Personality organization in borderline patients with a history of suicide attempts.

Suicide attempts (SA) are common in patients with Borderline Personality Disorder (BPD). Recent studies focus on aspects of personality associated with risk for SA such as deficits in affect regulation including impulse control and aggression. The current study examines associations of dysfunctional personality organization, psychiatric comorbidities as well as non-suicidal self-injury (NSSI) with SA in a sample of 68 BPD outpatients. Patients with a history of SA yielded higher scores in personality domains of aggression, especially self-directed aggression. Further, a history of SA was associated with a worse general level of personality organization and a higher prevalence rate of NSSI and substance abuse disorder. The results demonstrate that SA in BPD patients might be regarded as a manifestation of impaired personality functioning rather than mere state variables and symptoms. Moreover, these findings might have implications for indication, treatment, and prognosis of Borderline Personality Disorder.

Lithium in drinking water and suicide mortality.

BACKGROUND: There is some evidence that natural levels of lithium in drinking water may have a protective effect on suicide mortality. AIMS: To evaluate the association between local lithium levels in drinking water and suicide mortality at district level in Austria. METHOD: A nationwide sample of 6460 lithium measurements was examined for association with suicide rates per 100,000 population and suicide standardised mortality ratios across all 99 Austrian districts. Multivariate regression models were adjusted for well-known socioeconomic factors known to influence suicide mortality in Austria (population density, per capita income, proportion of Roman Catholics, as well as the availability of mental health service providers). Sensitivity analyses and weighted least squares regression were used to challenge the robustness of the results. RESULTS: The overall suicide rate (R(2) = 0.15, ß = -0.39, t = -4.14, P = 0.000073) as well as the suicide mortality ratio (R(2) = 0.17, ß = -0.41, t = -4.38, P = 0.000030) were inversely associated with lithium levels in drinking water and remained significant after sensitivity analyses and adjustment for socioeconomic factors. CONCLUSIONS: In replicating and extending previous results, this study provides strong evidence that geographic regions with higher natural lithium concentrations in drinking water are associated with lower suicide mortality rates.

[Mentalization and bonding in chronic pelvic pain patients: a pilot study]. / Mentalisierungsfähigkeit und Bindung bei Patientinnen mit chronischen Unterbauchschmerzen: eine Pilotstudie.

OBJECTIVES: The study assesses mentalization (reflective functioning, RF), parental bonding, psychiatric comorbidity, and experiences of violence in chronic pelvic pain patients (CPP). METHODS: Twenty-two CPP patients were investigated using SCID I and II as well as the German version of the parental bonding instrument (FEB). Experiences of violence were assessed by semistructured interviews. Adult attachment interviews (AAI) were rated according to the Reflective Functioning Scale (RF Scale). RESULTS: CPP patients showed a lower capacity of mentalization (RF=2.3) compared to that of healthy individuals (RF approximately 5). Maternal bonding was rated as affectionless control (36.4 %) and as neglectful parenting (31.8 %). 54 % of the women reported experiences of violence. Axis I comorbidity was prevalent in 54.5 %, and axis II comorbidity was prevalent in 36.4 %. CONCLUSIONS: Further psychoanalytic-psychosomatic research should focus on the low capacity of mentalization, adverse parenting, and experiences of violence in chronic pelvic pain patients.

[The psychic structure of chronic pain patients]. / Psychische Struktur bei chronischen Schmerzpatienten.

OBJECTIVES: The study investigates the psychic structure and psychiatric comorbidity of chronic pain patients according to Kernberg's concept of personality organization. METHODS: We assessed 48 chronic pain patients attending the Behavioural Medicine Pain Clinic in the Department of Psychiatry. Patients were diagnosed using the SCID (DSM-IV). Psychic structure was assessed using the Structured Interview of Personality Organization (STIPO). RESULTS: At least one psychiatric diagnosis was found in 94 % of the patients, and 63 % of the patients met the criteria of at least one diagnosis of a personality disorder. In 58 % of the patients, we diagnosed a borderline personality organization, with high deficits in the dimensions of coping, defence mechanisms and identity. CONCLUSIONS: The high prevalence of borderline personality organization confirms the importance of a diagnostic investigation of the psychic structure and the necessity for psychotherapeutic treatment in chronic pain patients.

[The capacity for mentalization in depressive patients: a pilot study]. / Mentalisierungsfähigkeit bei depressiven Patientinnen: Eine Pilotstudie.

OBJECTIVES: Mentalization has been primarily investigated in Borderline Personality Disorders. This pilot study takes the first step toward investigating mentalization in depressive patients. METHODS: First, we present the theoretical background of the concept of mentalization and previous studies. Secondly, we report the results of this pilot study. 20 female inpatients suffering from Major Depressive Disorder were investigated with SKIDI+II, depression-scales (HAM-D, BDI), cognitive tests (TMT, MCVCT), and the Adult Attachment Interview (AAI), rated according to the Reflective Functioning Scale (RF Scale). RESULTS: Depressed patients showed less capacity for mentalization (RF = 2.3) than did borderline patients (RF approximately 3) and healthy individuals (RF approximately 5). Comorbidity with dependent personality disorder correlated with higher RF scores, while comorbidity with schizoid personality disorder correlated with lower RF scores. CONCLUSIONS: Moderate to severe depression goes along with a breakdown of mental capacity. Further research should focus on investigating changes in the capacity for mentalization in remission and changes in the course of psychotherapeutic treatments.

[Treatment of depression: what do women need?]. / Depressionsbehandlung--was brauchen Frauen?

OBJECTIVES: To answer the question of adequate treatment of depression in women from a scientific point of view, it is necessary to investigate the aetiology of depressive disorders as they relate to bio-genetic, mental and social factors. METHODS: For a comprehensive understanding of depressive disorders in women three factors are analysed: (1) the severity of a depression, (2) the phenomenological description, and (3) the factors of the development of depression in the female life cycle. RESULTS: Different treatment strategies for women can be developed on the basis of these phenomenological and psychodynamic considerations. A case study of a female patient suffering from depressive adjustment disorder who had a background history of sexual reproductive problems is presented to demonstrate characteristic factors in women which may serve as indicators for psychoanalytic focal psychotherapy. DISCUSSION: In our opinion, psychoanalytic theory in its complexity, working with unconscious phantasies, fears concerning body integrity and relationships to others, is the most appropriate method to determine specific factors behind the pathogenesis and the persistence of depressive disorders in women.