There is growing body of evidence that support an association between stressful life events (SLEs) and an increase risk for Multiple Sclerosis (MS) exacerbations. The aims of this study were: first, to examine the relationship between SLEs and MS exacerbations; second, to investigate how SLEs frequency influence MS disease activity.

Twenty six ambulating women (Expanded Disability Status Score, EDSS ≤3) with relapsing-remitting Multiple Sclerosis were followed-up for one year or more. Patients documented SLEs weekly in self report diaries which were then collected at regular clinic visits every 4 weeks. Neurological examination was performed, at baseline and at every regular and additional visit after a suspect exacerbation.

A Cox univariate regression analysis showed that 1 or 2 SLEs had no effect on risk for relapses. In the opposite 3 and ≥ 4 SLEs were associated with 5.3 (95% CI 1.7 to 16.4, p=0.003) and 16.7 (95% CI 4.6 to 60.5, p<0.001) times respectively the rate of relapsing during the following four weeks. The number of the reported SLEs was not correlated with the EDSS score [r(26)=-0.10, p>0.05], the system involved [r(26)=0.01, p>0.05], or the duration of the relapse [r(26)=0.02, p>0.05].

This data provide prospective evidence that SLEs may trigger MS exacerbations. The effect of stress on relapse risk in MS is cumulative. A higher density of stress is not related with a mayor inflammation process.

There exist almost no data on the efficacy of treatment of posttraumatic stress disorder (PTSD) in refugees coming to Western countries, even though many studies show a very high prevalence of posttraumatic problems among refugees. The present study focuses on the efficacy of a culture sensitive treatment for PTSD primarily designed for work in refugee camps in third world countries. Using a randomized controlled design, Narrative Exposure Therapy is compared to Treatment as Usual in a sample of refugees and asylum seekers in Norway.

Adult refugees or asylum seekers diagnosed with PTSD according to DSM IV were included in the study. Treatments comprised of 10 sessions and follow-up interviews were conducted 1 and 6 months after treatment using Clinician Administered PTSD Scale, Mini International Neuropsychiatric Interview, and the Hamilton Rating Scale for Depression. The study will continue until the end of 2008.

So far, 72 patients with PTSD have been included in the trial, and among them 40 have completed treatment and post-tests. Preliminary results at 1 month follow up show a significant PTSD and depression symptom reduction in patients who had received NET and, to a much smaller extent, in those treated with usual therapy protocols. However, data present so far indicate that only in the NET group, PTSD and Depression symptom reduction remains stable over time.

Preliminary findings indicate the importance of providing also refugees and asylum seekers with focused treatment of PTSD, where Narrative Exposure Therapy seems to be a promising treatment approach.

We assumed that the shizophrenic patients with low social functioning use less successful stress coping skills. The study was designed to examine connection between social functioning and stress coping skills in a group of schizophrenic patients according to the influence made by age, gender, professional education, involvement in occupation therapy, guardianship, duration of illness and social contacts.

Examinees (n=123) with diagnosed shizophrenia accommodated at a social care Institution for mentally ill persons. The housing process was identified as a stressful event. Coping skills scale adapted from Arcel and Ljubotina and an Adaptive function scale according to Bellack have been used in the study. The following methods have been used for statistics: descriptive analysis, regression analysis, discriminatively analysis and group centroids.

There were statistically significant between better social functioning and use of special types of stress coping, especially by females and patients involved in occupation therapy. There is no statistically significant difference between groups of examinees considering their age, professional education, guardianship and duration of illness in relation to social functioning and stress coping skills. In reference to social contacts, statistically significant difference exists in the segment of stress coping while in social functioning there are no significant differences.

There were statistically significant differences between social functioning and stress coping skills in schizophrenic patients in term that patients with better social functioning use more successful coping skills. The results suggest that stress coping program for schizophrenic patients can influence the outcome of disease.

Aggression is a particular problem commonly observed in personality disorders, especially in antisocial personality disorder (APD). It is well known that APD is closely related to substance use disorder (SUD). Individuals with higher aggression levels have also been suggested to have higher rates of SUD. The aim of this study is to investigate aggression levels and substance use characteristics of APD subjects with and without violent criminal behavior.

A total of 124 male subjects with APD consecutively admitted to the Forensic Psychiatry Department of GATA Haydarpasa Training Hospital were involved in the study. All subjects were evaluated with an assessment battery using a semi-structured interview for socio-demographic, APD, and substance use characteristics, APD section of SCID-II, SCID-I, and Aggression Questionnaire. The sample was divided into 2 groups in terms of having a history of violent criminal behavior and compared correspondingly.

