Borderline personality disorder (BPD) seems to be a prevalent condition in Primary Care (PC) with high rates of comorbidity and health care use. The aim of this study is to describe the characteristics and patterns of comorbidity in patients with suspected BPD.

192 consecutive primary health care patients completed the IPDE screening questionnaire, CAGE and the Prime-MD patient questionnaire, and were interviewed by a general practitioner (GP) using the Prime-MD. Number of visits to the GP (last year), medical illnesses and treatments were also collected. “High Risk” of BPD group (RBPDg) was defined by scoring 4 or higher in the IPDE, and it was compared to patients without psychiatric morbidity and patients with any psychiatric disorder but not BPD's risk.

39 (20,3%) patients fulfilled the condition of RBPDg. Compared to the group of patients without psychiatry pathology (n=110) RBPDg had a higher number of visits to their GP (last year) (p<0,001), more somatic complaints (p<0,001), a worse health perception (p<0,001) and higher rates of alcohol abuse or dependence (p=0,016).

In the RBPDg we found a high rate of axis I disorders, mainly major depressive disorder (MDD) (40,0%) and generalized anxiety disorder (33,3%). Furthermore, they had a lower level of education (p=0,03) and a higher rate of MDD (p=0,026) than patients with psychiatric pathology but without risk of BPD (n=43).

Borderline personality traits or disorder could be present in many depressive patients seen in PC. GP's knowledge about personality disorders needs to be improved

Nowadays the Borderline Personality Disorder (BPD) lacks any treatment with administrative approval. International prestige guidelines accept the generalized use of atypical antipsychotics by clinicians for this disorder, including quetiapine.

To evaluate the clinical effect of Quetiapine in the treatment of BPD and the patient's perception of this treatment.

Multi-center, naturalistic, retrospective study. Patients over 18 with BPD diagnoses (DSM-IV-TR) in treatment with quetiapine for the previous 6 months were included. Assessments: CGI-C (Clinical Global Impression of Change), DAI-10 (Drug Attitude Inventory, 10 item) and a likert scale measuring the patient's subjective compliance.

105 patients were included. Mean age was 35.25±9.68 years old. 53.3% were male. Mean dose of Quetiapine was 422.06 mg/day (SD:171.42). The CGI-C results showed that 94.3% of the patients improved along the previous 6 months in treatment with quetiapine; 5,7% had no changes and 0% impaired. According to the DAI-10 results most of the patients thought good things about medication outweighed the bad (82,9%), took medication of their own free choice (72,4%) and associated treatment with breakdowns prevention (75.2%). Regarding to the perception of quetiapine most of the patients felt more relaxed (89.5%), with clearer thoughts (62.9%) and didn't associate treatment with sluggishness (62.9%) or strangeness and doping-up (74.3%). 96.1% of the patients reported compliance over 70%.

Clinicians found quetiapine effective for treating BPD and most of the patients perceived it positively and showed high levels of compliance

The purpose of this study was to confirm or not that there exists a difference between the two above groups of patients in relation with a commorbitity of somatic illnesses.

71 patients took part in this study.

37 of them had a personality disorder (AXIS II) and 34 a neurotic disorder (AXIS I).

The sample was chosen at random and came from a department of psychotherapy.

Several variables were examined such as: sex, age, marital status and diagnosis.

From the results what is worth noting, is that:

From the first group of personality disorders 5 men and 12 women (Total number 17, 46%) had somatic illnesses, while 10 men and 10 women (Total number 20, 54%) didn't.

From the second group of neurotic disorders no men but 8 women (Total number 8, 23,5%) had somatic illnesses, while 7 men and 19 women (Total number: 26, 76,5%) didn't.

From the results, it seems that the patients with personality disorders present a commorbitity of somatic problems in a significantly larger number in relation with the neurotic patients.

Additionally it seems that, from the total number of patients with personality disorders who present somatic problems, women predominate.

