1. (1) To learn about the experiences of adolescents participating in a DBT programme for adolescents (DBT-A) conducted virtually, including the challenges and benefits they identified.

2. (2) To learn about implications for clinical practice and future research directions.

The uncertainty of COVID-pandemia, vital danger and disruptions in the habitual social contacts can be paralleled to the experiences of severe emotional stress and violence, usually found in the people with Borderline Personality Disorder. Both can be regarded as hampering the ability to categorize and express thoughts, feelings and experiences. The implementation of distant forms of psychological counseling may accentuate the mentalization deficiency.

To develop a theoretical framework for an empirical typology of impairments of mentalization.

The model of consciousness proposed by L.S. Vygotsky was used for theoretical generalization of the levels of categorical structures of mentalization observed in previous empirical studies.

The following structures were identified: (1) the syncretic type of mentalization with low differentiation and complexity of object representations, their negative affective tone, autistic, chaotically mutable motivation and low emotional investment in relationships were described in patients with schizotypal disorders; (2) the “complex” type, with literal, non-generalized, field-dependent and rigid, or unstable, representation of the self, others and relationships as a result of the “fusion” of cognitive representations with the current emotional states. Similar types of mentalization were previously described in people with BPD and self-harming behavior (Sokolova, Laisheva, 2017).

The ’syncretic’ and ’complex’ types of mentalization produce affective-cognitive distortions of the image of a psychotherapist, hamper the understanding of the conditional and metaphorical character of the therapeutic process, render difficult the de-traumatization of the unbearable experiences, and lessen the effectiveness of consultations of people with BPD.

No significant relationships.

In a significant proportion of people diagnosed with Borderline Personality Disorder (BPD) and adult Attention Deficit Hyperactivity Disorder (aADHD) comorbid mental disorders, such as mood, anxiety, personality and substance use disorders can be detected. BPD and aADHD present with a partial overlap in the clinical symptoms, including increased impulsivity levels and difficulty in emotional regulation. Higher impulsivity and emotional dysregulation (ED) can result in impaired global functioning or damaged social relationships.

The aim of this study was to assess the comorbid psychiatric diagnoses of the two patient groups, and explore the possible role of ED and impulsivity in the background of the different comorbid disorders.

Data about BPD (N=49) and aADHD (N=60) patients were analyzed based on the M.I.N.I. Plus 5.0 and SCID-5-PD structured clinical interviews. Participants were further investigated with online questionnaires: e.g. Barratt Impulsiveness Scale (BIS-11) Difficulties in Emotion Regulation Scale (DERS). For measuring the influence of impulsivity and ED in the development of comorbid disorders binary logistic regression was used.

Our results showed comorbidity rates similar to previous findings in BPD patients, but lower rates were observed in aADHD. Elevated levels of ED increases the risk of suicidal ideation, mood, anxiety and eating disorders. Based on our data increased impulsivity can reduce the chance of comorbid anxiety disorders.

The results provide insight into the pattern of comorbid disorders, role of ED and impulsivity in people diagnosed with aADHD and BPD in Hungary. Understanding their underlying mechanisms helps to establish an accurate diagnosis, which affects treatment effectiveness.

No significant relationships.

BPD are often characterized by dependence, affectability, unpredictability, impulsivity and self-destructiveness. Paradoxically, the symptoms associated with BPD are the same behaviors that makes them difficult to accommodate by health professionals. They constitute the most excluded and stigmatized patient group.

To gain knowledge on how BPD patients felt acknowledged when they experienced the need for professional help.

We conducted semi-structured interviews with six BPD-women, aged between 18 to 46, all inpatient at different psychiatric units in the Capital Region of Denmark. The data were analyzed and interpreted through meaning condensation. We entered the philosophical hermeneutic framework of Hans-Georg Gadamer.

We found that the women experienced that; the diagnosis was a filter, in which they were always viewed and judged through as “just another BPD-patient” and not a unique individual. their cry for help was expected to be verbalized in a certain manner and therefore was often not understood nor heard, but instead they experienced to be scolded by health professionels. the emergency plan became a legitimate way for the health care professionals to avoid spending to many resources, rather than a helpful tool. the psychiatry as a unit was largely characterized by stigmatization and a distrustful attitude towards them. Therefore they felt deeply dependent on meeting that one special health professional who were experienced to have a genuine interest and desire to help them.

Findings correspond with the findings of existing research. Hence, there also seems to be significant barriers nationally for patients with BPD to experience being acknowledged and helped, when in need of professional help.

No significant relationships.

Patients with brief psychotic episodes (BPE) have variable and fluctuating clinical outcomes which challenge psychiatric care. Our meta-analysis aims at providing a comprehensive summary of several clinical outcomes in this patient group.

