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1.
Acta Psychiatr Scand ; 137(3): 206-215, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29417987

RESUMO

OBJECTIVE: Deficits in empathy, an important part of social cognition, have been described in patients with borderline personality disorder (BPD). Importantly, psychosocial stress enhances emotional empathy in healthy participants. However, it remains unknown whether stress affects empathy in BPD. METHOD: We randomized 47 women with BPD and 47 healthy women to either the Trier Social Stress Test or a control condition. Subsequently, all participants underwent the Multifaceted Empathy Test (MET), a measure of cognitive and emotional facets of empathy. RESULTS: Across groups, stress resulted in a significant increase in cortisol and stress ratings. There was a significant stress × group interaction for emotional empathy (Fdf1,92 = 5.12, P = 0.04, ηp2 = 0.05). While there was no difference between patients with BPD and healthy participants after the control condition, patients with BPD had significantly lower emotional empathy scores after stress compared to healthy individuals. There were no effects for cognitive empathy. CONCLUSION: The current finding provides first evidence that stress differentially affects emotional empathy in patients with BPD and healthy individuals such that patients with BPD showed reduced emotional empathy compared to healthy women after stress. Given the strong impact of stress on acute psychopathology in patients with BPD, such a response may exacerbate interpersonal conflicts in stress contexts and may be an important target for therapeutic interventions.


Assuntos
Transtorno da Personalidade Borderline/fisiopatologia , Emoções/fisiologia , Empatia/fisiologia , Estresse Psicológico/fisiopatologia , Adulto , Pressão Sanguínea/fisiologia , Feminino , Humanos , Hidrocortisona/metabolismo , Estresse Psicológico/complicações , Estresse Psicológico/metabolismo , Adulto Jovem
2.
Behav Res Ther ; 104: 7-13, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29477010

RESUMO

Although deficits in the recognition of emotional facial expressions are considered a hallmark of autism spectrum disorder (ASD), characterization of abnormalities in the differentiation of emotional expressions (e.g., sad vs. angry) has been rather inconsistent, especially in adults without intellectual impairments who may compensate for their deficits. In addition, previous research neglected the ability to detect emotional expressions (e.g., angry vs. neutral). The present study used a backward masking paradigm to investigate, a) the detection of emotional expressions, and b) the differentiation of emotional expressions in adults diagnosed with high functioning autism or Asperger syndrome (n = 23) compared to neurotypical controls (n = 25). Compensatory strategies were prevented by shortening the stimulus presentation time (33, 67, and 100 ms). In general, participants with ASD were significantly less accurate in detecting and differentiating emotional expressions compared to the control group. In the emotion differentiation task, individuals with ASD profited significantly less from an increase in presentation time. These results reinforce theoretical models that individuals with ASD have deficits in emotion recognition under time constraints. Furthermore, first evidence was provided that emotion detection and emotion differentiation are impaired in ASD.


Assuntos
Transtorno do Espectro Autista/psicologia , Emoções/fisiologia , Expressão Facial , Reconhecimento Facial/fisiologia , Percepção Social , Adulto , Feminino , Humanos , Masculino
3.
Nervenarzt ; 87(7): 739-45, 2016 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-27271516

RESUMO

BACKGROUND: Borderline personality disorders (BPD) are severe mental diseases which place high pressure on the psychiatric healthcare system. Nowadays, well-tested, disorder-specific treatment concepts are available also for inpatient treatment in Germany. These show very good and long-term improvements in the psychopathology as well as posttreatment social participation; however, prerequisites for the implementation of these evidence-based inpatient psychotherapy programs are well-trained treatment teams and appropriate financing of resource expenditure. OBJECTIVE: The aim was to formulate a definition of normative needs for treatment duration and intensity for a guideline-conform, empirically proven and effective inpatient treatment of borderline personality disorder as well as the derived personnel requirements in comparison to the currently available resources within the framework of the Psychiatry Personnel Act (Psych-PV). MATERIAL AND METHODS: The resource requirements were established based on evaluated hospital ward models, the recommendations of the S2 guidelines and the criteria of specialist societies and compared with the personnel stipulations according to the Psych-PV. RESULTS: The results for a normatively established treatment program showed a pronounced deficit in the financing of the evaluated resource requirements, even when the stipulations laid down in the Psych-PV were implemented to 100 %. DISCUSSION: Disorder-specific inpatient treatment programs for borderline personality disorder have been scientifically proven to be highly effective; however, resource analyses show that the personnel requirements necessary for effective implementation of these programs are much higher than those allocated by the funding according to the Pysch-PV. The current underfunding leads to inadequate treatment outcomes with high readmission rates and as a result high direct and indirect costs of illness.