The results seem to agree with what the bibliography declares: that the patients with personality disorders present a somatic commorbitity in a clinical significant way.

Atypical antipsychotics are a new treatment option for patients with impaired impulse regulation as seen in Cluster B personality disorders. Preliminary data are available on the use of atypical antipsychotics especially in the treatment of impulsivity in borderline personality disorder. The aim of the present study is to investigate efficacy regarding impaired impulse regulation, different psychopathological symptoms and tolerability of quetiapine in a group of patients with Cluster B personality disorder.

Fifteen consecutive patients with a DSM-IV diagnosis of borderline, histrionic, or narcissistic personality disorder were treated for 8 weeks with open-label quetiapine at the dose of 400 mg/day. Patients were assessed at baseline, week 1, 2, 3, 4, 6, and week 8. The clinical efficacy and side effects were assessed using the following scales: Hamilton Scales for Depression (HAM-D) and Anxiety (HAMD-A), Beck-Depression Inventory (BDI), Barratt Impulsivity Scale version 10 (BIS-10), Brief Psychiatric Rating Scale (BPRS), and the Dosage Record and Treatment Emergent Symptom Scale (DOTES).

Twelve patients completed the study. Three patients (20%) dropped out due to noncompliance. A significant improvement was found for the scores of the following scales: BPRS (anxiety/depression subscale), HAM-D, and BDI. No significant result was found for impaired impulse regulation. Common adverse effects, possibly due to study medication, were mild-to-moderate somnolence, mouth dryness, agitation, nausea, and dizziness.

An 8 week open label treatment with 400mg quetiapine daily seems to improve depressive and anxiety, but not impulsivity symptoms in cluster-B personality disorders.

In the clinical practise it has been observed that the person changes physically, too, after aesthetic surgery. The aim of this work was to examine, by objective psychological measurements, what changes occur, and what personality features change.

Forty six subjects that had an aesthetic surgery were examined; they were tested before, and eighteen month after the surgery by the Profile Index of Emotion (PIE). Before the re-testing the subjects were analyzed by "The Life Events Scale" to exclude the possibility of the influence of new life events on the results of the re-test. The control group of volunteers was tested by the same psychological instruments. The control group never verbalized the wish for an aesthetic surgery; they were never in psychiatric treatment, and the corresponded to the experimental group in the age, sex and education level.

Analysis of the data obtained from PIE test before and after the operation shows a statistical significant increase of the adaptability segments and an improvement of capacity for giving and taking.

Emotional conflict does not disappear, but a new balance is established, satisfaction is higher, and the identity is more integrated.

Despite the intense study on impulsivity in BPD, little attention has been given to the relationship between gender, impulsivity and BPD. Previous findings are inconsistent and there is a lack of specific research.

The purpose of this study is to examine the differences between man and women with BDP in different impulsivity measures.

We examined the gender differences in 45 subjects recruited in a psychiatric unit, in which 33 (73,3%) were women and 12 (26,7%) were men. Mean age of the study sample was 28.9 years old (SD= 1.04). No differences were found in socio-demographic variables between men and women. In order to establish a BDP diagnose the Structured Clinical Interview for DSM-IV Axis II Personality Disorder (SCID-II) was used. Impulsivity was assessed with the Barrat Impulsivity Scale (BIS-11) and the Continuous Performance Test identical pairs version (CPT-IP).

We found significant gender differences in BIS scores. Men have scored higher than women in all BIS scores, especially in the second-order factor of nonplanning impulsiveness.

In CPT-IP results there were also significant differences between men and women performance. Men made a higher number of correct answers (hits) and a higher number of false alarms (commission errors) than women. Also, men had a significant higher score in the d index (attentional capacity) than women.

Gender differences influence the performance in laboratorial and psychometric measures of impulsivity in BPD subjects. This pattern of impulsivity is consistent with the attentional performance in these subjects.

