Interventions for perinatal borderline personality disorder and complex trauma: a systematic review.

Perinatal borderline personality disorder (BPD) and complex post-traumatic stress disorder (cPTSD) are associated with significant impairment to interpersonal functioning, and risk of intergenerational transmission of psychopathology. Evaluation of interventions, however, is scarce. To date, no systematic review has addressed interventions for perinatal BPD, cPTSD, and associated symptomatology. Given the modest evidence to support informed clinical guidelines, the objective of this systematic review is to synthesise the literature on interventions for perinatal BPD and cPTSD, and to generate future directions for research. A comprehensive literature search following PRISMA guidelines was conducted in PsycInfo, MEDLINE, Emcare, Scopus, and ProQuest Dissertations and Theses Global databases. Seven original studies were included, of which only two were randomised controlled trials, using less intensive comparison conditions. Results suggest an association between Dialectical Behavioural Therapy (DBT) group skills training, a multimodal therapeutic approach at a Mother-Baby Unit (MBU), and Child-Parent Psychotherapy with improved perinatal mental health outcomes and remission of symptoms. MBU admission and home-visiting programs were associated with healthy postpartum attachment relationships. Home-visiting programs and DBT group skills were additionally associated with improved maternal parenting capabilities. Conclusions to inform clinical guidelines are limited by a lack of credible comparison conditions, and low quantity and quality of evidence. The feasibility of implementing intensive interventions in real-world settings is dubious. Hence, it is suggested that future research considers utilising antenatal screening to identify at-risk mothers, and the implementation of early intervention, using robust designs that can inform robust conclusions.

Health of the Nation Outcome Scales for Infants field trial: concurrent validity.

BACKGROUND: A review of Australian mental health services identified a gap in routine outcome measures addressing social, emotional and behavioural domains for pre-schoolers and infants. A Child and Adolescent Mental Health Information Development Expert Advisory Panel working group developed the Health of the Nation Outcome Scales for Infants (HoNOSI), a clinician-reported routine outcome measure for infants 0-47 months. Prior face validity testing showed that the HoNOSI was considered useful in measuring mental health outcomes. AIMS: To examine the concurrent validity of the HoNOSI. METHOD: Mental health clinicians providing assessment and treatment to infants in routine clinical practice participated in the study. The mental health status of 108 infants were rated by a minimum of 26 clinicians with the HoNOSI, the Parent-Infant Relationship Global Assessment Scale (PIR-GAS) and measures of symptom severity and distress. RESULTS: The HoNOSI was statistically significantly correlated with the PIR-;GAS, rs = -0.73; Clinical Worry, rs = 0.77; and Severity Judgement ratings, rs = 0.85; P < 0.001. A good level of internal consistency was found. Using the COsensus-based Standards for the selection of health Measurement INstruments (COSMIN) criteria for judging instrument acceptability, the HoNOSI meets the standard for both concurrent validity and internal consistency. CONCLUSIONS: There has been a clear need for a routine outcome measure for use with infants. This study provides positive evidence of aspects of validity. These findings, along with those from the prior face validity study, support a controlled release of the HoNOSI accompanied by further research and development.

Behavioral Interventions for Infant Sleep Problems: A Randomized Controlled Trial.

OBJECTIVES: To evaluate the effects of behavioral interventions on the sleep/wakefulness of infants, parent and infant stress, and later child emotional/behavioral problems, and parent-child attachment. METHODS: A total of 43 infants (6-16 months, 63% girls) were randomized to receive either graduated extinction (n = 14), bedtime fading (n = 15), or sleep education control (n = 14). Sleep measures included parent-reported sleep diaries and infant actigraphy. Infant stress was measured via morning and afternoon salivary cortisol sampling, and mothers' self-reported mood and stress. Twelve months after intervention, mothers completed assessments of children's emotional and behavioral problems, and mother-child dyads underwent the strange situation procedure to evaluate parent-child attachment. RESULTS: Significant interactions were found for sleep latency (P < .05), number of awakenings (P < .0001), and wake after sleep onset (P = .01), with large decreases in sleep latency for graduated extinction and bedtime fading groups, and large decreases in number of awakenings and wake after sleep onset for the graduated extinction group. Salivary cortisol showed small-to-moderate declines in graduated extinction and bedtime fading groups compared with controls. Mothers' stress showed small-to-moderate decreases for the graduated extinction and bedtime fading conditions over the first month, yet no differences in mood were detected. At the 12-month follow-up, no significant differences were found in emotional and behavioral problems, and no significant differences in secure-insecure attachment styles between groups. CONCLUSIONS: Both graduated extinction and bedtime fading provide significant sleep benefits above control, yet convey no adverse stress responses or long-term effects on parent-child attachment or child emotions and behavior.

Clinical characteristics and mental health outcomes for women admitted to an Australian Mother-Baby Unit: a focus on borderline personality disorder and emotional dysregulation?

OBJECTIVE: To describe the clinical population of women admitted to a Mother-Baby Unit in Adelaide, South Australia and to evaluate changes during admission in both Axes I and II diagnoses of maternal mental health, and in mother-infant relationships. METHOD: Both clinical and self-report assessments of maternal mental health were made at admission and discharge, and self-report comparisons of the mother-infant relationship. RESULTS: Depressive illnesses (46.2%) were found to be the most prevalent conditions leading to admission, with rates of psychosis (10.3%) and bipolar disorder (3.4%) being lower. A high incidence of borderline personality disorder (23.1%) was found clinically, with almost half the admitted women showing features of borderline personality disorder on a self-report measure at admission. Significant improvements in maternal mental health and the mother-infant relationship were found at the time of discharge. CONCLUSIONS: Admission to this Mother-Baby Unit on mothers' self-report scales showed improvement in mothers' mental health and the relationship that they have with their infant. Given the high prevalence of borderline personality disorder and emotional dysregulation identified within the population, treatment implications and possible consequences for the infant are discussed for this client group.

How acceptable are one-off consultations for consumers? Further information on Item 291.

OBJECTIVE: The aim of this paper is to evaluate consumer and carer views of one-off psychiatric assessments, Item 291 in the Australian Medicare system. METHOD: Following general practitioner referral to a psychiatrist, consumers were invited to enroll in this study and provide: demographic data; a one-off face-to-face recorded interview 6-8 weeks following psychiatric assessment; and longitudinal assessment of their mental health, using the DASS, K10 and WHOQoL (prior to psychiatric assessment, 6-8 weeks after assessment and 3-4 months later). RESULTS: Consumer and carer enrollment were very difficult to obtain. Sufficient consumers (8) enrolled to provide meaningful qualitative data. Most had good mental health literacy, had severe and chronic mental health problems, and appreciated the opportunity to access a mental health expert and receive a management plan. Overall, GPs had appropriately informed consumers of the process. Following assessment, the GP and consumer were implementing the suggested management plan. Negative statements included instances of failure to improve, insufficient appointments with the psychiatrist, and concern with GP follow-up. CONCLUSION: One-off psychiatric assessments using Item 291 appear highly acceptable to referred consumers. Qualitative outcomes showed trends towards an improvement in mental health, in an appropriate target group.