A multistep systematic PRISMA/MOOSE-compliant literature search was performed for articles published from inception until 1st March 2021. Web of Science database was searched, complemented by manual search of original articles reporting relevant outcomes (psychotic recurrence, prospective diagnostic change or stability, remission, quality of life, functional status, mortality and their predictors) for patients diagnosed with acute and transient psychotic disorders (ATPD), brief psychotic disorders (BPD), brief intermittent psychotic symptoms (BIPS) and brief limited intermittent psychotic symptoms (BLIPS). Random-effects methods and Q-statistics were employed, quality assessment with Newcastle-Ottawa Scale, assessment of heterogeneity with I2 index, sensitivity analyses (acute polymorphic psychotic disorders, APPD) and multiple meta-regressions, assessment of publication bias with funnel plot, Egger's test and meta-regression (psychotic recurrence and sample size).

A total of 91 independent articles (n = 94 samples) encompassed 37 ATPD, 24 BPD, 19 BLIPS and 14 BIPS samples, totalling 15 729 individuals (mean age: 30.89 ± 7.33 years, mean female ratio: 60%, 59% conducted in Europe). Meta-analytical risk of psychotic recurrence for all BPE increased from 15% (95% confidence interval (CI) 12–18) at 6 months, 25% (95% CI 22–30) at 12 months, 30% (95% CI 27–33) at 24 months and 33% (95% CI 30–37) at ⩾36 months follow-up, with no differences between ATPD, BPD, BLIPS and BIPS after 2 years of follow-up. Across all BPE, meta-analytical proportion of prospective diagnostic stability (average follow-up 47 months) was 49% (95% CI 42–56); meta-analytical proportion of diagnostic change (average follow-up 47 months) to schizophrenia spectrum psychoses was 19% (95% CI 16–23), affective spectrum psychoses 5% (95% CI 3–7), other psychotic disorders 7% (95% CI 5–9) and other (non-psychotic) mental disorders 14% (95% CI 11–17). Prospective diagnostic change within APPD without symptoms of schizophrenia was 34% (95% CI 24–46) at a mean follow-up of 51 months: 18% (95% CI 11–30) for schizophrenia spectrum psychoses and 17% (95% CI 10–26) for other (non-psychotic) mental disorders. Meta-analytical proportion of baseline employment was 48% (95% CI 38–58), whereas there were not enough data to explore the other outcomes. Heterogeneity was high; female ratio and study quality were negatively and positively associated with risk of psychotic recurrence, respectively. There were no consistent factor predicting clinical outcomes.

Short-lived psychotic episodes are associated with a high risk of psychotic recurrences, in particular schizophrenia spectrum disorders. Other clinical outcomes remain relatively underinvestigated. There are no consistent prognostic/predictive factors.

Research has shown the relationship between borderline personality disorder (BPD) and complex posttraumatic stress disorder (cPTSD), pointing out the overlapping nature and expression of both conditions. In order to understand their differences and similarities, we present a case of a 22-years-old patient with a history of repeated sexual trauma throughout all her adolescence, whose diagnose was changed from BPD to cPTSD after she was admitted in an acute inpatient mental health unit.

To gather the similarities between borderline personality disorder and complex posttraumatic stress disorder.

A narrative review of the literature through the presentation of a case. Articles were chosen based on its clinical relevance.

cPTSD merges the clinical features and symptoms of PTSD with affect dysregulation, negative self-perception, unstable relationships and somatization, also present in BPD. Furthermore, BPD is known to frequently have a traumatic etiology.

It is not always simple to draw a clear line between cPTSD and BPD conditions. However, each diagnosis may have a different impact on patient understanding and treatment.

No significant relationships.

A 47 y.o. female patient was admitted to the female PICU with a manic episode. Upon admission she presented with mood elation, psychosis, pressured speech, lack of sleep and agitation.

To investigate negative prognostic factors such as the co-morbidity with a personality disorder in patients presenting with severe mania.

The patient was assessed regularly by the psychiatric team consisting of a CT doctor and one General Adult Consultant. Appropriate psychological assessments for mania and laboratory investigations took place.

The patient initially scored above 45 in the Young Mania Rating Scale (YMRS), establishing a diagnosis of severe mania. She was treated with Olanzapine titrated up to 20mg OD and augmentation with Lithium treatment. Lithium plasma levels were at 0,6. Due to the treatment resistant manic presentation a second antipsychotic agent was administered and the patient was also treated with Zuclopenthixol depot 400mg every two weeks. Clinical improvement was observed after 16 days from admission.

The clinical team wondered about the clinical challenges of the case. According to the literature having a Personality Disorder diagnosis is a negative prognostic factor for patients with mania and this is relevant to this case as well.

No significant relationships.

Borderline personality disorder (BPD) usually begins in adolescence and manifests itself in adult life. Early intervention can improve the prognosis or reduce its severity. Nevertheless, there are currently few studies of adolescent patients with severe emotion instability and borderline personality traits.