Author of the Scientific Theory "Something, that, my, self: Origin of other Life" and THERAPY OF TRANSFER (©USA) exposed: XXIV APAL Congress. IV World Congress on Traumatic Stress. 19th World Congress of Psychotherapy. 9th World Congress of Psychosocial Rehabilitation. XIII World Congress of Psychiatry. WPA International Congress (Istanbul2006).

Demonstrate that ‘Mental Illness’ is a phenomenon initiated at home, reinforced in society and stylized internally.

Planned introspection, and meticulous evolutionary record of all those internal conflicts unleashed after tireless search of the I, during 30 years.

Paternal impositions, taking implicit social aims, are stimuli that wait, of child, a response; initially they do not work in an automatic way (due to gravitational Natural Inertia of organism tending to be interrelated with the Universe), but as punishment and recompense are imposing on him, time between stimulus-response will be diminishing until reaching the automatization. Reinforced and rewarded such a process, the individual, will be suitable to generate unthinking answers before any stimulus foreign to his essence. Given these conditions any impulse, image or idea arisen in mind unconsciously it turns into stimulus, to which, man, will not be able to escape, undo or obviate having to exercise necessarily an immediate response, according to needs of social rules, avoiding this way non-adaptation or interior conflict: Conditional Inertia.

The dynamic mind-body, in ‘Mental Illness’, is a reply of the interrelationship father-child but stylized, in which, to less time between stimulus-response the worst it will be the forecast.

The diagnosis of personality disorders is highly dependent on how a society views certain behaviour. Self concept, adaptation and social context are important aspects to the cultural dimensions of personality disorders. However, the relevance and implications of the influence of sociocultural factors are seen differently. Accordingly there are very distinct conceptional, nosological and diagnostic approaches to classify personality dispositions and personality disorders in a cross-cultural perspective.

The paper describes the social, demographical and political context of migration in Europe and tries to indicate the needs and mental health problems of immigrants. A review of the literature concerning mental health risk in immigrants is carried out. Special focus lies on the impact of cultural concerning the emergence and manifestation versus prevention of personality disorders. The work also faces the problems of health policy towards immigrants and the access to mental health care services for immigrants in Europe.

Due to globalization and migration processes clinicians and therapists are increasingly asked to evaluate and differentiate the level of personality functioning not only in patients from different cultures and ethnic groups but also in traumatized refugees and migrants. Multiple social and cultural factors have influence on each level of the diagnostic and therapeutic process. Apart from a high back ground knowledge concerning trauma, migration and culture specific issues, such skills as cultural sensitivity and cultural competence are requirements for clinicians and therapists.

In previous studies, we have described a comparison of new eating disorders (permarexia, orthorexia, megarexia, vigorexia, selective eating ang binge eating), which appear and develop according to certain social and aesthetic canons, from a dynamic point of view. In this study, we advance through new therapeutic strategies which require some modifications in anorexia and bulimia classic protocols, at several levels.

A bibliographical overview since last 5 years of those emergent eating disorders and their treatment has been made

Medical magazines and publications, textbooks of psychiatry and more usual data bases (Medline, Embase) also have been reviewed.

We contribute as well with our current modified protocols, daily experience and healthcare assistance.

We make a review of new eating disorders: concept, profiles and main symptoms, emphasizing on new therapeutic strategies which are described from several points of view, such us pharmacologic, behavioral therapy, cognitive restructuring, work on self image and self concept.

We also emphasize the differential characteristics of each treatment for every new eating disorder.

1. 1. New therapeutic strategies are necessary to include in the protocols of Psychiatric Units as frequency of new eating disorders is increasing.

2. 2. These strategies still must be focused on cognitive behavioural therapies, considering psychopharmacologic treatments mainly in case of comorbidity.

3. 3. Although they share the eating element, their origin and consequences are diverse, and this demands an adaptive change of therapeutic strategies we usually considered in our protocols.