Assuntos
Transtorno da Personalidade Borderline/terapia , Pacientes Internados/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Psicoterapia/estatística & dados numéricos , Psicoterapia/normas , Transtorno da Personalidade Borderline/epidemiologia , Alemanha/epidemiologia , Fidelidade a Diretrizes/organização & administração , Humanos , Modelos Organizacionais , Modelos Estatísticos , Avaliação das Necessidades , Admissão e Escalonamento de Pessoal/normas , Carga de Trabalho/normas , Carga de Trabalho/estatística & dados numéricos
4.
Psychol Med ; 46(12): 2523-34, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-27335220

RESUMO

BACKGROUND: Intrusive memories of traumatic events are a core feature of post-traumatic stress disorder but little is known about the neurobiological formation of intrusions. The aim of this study was to determine whether the activity of the noradrenergic system during an intrusion-inducing stressor would influence subsequent intrusive memories. METHOD: We conducted an experimental, double-blind, placebo-controlled study in 118 healthy women. Participants received a single dose of either 10 mg yohimbine, stimulating noradrenergic activity, or 0.15 mg clonidine, inhibiting noradrenergic activity, or placebo. Subsequently, they watched an established trauma film which induced intrusions. The number of consecutive intrusions resulting from the trauma film, the vividness of the intrusions, and the degree of distress evoked by the intrusions were assessed during the following 4 days. Salivary cortisol and α-amylase were collected before and after the trauma film. RESULTS: A significant time × treatment interaction for the number of intrusions and the vividness of intrusions indicated a different time course of intrusions depending on treatment. Post-hoc tests revealed a delayed decrease of intrusions and a delayed decrease of intrusion vividness after the trauma film in the yohimbine group compared with the clonidine and placebo groups. Furthermore, after yohimbine administration, a significant increase in salivary cortisol levels was observed during the trauma film. CONCLUSIONS: Our findings indicate that pharmacological activation of the noradrenergic system during an emotionally negative event makes an impact on consecutive intrusive memories and their vividness in healthy women. The noradrenergic system seems to be involved in the formation of intrusive memories.


Assuntos
Adrenérgicos/farmacologia , Hidrocortisona/metabolismo , Memória Episódica , Norepinefrina/fisiologia , Trauma Psicológico/metabolismo , Trauma Psicológico/fisiopatologia , Adolescente , Adrenérgicos/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Agonistas de Receptores Adrenérgicos alfa 2/farmacologia , Antagonistas de Receptores Adrenérgicos alfa 2/administração & dosagem , Antagonistas de Receptores Adrenérgicos alfa 2/farmacologia , Adulto , Clonidina/administração & dosagem , Clonidina/farmacologia , Método Duplo-Cego , Feminino , Humanos , Norepinefrina/metabolismo , Ioimbina/administração & dosagem , Ioimbina/farmacologia , Adulto Jovem
5.
Psychol Med ; 46(3): 575-87, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26467724

RESUMO

BACKGROUND: Patients with borderline personality disorder (BPD) show negative and unstable self- and other-evaluations compared to healthy individuals. It is unclear, however, how they process self- and other-relevant social feedback. We have previously demonstrated a positive updating bias in healthy individuals: When receiving social feedback on character traits, healthy individuals integrate desirable more than undesirable feedback. Here, our aim was to test whether BPD patients exhibit a more negative pattern of social feedback processing. METHOD: We employed a character trait task in which BPD patients interacted with four healthy participants in a real-life social interaction. Afterwards, all participants rated themselves and one other participant on 80 character traits before and after receiving feedback from their interaction partners. We compared how participants updated their ratings after receiving desirable and undesirable feedback. Our analyses included 22 BPD patients and 81 healthy controls. RESULTS: Healthy controls showed a positivity bias for self- and other-relevant feedback as previously demonstrated. Importantly, this pattern was altered in BPD patients: They integrated undesirable feedback for themselves to a greater degree than healthy controls did. Other-relevant feedback processing was unaltered in BPD patients. CONCLUSIONS: Our study demonstrates an alteration in self-relevant feedback processing in BPD patients that might contribute to unstable and negative self-evaluations.