To evaluate the effectiveness of the Systems Training for Emotional Predictability and Problem Solving (STEPPS) programme in a sample of 21 adolescents (aged 13–17 years) in the Child and Adolescents Mental Health Center of Tarragona in Spain.

We evaluated BPD traits using the Diagnostic Interview for Borderline Disorder-Revised (DIB-R) and the Global Clinical Impression Scale of Illness Severity for TLP (CGI-TLP). We compared pre- and post-treatment scores for the DIB-R, CGI-GI scale, general psychopathology using the Personality Inventory for Adolescents (PAI-A) and impulsivity with the Barratt Impulsivity Scale (BIS-11). The therapeutic objectives were evaluated with the Borderline Estimate Severity over Time (BEST) scale.

There was a statistically significant improvement in the scores for the affective area and in the total score of the DIB-R, a decrease in the percentage of patients who failed to meet criteria for BPD, and an improvement (although not statistically significant) in the scores of the BEST scale throughout the treatment. The results of the CGI-GI scale showed global improvement in almost 72% of patients.

Our study suggests that STEPPS can be an effective treatment to improve BPD symptoms and is very useful in community settings with limited resources in which efficient treatment alternatives must be sought. However, this conclusion must be interpreted with caution, as there is no comparison control group.

No evidence-based therapy for borderline personality disorder (BPD) exhibits a clear superiority. However, BPD is highly heterogeneous, and different patients may specifically benefit from the interventions of a particular treatment.

From a randomized trial comparing a year of dialectical behavior therapy (DBT) to general psychiatric management (GPM) for BPD, long-term (2-year-post) outcome data and patient baseline variables (n = 156) were used to examine individual and combined patient-level moderators of differential treatment response. A two-step bootstrapped and partially cross-validated moderator identification process was employed for 20 baseline variables. For identified moderators, 10-fold bootstrapped cross-validated models estimated response to each therapy, and long-term outcomes were compared for patients randomized to their model-predicted optimal v. non-optimal treatment.

Significant moderators surviving the two-step process included psychiatric symptom severity, BPD impulsivity symptoms (both GPM > DBT), dependent personality traits, childhood emotional abuse, and social adjustment (all DBT > GPM). Patients randomized to their model-predicted optimal treatment had significantly better long-term outcomes (d = 0.36, p = 0.028), especially if the model had a relatively stronger (top 60%) prediction for that patient (d = 0.61, p = 0.004). Among patients with a stronger prediction, this advantage held even when applying a conservative statistical check (d = 0.46, p = 0.043).

Patient characteristics influence the degree to which they respond to two treatments for BPD. Combining information from multiple moderators may help inform providers and patients as to which treatment is the most likely to lead to long-term symptom relief. Further research on personalized medicine in BPD is needed.

Dialectical behaviour therapy (DBT) is a multi-modal psychological therapy with established efficacy in treating borderline personality disorder (BPD). Younger adults represent a group more likely to drop out of treatment than their older counterparts and treatments specifically targeted at this younger cohort may be advantageous.

We describe an evaluation of a DBT programme in a mental health centre for younger adults 18–25 years who met criteria for BPD (n=11).

We used a simple pre/post-test design, measuring BPD symptoms, general mental health symptoms, and coping skills using self-report questionnaires at the beginning of DBT and again following the delivery of 22 weeks of DBT.

Statistically significant reductions were found in BPD symptoms and several mental health symptoms alongside an increase in DBT skills use. Dropout was 31% at 22 weeks of treatment. Methodological weaknesses and avenues for future research are discussed.

Recall of adverse life events under brain imaging conditions has been shown to coincide with activation of limbic and prefrontal brain areas in borderline personality disorder (BPD). We investigate changes of functional magnetic resonance imaging (fMRI) activation patterns during the recall of unresolved adverse life events (ULE) over 1 year.

Thirteen female BPD patients participated in the study. During fMRI measurement subjects recalled ULE and negative but resolved life events (RLE) after individual cue words to stimulate autobiographical memory retrieval. Subjective intensity of emotional and sensoric experiences during recall was assessed as well as standardized measures of psychopathology.

A 2×2 factorial analysis of fMRI data (Δt1/t2×ΔULE/RLE) revealed major right more than left differences of activation (i.e. t1>t2) of the posterior more than anterior cingulate, superior temporal lobes, insula, and right middle and superior frontal lobes (second-level analysis, t=3.0, puncorrected=0.003). The opposite contrast (Δt2/t1×ΔULE/RLE) did not reveal any differences. We did not find changes of emotional or sensoric qualities during recall (ULE versus RLE) or of psychopathology measures over the 1-year period.

Although subjective and clinical data did not change within 1 year, we observed a substantial decrease of temporo-frontal activation during the recall of ULE from t1 to t2. If future research confirms these findings, the question arises whether the decrease of neural activation precedes clinical improvement in BPD.