There are strong wishes to be slender not only in the western country but also in Japan. The young women's BMI doesn't show a normal distribution. Almost of that is under BMI 24.2 (normal). Obesity is not good for metabolic syndrome. But being too thin is not good for health especially motherhood. And that influences not only physical health but also mental health. It is thought young women's energies lose in eating or saving meals.

Self-administered questionnaire about wishes to be slender, eating behaviour and General Health Questionnaire were used. Objects were 180 adolescent women in the nutrition course (80) and nursing school (100).

About 95% or more of Japanese objects have wishes to be slender. Their physical BMI is about 20.7. But in order to estimate their wish to be slender, we asked three weights. One is the weight they think most healthy (we call “healthy weight”). The second is more beautiful (“beautiful weight”). The third is they actually aim to be (“aiming weight”).

In Japan general speaking physical weight is heaviest, the second is “healthy weight”, the third is “aiming weight” and lightest is “beautiful weight”. But some parts of them aim to be under BMI 17.5 (ICD-10 classified “Anorexia nervosa”). Weight order is now confusing.

The four BMI in Indonesian women are physical BMI is 19.7, healthy is 19.2, aiming is 19.1, beautiful is 18.9.

Compared to Japanese, Indonesian women's wishes are still sound. But taking precautions about health and eating behaviour is important.

Serotonergic and dopaminergic dysregulation as a core feature of anorexia nervosa, might be amenable to therapeutic modulation by atypical antipsychotics which encompass differing serotonergic and dopaminergic receptor affinities. There were no enough well-controlled clinical trials of antipsychotic medication in AN. Therefore, case reports seem to be of the certain help for clinicians.

Aim of the paper was to present a case of AN diagnosed with (DSM-IV) anorexia nervosa, restricting subtype, who responded well to risperidone treatment.

Psychopathology was evaluated by means of Eating Disorders Inventory (EDI-2) and Symptom Check List 90 (SCL-90-R). Patient was prescribed a starting dose of 0.5 mg/day of risperidone (baseline), with subsequent titration up to 2 mg/day during 6 weeks. Than, drug treatment was stopped.

With 6 weeks treatment on low-doses of risperidone, she started to gain weight during the next month, as well as to improve the attitudes toward eating. Moreover, normalization was evident in terms of body image alteration (BMI= 16.8); anxiety about meals was reduced; frequency of obsessive thoughts about body image decreased.

This case report suggests that the atypical antipsychotic risperidone is associated with significant improvement of AN simptomatology, We suggest that therapy with risperidone might be beneficial for severe AN. However, many questions could be raised: is it a therapy of choice, or it is a second, third or any other line of treatment; is it also beneficial considering further course of the illness; etc…

Clinical reports indicate that 5-9% of adolescents injure themselves deliberately (2). Studies of self-injurious behavior point to higher rates in patients with personality disorders, mental retardation or eating disorder (deliberate self-harm /DSH/ is present by 30-40%). We are examining the relation between DSH and pain and body image perception (BIP) in ED patients. An elevated pain threshold is consistent finding in eating disorders (1).

Body image perception and dissatisfaction is measured by software Anamorphic Micro, Body attitude test (BAT) and Somatoform dissociation questionnaire (SDQ-20). We diagnosed the comorbidity with Mini International Neuropsychiatric Interview. Pain threshold latencies for thermal stimuli were measured using the Analgesia meter (IITC Life science USA-Model 33) under mental arithmetic stress and rest conditions.

Our preliminary data include comparison of 3 groups (ED /n=20/, ED with DSH /10/, controls /20/) were age, BMI, illness duration and diagnoses matched. 10 patients from the total of 93 were displaying DSH in the past. The ED-DSH group didn't show any differences in pain threshold from the controls (contrary to ED), but we found that the stress analgesia of the ED-DSH group was significantly lower than controls (p=0,01) and ED (p=0,03). Dissatisfaction characteristics from Anamorphic Micro correlated with BAT (r=-0,82; p=0,007) but not significantly with SDQ-20.