Of the APD subjects, 90.3% reported a lifetime history of substance abuse and 75% had a current co-diagnosis of SUD. APD subjects with violent criminal behavior were more likely to be diagnosed with SUD as compared to those without violent crimes. Moreover, APD subjects with SUD had higher aggression levels than those without SUD.

Our results indicate that substance use may mediate the association between APD and aggression. Therefore, the treatment of SUD in APD subjects is an important target particularly for prevention of violent criminal behaviors.

Alexithymic characteristics have been observed in antisocial personality disorder (APD). On the other hand, aggression is a particular problem commonly observed in personality disorders, especially in APD. We investigated the alexithymic features and aggression levels in outpatients diagnosed with APD in a military hospital setting.

71 male subjects diagnosed with APD and 81 sex and age matched normal subjects with no known medical or psychiatric disorder were assessed with an assessment battery using a sociodemographic data form, APD section of SCID-II, the Toronto Alexithymia Scale (TAS)-20 items, and Aggression Questionnaire.

The subjects with APD have showed significantly higher rates of unemployment, lower educational and socioeconomic status. The APD group also displayed significantly higher scores on alexithymia and aggression than control group. APD subjects with higher scores of aggression revealed significantly higher scores of alexithymia.

Use of action to express emotions, a commonly observed feature of APD, was once considered to be a part of alexithymia. The subjects with APD may have less developed cognitive skills which lead to a failure in communicating their feelings. This may result in immature methods of communicating distress. Our study indicate that alexithymia may contribute to aggressive behavior in patients with APD. To draw a more definitive conclusion on this issue, larger community based studies that compares APD subjects with sociodemographically matched patient control groups are necessary.

Cluster B personality disorders are the most common in psychiatric patients and are correlated with specific characteristics. However, dissimilarities may be noticed between different personality types.

This study aimed to compare sociodemographic and clinical features of patients with varied types of this cluster.

It's a comparative study held in the psychiatric outpatient unit. All five years first time attendances to the unit were retrospectively examined in order to identify those with diagnosis of cluster B personality disorder according to DSM-IV criteria (N=81). Statistical comparisons were performed for sociodemographic features, medical history and axis I comorbidity.

Antisocial personality was the most common (n=32), followed by histrionic (n=28), then borderline personality (n=19).

Patients with antisocial personality were mainly of male gender (p<10-4) and had more antecedents of incarcerations (p<10-4) than the remainder.

Patients with borderline personality had reported less alcohol (p=0.035) and prescribed drugs (p=0.01) use than patients with antisocial personality and more alcohol use (p=0.013) than patients with histrionic personality. History of alcohol (p<10-4), cannabis (0.002) and prescribed drugs (p<10-4) use was more frequent in antisocial compared to histrionic personality. Also, patients with histrionic personality had more conversion disorder than those with antisocial personality (p=0.001).

Cluster B personality disorders seem to share similar family and personal past medical history, but are very different in matter of substance use and comorbid conversion disorder. These findings support the idea that adapted psychiatric care is needed for each type of cluster B personality disorder.

The « epileptic personality, rest on the psychiatric conceptions that combine the mental illness and the epilepsy. A multiplicity of factors could explain acts of violence committed by epileptics.

Authors reports three observations of epileptics having committed medicolegal acts and hospitalized in a psychiatric service between 1991 and 2003, the average of our patients was 35 years old; two with mental retardation and three a schizophrenics patients, they have been declared irresponsible, two had commit homicide and one commit steal. It was difficult to determine if acts were the consequence of an epileptic fury or the consequence of a delirium. The syphilitic serology was negative. The evolution under neuroleptics and anti- epileptics drugs were marked by a stabilization of all patients. We deplore two deaths by cardiac arrest.

The links between violent behaviours and epilepsy involve multiple factors, no characteristic type of crime is related with epileptic patients. The violence is significantly higher (23%) during postictal psychotic episodes than during acute interictal episodes (5%) and postictal confusion (1%). The interictal violence is associated more with psychopathology and mental retardation than with epileptiform activity or other seizure variables. It is what we reported in our three cases.

A change in the law in our country is necessary to remove epileptic offenders from the legal ambit of insanity, and to save them the threat of detention in a mental hospital as a consequence of their crime.

The current study investigates the cognitive and emotional abilities of psychopathic individuals. To assess whether psychopathic individuals show decision-making impairment, group differences are mirrored by correlations between cognitive and emotional measures and psychopathy.

