The two-faceted nature of impulsivity in patients with borderline personality disorder and substance use disorder.

BACKGROUND: Impulsivity, which has been the subject of extensive debate in psychiatric research, is a clinically important concept, especially with respect to Borderline Personality Disorder (BPD) and Substance Use Disorders (SUD). The current study aims to examine the presence of two aspects of impulsivity (self-reported impulsivity and delay discounting) in patients with BPD, SUD (alcohol use=AUD or drug use=DUD) and the combination of both disorders (BPD+SUD). METHODS: Patients were recruited from eight different mental health treatment service facilities. A total of 345 participants were assessed and divided into six groups: (1) healthy controls (non-BPD, non-SUD), (2) patients with BPD (non-SUD), (3) DUD (non-BPD), (4) AUD (non-BPD), (5) BPD+AUD and (6) BPD+DUD. RESULTS: The behavioural measure of impulsivity is more conservative than the results of self-reported impulsivity. Furthermore, ANOVA indicated that BPD and SUD have significant effects on self-reported impulsivity, even when demographic variables, income, other psychiatric symptoms or depression are considered as covariates. On the other hand, the main effects of BPD and SUD are mediated by psychiatric symptoms and depression when delay discounting is considered as a dependent variable. CONCLUSIONS: When self-reported, impulsivity is over-estimated as compared to reports based on behavioural measures. These results provide support for the notion that impulsivity is not a unitary construct, and that it instead has different manifestations in BPD and SUD patients.

[Changes in the subjective perception of the quality of life. Retrospective study of patients treated at the Thalassa House]. / A szubjektív életminoség változása. A Thalassa Házban kezelt páciensek retrospektív vizsgálata.

INTRODUCTION: Quality of life and psychosocial functioning are considered important factors both in psychiatric and psychotherapeutic rehabilitation; similarly they are useful outcome measures in prospective studies. In this paper we present a retrospective study conducted with patients treated in Thalassa Haz Psychiatric and Psychotherapeutic Rehabilitation Center (TH). METHOD: 1. Non-systematic review of the literature concerning quality of life and social functioning measures 2. Patients discharged form TH between 01. 01. 2008 and 31. 12. 2008 were included in the study. A semi-structured, patient reported instrument was used to assess psychosocial functioning, including single questions and an open-ended questions. Statistical analysis and manual content analysis were performed. RESULTS: 208 patients were contacted, 84 completed questionnaires were sent back and analysed. Less than 31% of the patients were rehospitalized within six months with the same problem. Subjective evaluation showed that 72% of the patients suffer less from the problem, with which they were treated in TH. The majority reported positive effect on interpersonal relations (67%) and autonomy (70%) due to the treatment. There is a significant correlation between treatment satisfaction and duration of treatment. The content analysis revealed significant negative correlation between generalisational content frequencies and treatment satisfaction. CONCLUSIONS: Psychosocial functioning improved after treatment in the TH. Correlation was identified between treatment satisfaction and satisfaction with life, thus quality of life and duration of treatment. Combination of objective and subjective methods, as well as content analysis are useful measures in the effectiveness studies of therapeutic communities.