We found lower stress analgesia in ED-DSH group and we suppose that further pain and body perception studies are promising for understanding neuropathophysiology in ED.

The Aims of the current study are threefold: 1) to analyze the prevalence of Personality disorders (PD) in Eating Disorders (ED); 2) to compare clinical, psychopathological and personality differences between ED with PD vs. ED without PD; 3) to compare the differential observed prevalence of PD in ED and their healthy sisters.

101 ED individuals and 34 discordant healthy sisters participated in the study. All the patients were consecutively admitted to our Unit. All patients met DSM-IV criteria for ED and were female. Assessment measures included the Eating Disorders Inventory-2 (EDI-2), the Symptoms Check List (SCL-90-R) and the Temperament and Character Inventory-R (TCI-R), The International Personality Disorder Examination (IPDE) as well as a number of other clinical and psychopathological indexes.

As the most prevalent PD in ED, we found Borderline (21,5%, specially in BN), and the Obsessive-Compulsive PD (12%; specially in AN). When compared ED+PD and ED-PD, the former showed higher general psychopathology and ED severity, but also some specific personality traits (higher harm Avoidance, p<.001; and lower self-directedness, p<.001). From, comparing the ED and their healthy sisters, PD was more prevalent in the former (32.3% vs. 9.4%; X2 =10,15, p<.001).

the most common PD in ED are Borderline (especially in BN) and the Obsessive-Compulsive PD (especially in AN). Comorbid PD was associated in ED to greater general psychopathology and higher ED severity. These results were found to be differential when comparing ED and their healthy sisters.

Supported by FIS (PI040619; CB06/03/0034)

The purpose of this study was to demonstrate the usefulness of multi-group piece-wise latent growth curve models (LGCM) in clinical research, particularly for assessing and comparing treatment effects. As an empirical example, this analytic technique was used to compare the effectiveness of Guided Self-Change (GSC) and Cognitive Behavioral Therapy (CBT) treatments for bulimia nervosa.

Sixty-two female patients (M age = 28.1, SD = 8.00) with bulimia nervosa were randomly assigned to a) a GSC treatment involving a self-care manual plus 8 bi-weekly sessions of CBT or b) 16 weekly sessions of CBT.

Both groups showed significant improvements in treatment outcomes across the treatment period, although the CBT group showed greater improvements. However, the GSC group evidenced more continued improvement post-treatment. CBT showed greater variability in effectiveness during the treatment period, while GSC showed greater variability during follow-up. For GSC patients, baseline levels on some treatment outcomes were related to follow-up improvement levels.

LGCM provided a rich analysis of these data, and addressed important questions regarding differences in the effectiveness of the two treatment programs. For example, CBT tended to show greater improvements during treatment, while GSC evidenced more continued improvements during follow-up.

Obesity is considered an important Public Health problem, due to his continuous growing and terrible medical and psychological consequences. In morbid obesity this problems are even more complicated and surgery is sometimes the only solution. Bariatric surgery is a term derived from the Greek words: “weight” and “treatment.” Weight reduction may be life saving for patients with extreme obesity, for whom no other satisfactory long term therapy currently exists. The patients proposed for this procedure are always submitted to psychiatry avaliation.

Psychopathological characterization of morbid obese patients proposed for bariatric surgery.

We studied 60 morbid obese outpatients of the Psychiatry Department of our Hospital, proposed for bariatric surgery. Their age ranged between 18 and 60 years. Informed Consent was obtained from all participants. We evaluated patients trough the following sequence: clinical interview in order to obtain clinical and social variables; EDI, SCL 90-R, MOS SF-36, and impulsiveness and body image scales.

The study is now under statistically evaluation. The authors enhance the crucial role of Psychiatry in the multidisciplinary approach of morbid obese patients.