Twenty psychopathic individuals and a comparaison group, as defined by DSM-IV criteria for antisocial personality disorder and the Psychopathy Cheklist Revised (PCL-R), were tested a standardized psychometric measures of alexithymia and cognitive empathy (LEAS), a facial emotion recognition (RME). We also examined these patients with procedure designed to measure decision-making (Iowa Gambling Task) and standardized neuropsychological tests were applied to assess their cognitive intelligence, executive functioning, attention as well. Their results were compared with those of 20 controls subjects.

Compared with controls, psychopathic individuals were characterized by a selective impairment for cognitive flexibility, cognitive empathy and decision-making. These results are interpretated with reference to amygdale dysfunction and to somatic markers hypothesis. Moreover, the psychopathic individuals show defective performance and absence punishment learning on the gambling task, who mimicked the gambling behavior of orbitofrontal patients.

Our findings suggest that emotional and social functioning is critically tied to on-going experience of autonomic arousal state. Furthermore our results extend the link between dysfunction of ther orbitofrontal circuit, but also dorsolateral prefrontal circuit, and psychopathy. The implications of these results for models of psychopathy are discussed.

There are only a few epidemiology studies of personality disorders in the general population related with gender distribution. Due the important relevated actually increase in the clinic and non clinic environment of this type of disorders, the intention of this work is to study the prevalence of the personality disorder (PD) by gender in a sample of 684 students of the city of Barcelona (Spain).

It has been administrate the questionnaire Personality Diagnostic Questionnaire-4+ (PDQ-4+) Spanish version. That assessed the 12 PD following DSM-IV criteria (the 10 PD specifics of the axis II and the 2 PD of the appendix) (Huang and cols., 2007).

The analysis obtained, there are the comparison of dimensional scores (t test of Student) and the prevalence's by gender (test χ2).

In general, the totally scores of the PDQ-4+ show that the woman obtain higher scores of PD presence than the man. Related with the specific scales, the scores of the woman is significantly in the two analysis paranoide, avoidant, obsessive-compulsive and depressive; on the contrary the man in the antisocial.

To evaluate open-label treatment with olanzapine in patients with borderline personality disorder (BPD).

In two concurrent studies, patients received 12 weeks of open-label olanzapine after completing 12-weeks of double-blind treatment with either olanzapine or placebo. Open-label olanzapine dosing started at 2.5 or 5mg/day and could be increased up to 20mg/day (Study 1) or 15mg/day (Study 2).

Mean ZAN-BPD total scores decreased from approximately 17 points to approximately 8-10 points during the acute phase. After 12 weeks of open-label olanzapine treatment, mean ZAN-BPD total scores were approximately 6-7 points. Patients treated with placebo during the acute phase and then open-label olanzapine showed changes in weight, prolactin, and other laboratory values similar in magnitude to those seen in acutely olanzapine-treated patients. Patients treated with olanzapine during the acute phase showed smaller changes in weight and laboratory values during the open-label extension.

Overall BPD symptom severity was low by the end of the open-label olanzapine treatment period. The types of treatment emergent adverse events appeared to be consistent with those seen previously in patients treated with olanzapine. The direction and magnitude of effects on safety measures depended on the treatment received during the prior double-blind period.

To study the association between irritable bowel syndrome (IBS) variants (constipation, diarrhea or both) with personality traits in non-psychiatric patients.

IBS was diagnosed using the Rome II diagnostic criteria after exclusion of organic bowel pathology. The entry of each patient was confirmed following a psychiatric interview. Personality traits and score of each factor was evaluated using NEO five factor personality inventory.

One hundred and fifty patients were studied. The mean age (±SD) was 33.4(±11.0) years (62% female). They scored higher in Neuroticism, Openness and Conscientiousness compared to our general population. Our studied population consisted of 71 patients with D-IBS, 33 with C-IBS and 46 with A-IBS. Score of conscientiousness and Neuroticism was significantly higher in C-IBS compared to D-IBS and A-IBS. Conscientiousness was the higher dimension of personality in each of variants. Patients with C-IBS had almost similar personality profile, composed of higher scores of Neuroticism and Conscientiousness, a low level of Agreeableness with Openness and Extraversion close to general population.

Differences were observed between IBS patients and general population as well as between IBS subtypes in term of personality factors. Patients with constipation predominant IBS showed a similar personality profile. Patients with each subtype of IBS may benefit from psychological interventions, which can be more practical considering characteristics of each subtype.

Psychotherapy is considered the primary treatment for Borderline Personality Disorder (BPD) and Dialectical Behavior Therapy (DBT) is one of the most effective, based on empirical data (Lieb et al.,2004). Pharmacotherapy strategies have been successful in decreasing some core symptoms like impulsivity (Oldham,2005). Topiramate has been effective against BPD anger, considered as an expression of affective instability and a proxy measure of impulsivity (Nickel et al.,2004;2005).

