = 0.000; social r = 0.302, p = 0.019; environmental r = 0.480, p = 0000; and global r = 0.501, p = 0.000) and a negative correlation with DLQI (r = -0.281, p = 0.030) indicating higher QoL in patients with high hope. Hope was not correlated with disease severity or duration. Hope may play a substantial role in preventing QoL impairment in psoriasis. Psychotherapeutic interventions aimed at strengthening hope could improve QoL in this condition.