Assuntos
Transtorno da Personalidade Borderline/psicologia , Retroalimentação Psicológica , Relações Interpessoais , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Alemanha , Humanos , Autoavaliação (Psicologia) , Adulto Jovem
7.
Nervenarzt ; 84(7): 879-86; quiz 887-8, 2013 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-23636574

RESUMO

Narcissism is a multifaceted term which encompasses traits of normal personality as well as a specific personality disorder. While much research has been concerned with narcissism as a trait there are only few empirical studies available on narcissistic personality disorder (NPS). The current diagnostic of NPS according to DSM-IV-TR focuses on grandiose type narcissism whereas vulnerable narcissism, which has been described by clinicians and researchers has not yet been recognised. Psychotherapy of narcissistic patients through different psychotherapeutic schools focuses mainly on processes in the therapeutic relationship, the analysis and change of grandiose and vulnerable schemas, emotion regulation techniques and correction of narcissistic behavior in favor of prosocial interactions.


Assuntos
Transtornos da Personalidade/diagnóstico , Transtornos da Personalidade/terapia , Personalidade , Psicoterapia/métodos , Humanos , Transtornos da Personalidade/psicologia
8.
Psychol Med ; 41(9): 1929-38, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21306661

RESUMO

BACKGROUND: Disturbances in social interaction are a defining feature of patients with borderline personality disorder (BPD). In this study, facial emotional expressions, which are crucial for adaptive interactions in social contexts, were assessed in patients with BPD in response to social exclusion. METHOD: We examined facial emotional reactions of 35 patients with BPD and 33 healthy controls when playing Cyberball, a virtual ball-tossing game that reliably induces social exclusion. Besides self-reported emotional responses, facial emotional expressions were analyzed by applying the Emotional Facial Action Coding System (EMFACS). RESULTS: Patients with BPD showed a biased perception of participation. They more readily reported feeling excluded compared to controls even when they were included. In BPD, social exclusion led to an increase in self-reported other-focused negative emotions. Overall, EMFACS analyses revealed that BPD patients reacted with fewer positive expressions and with significantly more mixed emotional expressions (two emotional facial expressions at the same time) compared to the healthy control group when excluded. CONCLUSIONS: Besides a negative bias for perceived social participation, ambiguous facial emotional expressions may play an important role in the disturbed relatedness in patients with BPD.


Assuntos
Transtorno da Personalidade Borderline/psicologia , Emoções , Expressão Facial , Isolamento Social/psicologia , Adulto , Análise de Variância , Feminino , Jogos Experimentais , Alemanha , Humanos , Relações Interpessoais
9.
Pharmacopsychiatry ; 41(5): 176-81, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18763219

RESUMO

INTRODUCTION: Atypical antipsychotics might become a new treatment option for patients with an impaired impulse regulation as seen in cluster B personality disorders (PD). The aim of the present study is to investigate the efficacy and tolerability of quetiapine in patients with cluster B PD. METHODS: Fifteen in-patients with a DSM-IV diagnosis of borderline, histrionic, or narcissistic PD were treated for 8 weeks with quetiapine at a dose of 400 mg/day in an open-label fashion. Effects on impulsivity (Barratt Impulsiveness Scale, BIS), depressive symptoms (Hamilton Depression Scale, HAMD, and Beck Depression Inventory, BDI) and side effects (Dosage Record and Treatment Emergent Symptom Scale, DOTES) were assessed. RESULTS: Twelve patients completed the study. No positive effect on impulsivity (BIS) was found, but a significant improvement on depression scores (HAM-D and BDI) was noted. Adverse effects that might have been due to study medication were mainly anticholinergic and mild-to-moderate. DISCUSSION: The data of our preliminary open-label study do not argue for a general recommendation of quetiapine for the treatment of impulsivity in cluster B PD, but indicate positive effects on depressive symptoms.


