Metarepresentative functions in borderline personality disorder

Many authors consider that patients suffering from Borderline Personality Disorder (BPD) are hampered in their ability to metarepresent, which is the correct ascribing of states of mind to oneself and to others and the reflecting thereon. Although the ability to mentalize is generally described as being uniform, various authors pinpoint problems which appear to be of a diverse psychological nature. Some describe difficulties in identifying emotions or a shortfall in their regulation, others identify a lack of integration between representations of self and those of others, and yet others focus on the failure to distinguish between fantasy and reality. In the present research all sessions during the first year of therapy of four patients suffering from BPD were tape-recorded and transcribed, and then analyzed using the Metacognition Assessment Scale (MAS), which is designed for the evaluation of the ability to metarepresent in clinical reports. The results support the hypothesis that there is a metarepresentation impairment in BPD but that it is more selective than was thought until now. In particular, such patients maintain their ability to identify internal states, whereas they are impaired in the integration of representations of self and others and in the differentiation between fantasy and reality.     

Introduction to the special feature on the integrated treatment of personality disorder

The solid evidence that personality disorders can be treated effectively goes side by side with, on the one hand, sparse evidence for disorders other than borderline and for personality disorders co-occurrent with one another, and, on the other hand, with a relative lack of knowledge about the actual effective mechanisms of change that underpin successful psychotherapies. In this introduction we present the rationale for this special feature, advocating for an integrated treatment of personality pathology in which empirically-supported strategies and techniques are selected from different traditions on the basis of the pragmatic principle of what works.     

Religious Beliefs or Physicians’ Behavior: What Makes a Patient More Prone to Accept a Physician to Address His/Her Spiritual Issues?

The present study aims to understand the relation between religious beliefs, physicians’ behavior and patients’ opinions regarding “Spirituality, religiosity and health (S/R)” issues, and what makes a patient more prone to accept a physician to address his/her spiritual issues. A cross-sectional study was carried out in outpatients from a tertiary hospital, and a path analysis was used to examine the direct and indirect relationships between the variables. For the final analysis, 300 outpatients were evaluated. Most patients would like their doctors to address S/R issues but did not feel comfortable to ask them. In contrast, they reported most doctors have never addressed S/R issues, and they believe doctors are not prepared to address these issues. The path analysis revealed that patients’ previous experiences with their doctors may be as important as their religious/spiritual beliefs in proneness to accept a physician to address his/her spiritual issues.     

Short-Term Inpatient DBT Combined with Metacognitive Interventions for Personality Disorders: A Pilot Acceptability and Effectiveness Study

This study aims at evaluating the effectiveness of an intensive 1-month residential treatment course in an Italian psychiatric unit for patients meeting criteria for personality disorders (PD). This study involved 189 patients consecutively admitted to the unit and assessed at admission and discharge. The inpatient program was based on Dialectical Behavior Therapy (DBT) combined with Metacognitive interventions. Primary outcome was a reduction of general symptom severity (as measured by SCL-90-R). Secondary outcomes were reduction in depression (BDI), interpersonal problems (IIP-47). Other outcomes were impulsivity (BIS-11), aggressiveness (AQ), and dissociation (DES). We found a significant reduction in symptom severity, as well as in depression, interpersonal problems, dissociation, impulsivity and aggressiveness. The size of this benefit was predicted mostly by number of criteria met at SCID-II and intake scores mostly for impulsiveness and dissociation. In conclusion, intensive 1-month residential DBT combined with metacognitive interventions can be effective in treating patients with any PD presenting with severe global suffering, prominent self-harm and suicidal risk.

     

Impaired self-reflection in psychiatric disorders among adults: A proposal for the existence of a network of semi independent functions

Self-reflection plays a key role in healthy human adaptation. Self-reflection might involve different capacities which may be impaired to different degrees relatively independently of one another. Variation in abilities for different forms of self-reflection are commonly seen as key aspects of many adult mental disorders. Yet little has been written about whether there are different kinds of deficits in self-reflection found in mental illness, how those deficits should be distinguished from one another and how to characterize the extent to which they are interrelated. We review clinical and experimental literature and suggest four different forms of deficits in self-reflection: (a) sense of ownership of one’s own thoughts and actions, (b) emotional awareness, (c) distinction between fantasy and reality and (d) the integration of a range of different views of oneself and others. We propose how these different impairments in self-reflection are linked with one another.     

Changes in acetylcholine extracellular levels during cognitive processes

Measuring the changes in neurotransmitter extracellular levels in discrete brain areas is considered a tool for identifying the neuronal systems involved in specific behavioral responses or cognitive processes. Acetylcholine (ACh) is the first neurotransmitter whose diffusion from the central nervous system was investigated and whose extracellular levels variations were correlated to changes in neuronal activity. This was done initially by means of the cup technique and then by the microdialysis technique. The latter, notwithstanding some technical limitations, makes it possible to detect variations in extracellular levels of ACh in unrestrained, behaving animals. This review summarizes and discusses the results obtained investigating the changes in ACh release during performance of operant tasks, exposition to novel stimuli, locomotor activity, and the performance of spatial memory tasks, working memory, and place preference memory tasks. Activation of the forebrain cholinergic system has been demonstrated in many tasks and conditions in which the environment requires the animal to analyze novel stimuli that may represent a threat or offer a reward. The sustained cholinergic activation, demonstrated by high levels of extracellular ACh observed during the behavioral paradigms, indicates that many behaviors occur within or require the facilitation provided by the cholinergic system to the operation of pertinent neuronal pathways.     

The Influence of Perceived Versus Aerobic Fitness on Psychological Health and Physiological Stress Responsivity

This study sought to evaluate the association between perceived and aerobic physical fitness and both psychological functioning and physiological stress responsivity. Sixty nonsymptomatic participants (30 males, 30 females) participated in the experiment. Participants completed a series of personality and mood questionnaires as well as a laboratory procedure measuring cardiovascular responses (i.e., heart rate and blood pressure) while performing stressful laboratory tasks (i.e., the Stroop Color Naming Test and a sham IQ test). Aerobic fitness (i.e., VO ₂ max using the Bruce protocol) as well as perceived fitness were also determined. Results suggest that perceived fitness was generally associated with positive personality and mood variables while aerobic fitness was not. Overall results support the view that perception of fitness may be as important or perhaps even more important than aerobic fitness in its association with psychological but perhaps not physical functioning.