The burden of disease in personality disorders: diagnosis-specific quality of life

A generic quality of life measure was used to investigate the burden of disease in a large sample of patients with personality disorders. The 1,708 subjects included in this study were recruited from six different mental health care institutes in the Netherlands. The burden of disease was measured using the EuroQol EQ-5D. Personality disorders were diagnosed using the Structured Interview for DSM-IV Personality (SIDP-IV). The mean EQ-5D index value was 0.56. Primarily the total number of personality disorder diagnoses rather than the specific type determined the quality of life. Notably borderline personality disorder was not associated with the highest burden. The findings indicate that patients with personality disorders experience a high burden of disease, comparable to that of severe somatic illnesses. The results call into question the primary focus in literature on borderline personality disorder. The current study yields a strong argument in favor of reimbursing (effective) treatments for this patient population.     

An integrative perspective on psychotherapeutic treatments for borderline personality disorder

Although there is an abundance of literature on the psychotherapeutic treatment of borderline pathology, little is known about differences and similarities between treatments of borderline personality disorder (BPD). Potential differences and similarities are especially important in the absence of evidence of the superiority of one treatment over the other (e.g., Livesley, 2004). This article offers an overview of the theory and practice of contemporary psychotherapeutic treatments of BPD, and delineates similarities and differences between the specific treatments. Results show that similarities concerning (1) the formal characteristics, and (2) the importance of therapeutic techniques in treatments for BPD, outnumber the differences. This article concludes by viewing the similarities and differences from an integrative perspective, and recommendations are given for future work in treating patients with and research on the effectiveness of treatments and treatment techniques for BPD.     

Mechanisms underpinning successful decision making in skilled youth soccer players: an analysis of visual search behaviors

The authors examined the complex interactions between perception, cognition, and expertise by using a film-based decision-making test. They stratified 40 youth soccer players (aged 13.0-15.8 years) into groups by using a within-task criterion. They assigned the players to successful or less successful groups on the basis of their performance on a laboratory-based test of tactical skill. Using soccer-specific film simulations, movement-based response measures, and eye movement registration techniques, the authors determined the players' decision-making processes and skill level. The results showed that investigators can use film-based tests to discriminate soccer players of comparable experience and playing level on the basis of their decision-making skills. When compared with their less successful counterparts, successful decision-makers used more goal-oriented search strategies, which resulted in superior performance, as characterized by faster decision times and greater response accuracy. Successful decision-makers (a) spent more time fixating the player in possession of the ball and (b) alternated gaze more frequently between that player and other areas of the display. An earlier study in which researchers (R. Vaeyens, M. Lenoir, A. M. Williams, L. Mazyn, & R. M. Philippaerts, 2007) stratified participants into groups on the basis of playing level had not revealed those differences. The implication of the present findings is that a within-task criterion provides investigators with a more sensitive approach when they try to identify the mechanisms underlying decision-making skill. Implications for research and practice are discussed.     

Connecting to the Heart: Teaching Value-Based Professional Ethics

Science and Engineering Ethics - Engineering programs in the United States have been experimenting with diverse pedagogical approaches to educate future professional engineers. However, a crucial...     

Neural evidence for the interplay between language, gesture, and action: a review

Co-speech gestures embody a form of manual action that is tightly coupled to the language system. As such, the co-occurrence of speech and co-speech gestures is an excellent example of the interplay between language and action. There are, however, other ways in which language and action can be thought of as closely related. In this paper we will give an overview of studies in cognitive neuroscience that examine the neural underpinnings of links between language and action. Topics include neurocognitive studies of motor representations of speech sounds, action-related language, sign language and co-speech gestures. It will be concluded that there is strong evidence on the interaction between speech and gestures in the brain. This interaction however shares general properties with other domains in which there is interplay between language and action.     

Action naming in anomic aphasic speakers: effects of instrumentality and name relation

Many studies reveal effects of verb type on verb retrieval, mainly in agrammatic aphasic speakers. In the current study, two factors that might play a role in action naming in anomic aphasic speakers were considered: the conceptual factor instrumentality and the lexical factor name relation to a noun. Instrumental verbs were shown to be better preserved than non-instrumental verbs in a group of anomic aphasic speakers but not in a group of Broca's aphasic speakers. Name relation to a noun improved the performance of the anomic aphasic speakers as well. Again, no effect was found in the group of Broca's aphasic speakers. Verbs with a name relation to a noun were better retrieved in action naming than verbs without a name relation. These findings are discussed in terms of the spreading activation theory of Dell. (Dell, G. S. (1986). A spreading activation theory of retrieval in sentence production. Psychological Review 93, 283-321.).     

Reliability and validity of the borderline personality disorder severity index

The psychometric properties and validity of the Borderline Personality Disorder Severity Index (BPDSI), a semistructured interview assessing the frequency and severity of manifestations of Borderline Personality Disorder (BPD) during a circumscribed period, were investigated in two studies. In study 1, patients with BPD (n = 15), with other personality disorders (PD; n = 18), and without Axis II disorders (but with Axis I disorders; n = 10) assessed with the SCID were interviewed with the BPDSI (1-yr. version). Patients also filled out a number of questionnaires. A second rater judged taped BPDSI interviews. The BPDSI appeared to yield highly reliable (ICC = .93) and internally consistent (Cronbach's alpha = .85) scores. The BPDSI strongly discriminated BPD patients from other patients, and was not related to other Axis II pathology. Concurrent and construct validity was excellent. In study 2, a version of the BPDSI suitable for use in treatment outcome research was investigated (3-month version) in a sample of 64 BPD patients, 23 Cluster C PD patients, and 20 nonpsychiatric controls. Again, reliability coefficients were excellent (ICC = 0.97; Cronbach's alpha = 0.93), and validity indices were good. Clinical norms were also derived. In a sample of 28 BPD patients, the instrument detected improvement during 6 months of psychotherapy.     

Do smokers have a negative implicit attitude toward smoking?

Swanson, Rudman, and Greenwald (2001 Swanson, J. E., Rudman, L. A. and Greenwald, A. G. 2001. Using the Implicit Association Test to investigate attitude-behavior consistency for stigmatised behaviour. Cognition and Emotion, 15: 207–230. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) used an Implicit Association Test (IAT) to measure attitudes toward smoking and found that smokers have negative implicit attitudes toward smoking. In a first experiment, we replicated the results of Swanson et al. but showed that scores on an attitude IAT do discriminate between smokers and nonsmokers to the same extent than scores on an IAT that is designed to measure associations between smoking and approach or avoidance. In a second experiment, we did find positive implicit attitudes toward smoking in smokers when we used a personalised version of the IAT that was designed to be less susceptible to effects of societal views. Our results indicate that implicit attitudes should not be dismissed as a causal factor in the maintenance of smoking behaviour.     

Prevalence and comorbidity of axis I and axis II disorders among treatment refractory adolescents admitted for specialized psychotherapy

Research shows that approximately half of the adolescents in a clinical setting suffer from a personality disorder (PD). This finding has not yet been replicated in Europe. To test whether this finding also applies to Europe, structured diagnostic interviews for both Axis I and Axis II disorders were used in 257 adolescents who were admitted to a highly specialized mental health setting in The Netherlands. In this study we found that 40.5% of the adolescents were diagnosed with at least one personality disorder. Most adolescents with a personality disorder (78.9%) also suffered from one or more Axis I disorders. These results are comparable to rates found in previous prevalence studies of personality disorders in both adolescents and adults. Our results provide further evidence to support the cross-national generalizability of the diagnosis of PD in adolescents.