Assuntos
Antipsicóticos/uso terapêutico , Depressão/tratamento farmacológico , Depressão/etiologia , Dibenzotiazepinas/uso terapêutico , Transtornos da Personalidade/complicações , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Comportamento Impulsivo/tratamento farmacológico , Comportamento Impulsivo/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Escalas de Graduação Psiquiátrica , Psicometria , Fumarato de Quetiapina , Estudos Retrospectivos , Fatores de Tempo
10.
Aging Ment Health ; 5(2): 159-64, 2001 May.
Artigo em Inglês | MEDLINE | ID: mdl-11511063

RESUMO

The revised Neuroticism (N), Extraversion (E), Openness (O) to experience Personality Inventory (NEO-PI-R) is a multidimensional measure of normal personality traits that is intended to assess five major personality dimensions or domains-N, E, O, Agreeableness (A), and Conscientiousness (C). Although several studies have been conducted examining N, E, and O factors in people 65 through to 85 years old, there has been little research examining all five-core domains of personality in individuals 85 and older. We compared the NEO-PI-R domains and facet traits in the middle-aged/young-old versus old-old normal subjects. Thirty-eight community-dwelling subjects (22 women, 16 men) free from major neuropsychiatric disorders were given the NEO-PI-R, a self-administered 240-item personality inventory, assessing 30 facet traits within the five domains. We compared the scores of 21 middle-aged and young-old (age 50-84) individuals, to those of 17 old-old (age 85-100) subjects. The personality profiles of the two groups were similar except that the old-old group had lower scores on Extraversion, and four of the 30 facet traits (warmth, positive emotions, impulsiveness, and order) compared to the middle-aged/young-old group. These results were limited by the cross-sectional design and small sample size. Nonetheless, the findings suggest that the middle-aged/young-old and the old-old normal subjects have fairly similar personality traits.


Assuntos
Envelhecimento/psicologia , Inventário de Personalidade/estatística & dados numéricos , Adaptação Psicológica , Idoso , Idoso de 80 Anos ou mais , Extroversão Psicológica , Feminino , Humanos , Masculino , Transtornos Neuróticos/diagnóstico , Transtornos Neuróticos/psicologia , Psicometria , Valores de Referência , Autorrevelação
11.
J Psychother Pract Res ; 9(3): 149-56, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10896740

RESUMO

There is considerable evidence that psychosocial treatments benefit younger adults with schizophrenia. However, no studies have been undertaken of such interventions for older patients with schizophrenia. This report describes the development of a novel integrated treatment combining cognitive-behavioral therapy (CBT) and social skills training (SST). This intervention is designed to address the needs of older patients with schizophrenia by challenging beliefs common in this population that interfere with treatment and by providing repetitive practice of behaviors to improve retention and skill development. The authors provide two case reports and pilot data suggesting benefits of this approach.


Assuntos
Terapia Cognitivo-Comportamental , Esquizofrenia/terapia , Psicologia do Esquizofrênico , Terapia Socioambiental , Adulto , Idoso , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Socialização
12.
J Clin Pharmacol ; 24(5-6): 228-34, 1984.
Artigo em Inglês | MEDLINE | ID: mdl-6747019

RESUMO

A total of 152 patients were treated at a single center in a single-dose, double-blind parallel study designed to compare the safety and efficacy of 25, 50, and 100 mg ketoprofen to 90 mg codeine and placebo in patients with moderate to severe postpartum pain (i.e., postepisiotomy, uterine cramping, or cesarean section pain). The analgesic responses to all three doses of ketoprofen and 90 mg codeine were superior to placebo and were not significantly different from each other. No dose-related response was observed with ketoprofen. The number of side effects was significantly greater (P = 0.001) among patients receiving codeine (six patients) than among those receiving ketoprofen (three patients).


Assuntos
Codeína/uso terapêutico , Cetoprofeno/uso terapêutico , Dor/tratamento farmacológico , Fenilpropionatos/uso terapêutico , Transtornos Puerperais/tratamento farmacológico , Adulto , Codeína/efeitos adversos , Método Duplo-Cego , Feminino , Humanos , Cetoprofeno/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Placebos , Gravidez
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