Development of therapeutic alliance in mentalization-based treatment-Goals, Bonds, and Tasks in a specialized treatment for borderline personality disorder.

Objective: Mentalization-based treatment (MBT) is an evidence-based long-term treatment for borderline personality disorder (BPD). Alliance is central for effective psychotherapies. Few studies have addressed aspects of working alliance in BPD evidence-based treatments. This study aimed to investigate alliance development in MBT therapies with different clinical outcomes. Method: The sample included 155 patients in an MBT programme. Clinical outcomes were based on Global Assessment of Functioning (GAF). The sample was divided in two subgroups according to GAF levels at the end of treatment (cut-off = 60). Working alliance was assessed by patient report (Working Alliance Inventory, subscales, Goals, Bonds and Tasks) and assessed repeatedly over 36 months. The method for statistical analyses was linear mixed models. Results: Initial levels of Goals, Bonds, and Tasks did not differ by subgroup, but change over time differed significantly by subgroup. In the good outcome subgroup, ratings of Goals, Bonds, and especially Tasks increased significantly over time. In the poor outcome subgroup, paranoid PD was associated with poorer alliance development over time. Conclusions: Good outcome therapies were characterized by a process where the working alliance grew over time. Results encourage an explicit focus on tasks in therapy particularly for patients with high levels of mistrust.

Interferon-gamma gene (T874A and G2109A) polymorphisms are associated with microscopy-positive tuberculosis.

Genetic susceptibility to tuberculosis includes several unknown yet different loci each contributing to a small extent. Intronic polymorphisms within the interferon-gamma (IFN-gamma) gene IFNG T+874A and IFNG G+2109A correlate with the IFN-gamma production in vitro, and the frequency of potential high IFN-gamma producers was previously reported by others to be lower in patients than in controls from Sicily. The aim of this study was to determine whether there is an association between polymorphisms in the IFN-gamma gene and predisposition to tuberculosis. We analysed two IFNG SNPs (T+874A and G+2109A) in patients (n = 253) hospitalized in Rijeka (Croatia) and controls (n = 519) from the same area. One-fifth of the controls were healthy contacts of the diseased, and the rest were blood donors. IFNG alleles, their predicted haplotypes or genotypes were not associated with disease susceptibility. Thus, we could not reproduce results from Sicilian case-control study. However, T/T+874 (possible high IFN-gamma producer) and +874A/A (putative low producer) genotypes were associated with microscopically positive-negative forms of disease. Haplotypes (T+874A and G+2109A) based on a prediction by software phase and subsequent genotype analysis corroborated these findings. Patients had significantly higher frequency of genotypes without T at +874 (AA/AA; AA/AG and AG/AG) in microscopy- or bacterial culture-positive groups compared with their negative counterparts. These data suggest an association with disease severity rather than susceptibility to tuberculosis in Croatian Caucasian population.

[Sexual abuse assessed by forensic examinations]. / Seksuelle overgreb bedømt ud fra retslaegelige undersøgelser.

Within a period of three years, 175 women and three men, with a median age of 25 years, underwent a medico-legal examination after sexual assault. Penal penetration (vaginal, anal and/or oral) was the case in 78% of the victims, more often if the victim had been under the influence of alcohol, and if the assailant was known to the victim. Only 52% of the raped victims were recommended follow up with an examination for and counselling about sexually transmitted diseases (STDs). Among those referred to an STD clinic 48% attended. Denmark is the only Nordic country without public services for rape victims. A police report is therefore a prerequisite for a medico-legal examination.

PIP: In a retrospective study, legal journal materials from Copenhagen, Frederiksberg, and Copenhagen county were examined with respect to persons over the age of 15 who had been subjected to sexual assault during the period of April 1, 1992, through March 31, 1995. A total of 178 forensic examinations of such persons occurred during this period. 175 were of women and 3 were of men, with an average age of 25 years (15-80 years). Penetration by penis (vaginally, anally, and/or orally) was described in 139 cases (78%). For 6 women in the age range of 15-21, the assault also meant the first sexual intercourse. At the time of the assault, 133 (75%) of the victims were asked about the use of contraception; 87 (65%) of these were not using any. 81 (46%) of the victims were under the influence of alcohol and 23 (13%) were under the influence of narcotics and/or drugs. In 107 cases (60%), the perpetrator was known to the victim. In 102 cases, the assault was carried out by means of physical violence and in 24 cases, under threat by a weapon. Forensic examination revealed lesions in 20 cases (11%), most often as bleeding or tears in the genital area. 72 (52%) of victims were advised to get an examination for sexually transmitted diseases (STDs). 28 (48%) of those referred to the Copenhagen Venereological Clinic underwent such an examination and none had an STD. There is need for follow-up examination, talk, and counseling after rape, and Denmark should establish a center for rape victims accessible to the public where the examination and support would not be dependent on a police report.