To analyze the topiramate contribution in the aggressive impulsivity decrease with BPD patients treated by DBT.

23 BPD patients, treated with DBT, participated in the study. Patients were evaluated with SCID-I and SCID-II. Topiramate dosage was adapted to the frequency and severity of self-aggressive impulsive behaviors.

The influence of topiramate in behavior outcomes was analysed using step by step multivariated regression analysis.

Topiramate didn't decrease suicidal attempts number, but had strong influence in parasuicidal behaviors (Standarized Betha=0.57;t=3.16,p<0.05) and in the reduction of emergencies visits (Standarized Betha=0.22;t=2.151, p<0.05). The medium topiramate dosage was 200 mg UID (100-500mg).

Topiramate can be helpful, as a symptom-targeted pharmacotherapy, for self-aggresive impulsive behavior with BPD patients treated by DBT.

This study assesses Conduct Disorder in Former USSR immigrant adolescents compared with native-born Israeli adolescents. Immigrant adolescents from the Former USSR face the complex task of forming their identity while having to adjust to a new culture. Meanwhile, studies have shown that their parents tend to use control and harsh punishment in their parenting methods. These adolescents are thus at greater risk of psychological distress and more prone to identify with socially deviant peer-groups, resulting in the dramatic increase in crime level found among them.

97 adolescents living in residential children's home, including 47 Former USSR immigrants and 50 native Israelis, completed questionnaires assessing level of hostility and sense of guilt (BDHI), ego identity (EIS), and parenting style (GPBS). Objective assessments of Conduct Disorder were obtained by the instructors at the residential children's home using the Child Behavior Checklist (CBCL).

Immigrant adolescents showed higher levels of fused ego identity, and reported more negative and punishing parenting styles (linked to Conduct Disorder), compared with native adolescents. Hierarchic regressions for predicting Conduct Disorder revealed that diffused ego identity has the greatest effect on behavioral disorders, while immigration variables and parenting style have an enhancing effect on levels of behavioral disorder among youths with diffused ego identity.

The high levels of identity fusion among immigrant adolescents, resulting in higher levels of Conduct Disorder, warrant ethnic-sensitive interventions.

To demonstrate that borderline personality disorder can be predictably overcome through ‘Breakthrough Intimacy’ - closeness between committed couples far greater than their previous maximum experiences.

Lifetrack therapy works with couples (the patient and his/her partner in life) bringing them far closer than ever before, guided by their own daily self-rating on 41 parameters that allow accurate graphic tracking via Internet of subtle changes in their personalities during each therapy session. Working in three-way teamwork, the therapist actively helps the couple to achieve closeness far greater than their previous maximum level, overcoming waves of symptom spikes (anxiety, anger, physical-symptoms, depression, and psychosis) until they disappear by exhaustion, as the couples undergo personality transformation.

The patients typically go through four distinct stages through Lifetrack therapy in the process of personality transformation, with stage IV representing complete transformation. Of the last 182 BPD diagnoses confirmed patients (out of total of 1,170 patients over the last 20 years), 15% reached stage IV, 12% reached stage-III, and 12% reached stage-II at the time of termination. 15% improved without going through typical four stages. However, 23% remained in stage-I and 35% remained in stage-0 at the time of termination.

Symptoms of borderline personality disorder can be better understood and treated as the consequence of one's personality which can be transformed through ‘Breakthrough Intimacy.’ The result of this study supports an alternative approach in treatment of borderline personality disorder through personality transformation, working in three-way teamwork.

Charland has stated in a philosophical analysis that B-cluster personality disorders are moral not medical categories. The status of borderline personality disorder has been challenged also using other grounds.

The aim of this paper is to discuss whether borderline personality is a moral or medical/psychological condition or just “bad behavior”, a moral category.

Char land's statement relies on a consideration that an act that can be characterized by using moral terms could not be characterized in another manner more efficiently and that this act is a failure of following a moral principle of ethical behavior. Using Jonathan Danthy's argumentation, it is stated that ethical behavior does not necessitate any principles. There may be several reasons for certain behaviors, and reasons may vary from one situation to another. Several results of modern cellular biology indicate that contrasting bad behavior and illness may be outdated and overstatements, as structure and functions are interrelated in biology. I present the case for considering all types of illnesses as some form of bad behavior or vice versa. Additionally, research gives reasonable basis for arguing that sense of agency is severely impaired in borderline personality disorder, and that this is associated with disturbed connectivity between amygdale, hippocampus and the orbitofrontal cortex impairing the regulation and integration of emotion and cognition.

Borderline personality can be considered an illness impairing abilities for judgment and agency.