International research on social withdrawal

IntroductionSince the 1990s the term “Hikikomori” has emerged as a way to describe a modern form of severe social withdrawal first described in Japan. Recently, there have been increasing reports of Hikikomori around the globe.ObjectivesTo describe operationalized research criteria for Hikikomori, as well as epidemiologic, diagnostic, and psychosocial features of the Hikikomori in international settings.MethodsParticipants were recruited from sites in India, Japan, Korea, and the US. Hikikomori was defined as a six-month or longer period of spending almost all time at home and avoiding social situations and social relationships, associated with significant distress/impairment. Lifetime history of psychiatric diagnosis was determined by the Structured Clinical Interview for the DSM-IV Axis-I and Axis-II Disorders. Additional measures included the Internet Addiction Test, UCLA Loneliness Scale, Lubben Social Network Scale (LSNS-6), and Sheehan Disability Scale (SDS).ResultsThirty-six participants meeting diagnostic criteria for Hikikomori were identified, with cases detected in all four countries. Avoidant personality disorder (41%), major depressive disorder (32%), paranoid personality disorder (32%), social anxiety disorder (27%), posttraumatic stress disorder (27%), and depressive personality disorder (27%) were the most common diagnoses. Sixty-eight percent had at least two psychiatric diagnoses. Individuals with Hikikomori had high levels of loneliness (UCLA Loneliness Scale M = 55.4, SD = 10.5), limited social networks (LSNS-6 M = 9.7, SD = 5.5), and moderate functional impairment (SDS M = 16.5, SD = 7.9).ConclusionsHikikomori exists cross-nationally and can be assessed with a standardized assessment tool. Individuals with Hikikomori have substantial psychosocial impairment and disability, and a history of multiple psychiatric disorders is common.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Impact of dialectical behavior therapy on incidence of suicidal attempts and non-suicidal self injury among a sample of Egyptian borderline personality disorder patients

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.709 ◽

2016 ◽

Vol 33 (S1) ◽

pp. s270-s270

Author(s):

A. Abdelkarim ◽

D. Nagui Rizk ◽

M. Esmaiel ◽

H. Helal

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Behavior Therapy ◽

Dialectical Behavior Therapy ◽

Borderline Personality ◽

Language And Culture ◽

Self Injury ◽

Suicidal Attempts ◽

Competing Interest ◽

Almost All

IntroductionDialectical behavior therapy (DBT) is a comprehensive psycho-social treatment developed by Marsha Linehan and originally designed for persons meeting criteria for borderline personality disorder (BPD). DBT is considered as a standard evidence based treatment for suicidal BPD patients in most international guidelines. Although its effectiveness has been proved in multiple studies across different patient populations but almost all the research was conducted in North American or European countries. The current study was the first trial to apply DBT in Egypt with a different language and culture than where the treatment was originally developed.ObjectivesAssessment of incidence of suicidal attempts and non-suicidal self-injury (NSSI) among a sample of Egyptian BPD patients enrolled in an outpatient DBT program.AimThe aim of the current study was to estimate impact of comprehensive DBT on suicidal attempts and NSSI when applied to Egyptian BPD patients.MethodsTwenty-five BPD patients, 4 males and 21 females, were included in a comprehensive outpatient DBT program for one year and incidence of suicidal attempts and NSSI were calculated.ResultsFive patients only attempted suicide again with an incidence of 20% and a mean of one attempt/patient. Seven patients attempted NSSI with an incidence of 28%, an overall 22 incidents and a mean of 3 incidents/patient.ConclusionAlthough this was the first time to apply DBT in an Egyptian population, DBT proved to be an effective psycho-therapeutic intervention for suicidal BPD patients across regardless of different language or culture.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Who are the Europeans admitted to psychiatric hospital in Tunisia?

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1232 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S698-S698

Author(s):

U. Ouali ◽

K. Ben Neticha ◽

R. Jomli ◽

A. Ouertani ◽

F. Nacef

Keyword(s):

Psychiatric Care ◽

Psychiatric Patients ◽

Insurance Coverage ◽

University Hospital ◽

Public Authorities ◽

Early Action ◽

Duration Of Hospitalization ◽

History Of ◽

Competing Interest ◽

Almost All

IntroductionA large number of foreign travellers and expatriates visits or lives in Tunisia.ObjectivesTo explore socio-demographic, clinical and therapeutic characteristics of European patients admitted to psychiatric care in Tunisia.MethodsThis is a retrospective, descriptive study on all European patients admitted to Razi psychiatric university hospital, which is situated at the outskirts of the capital Tunis, between 2000 and 2015.ResultsA total of 44 Europeans was admitted. Most frequent nationalities were: French and Germans (19 and 16 patients). The stay in Tunisia was mainly due to pathologic travel (17 subjects) and tourism (13 subjects). In total, 25 patients travelled without being accompanied. Average age was 51.3 years with extremes from 16 to 78 years. A history of psychiatric disorder was found in 15 patients, of whom almost all had stopped treatment. A majority (19 patients) was diagnosed with bipolar I disorder, and 8 patients suffered from schizophrenia. Average duration of hospitalization was 19 days. A total of, 22 patients were repatriated for medical reasons. Major difficulties during hospitalization were the language barrier, difficulties to contact family members or former treating psychiatrists for further information on the patient and his medical history, and the lack of insurance covering repatriation for medical reasons.ConclusionPsycho-education and early action on the precipitating factors could help to prevent psychiatric illness or relapse in these patients. Furthermore, attention of public authorities should be drawn to incomplete insurance coverage in many psychiatric patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Who are the suicide reattempters?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.2241 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S600-S600

Author(s):

E. Gattoni ◽

C. Gramaglia ◽

C. Delicato ◽

S. Di Marco ◽

I. Coppola ◽

...

Keyword(s):

Risk Factors ◽

Personality Disorder ◽

Suicide Attempt ◽

Emergency Room ◽

Suicide Attempts ◽

Somatoform Disorder ◽

Psychiatric Disease ◽

Psychiatric Evaluation ◽

Axis I ◽

Competing Interest

BackgroundHistory of previous suicide attempts is one of the most important risk factors for a subsequent completed suicide. Suicide reattempters (SR) has been long associated with demographic and clinical risk factors for suicide, such as unemployment and psychiatric disorders, however a recent review of the literature has not supported a specific age and gender profile of SR, but rather underscored that, as far as diagnosis is concerned, SR were more likely to have a personality disorder. According to literature, 16%–34% of the subjects repeat a suicide attempt within the first 2 years after the previous one.AimThe purpose of our study was evaluating clinical and socio-demographic characteristics and the outcome of psychiatric consultation among subjects referring to an emergency room for recommitting a suicide attempt.MethodsWe considered a sample of SR aged > 16 years. We extracted data from the database including all patients requiring psychiatric evaluation in the emergency room, and eventually compared the features of SR and patients with a single suicide attempt. For each patient, we gathered socio-demographic features, psychiatric history and current clinical issues, suicidal intent and suicidal behaviors.ResultsData collection and statistical analyses are still ongoing. Preliminary results show that, compared to patients with a single suicide attempt, SR were more frequent female, unmarried, employed, with a low level of instruction; they had a psychiatric disease (axis I – anxiety disorder, somatoform disorder; axis II – histrionic personality disorder); they are under the care of mental health services and under psychopharmacological treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Room for hope: How to deal with growing racism and discrimination?

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.897 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S43-S43

Author(s):

L. Küey

Keyword(s):

The Other ◽

Group Differences ◽

Psychosocial Characteristics ◽

Group Identities ◽

History Of ◽

The Subject ◽

Competing Interest ◽

Almost All ◽

And Behavior ◽

Attitudes And Behavior

Discrimination could be defined as the attitudes and behavior based on the group differences. Any group acknowledged and proclaimed as ‘the other’ by prevailing zeitgeist and dominant social powers, and further dehumanized may become the subject of discrimination. Moreover, internalized discrimination perpetuates this process. In a spectrum from dislike and micro-aggression to overt violence towards ‘the other’, it exists almost in all societies in varying degrees and forms; all forms involving some practices of exclusion and rejection. Hence, almost all the same human physical and psychosocial characteristics that constitute the bases for in-group identities and reference systems could also become the foundations of discrimination towards the humans identified as out-groups. Added to this, othering, arising from imagined and generalized differences and used to distinguish groups of people as separate from the norm reinforces and maintains discrimination.Accordingly, discrimination built on race, color, sex, gender, gender identity, nationality and ethnicity, religious beliefs, age, physical and mental disabilities, employment, caste and language have been the focus of a vast variety of anti-discriminatory and inclusive efforts. National acts and international legislative measures and conventions, political and public movements and campaigns, human rights movements, education programs, NGO activities are some examples of such anti-discriminatory and inclusive efforts. All these efforts have significant economic, political and psychosocial components.Albeit the widespread exercise of discrimination, peoples of the world also have a long history of searching, aiming and practicing more inclusive ways of solving conflicts of interests between in-groups and out-groups. This presentation will mainly focus on the psychosocial aspects of the anti-discriminative efforts and search a room for hope and its realistic bases for a more non-violent, egalitarian and peaceful human existence.Disclosure of interestThe author has not supplied his declaration of competing interest.

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Borderline Personality Disorder in Adolescence. Prevention and Early Intervention From a Cognitive Analytic Approach

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1863 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S505-S505

Author(s):

E. Gimeno ◽

C. Chiclana

Keyword(s):

Risk Factors ◽

Early Intervention ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Analytic Approach ◽

Diagnostic Threshold ◽

Potential Development ◽

Axis I ◽

Competing Interest

IntroductionBorderline personality disorder begins in adolescence, however, its diagnosis is subject to some controversy and tends to be underdiagnosed. Stigma associated with its diagnosis, comorbidity with other axis I disorders or the changeable sense of identity during adolescence are some of the elements that obscure the diagnosis. Increasingly, recent studies have shown the utility of prevention programs as well as instituting early intervention in adolescents, with very hopeful outcomes.ObjectivesThe aim of this study is to review the benefits derived from early prevention and intervention programs in adolescents with borderline symptoms from a cognitive analytic approach.MethodsA systematic review for scientific articles extracted from research databases including Dialnet, EBSCO, Pubmed, Unika and Scholar Google was conducted. Other high-impact studies in the field were also included.ResultsEvidence reported by reviewed articles supports Cognitive analytical therapy as one of the most successful approaches, the same as Mentalization based therapy, in the treatment of Borderline personality disorder. From this approach, prevention and early intervention have shown their effectiveness in reducing borderline symptoms and risk factors besides they contribute to interpersonal functioning improvement.ConclusionsPrevention and early intervention constitute the main pillars to prevent the potential development of Borderline personality disorder or its evolution in more complex and irreversible forms. But this intervention must be carried not only in young already diagnosed, but also in those who are on the diagnostic threshold, presenting risk factors for further development.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Trauma-related dissociation: Psychological features and psycho-physiological responses to script-driven imagery in borderline personality disorder

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1437 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S764-S764

Author(s):

D. Bichescu-Burian ◽

S. Jürgen ◽

S. Tilman ◽

T. Stefan

Keyword(s):

Heart Rate ◽

Borderline Personality Disorder ◽

Personality Disorder ◽

Clinical Symptoms ◽

Clinical Status ◽

Traumatic Events ◽

Borderline Personality ◽

Skin Conductance Responses ◽

History Of ◽

Competing Interest

BackgroundDefense reactions to threatening situations are vital adaptations to stress that protect organisms from injury and ensure survival. We retrospectively investigated the role of peritraumatic dissociation (PD) in the occurrence of severe psychopathology and dissociative patterns of reactions in borderline personality disorder (BPD).MethodsWe recruited 28 patients with a clinical diagnosis of BPD and 15 healthy controls. The BPD group was divided according to the level of PD (low vs. high): BPD and PD (n = 15) and BPD only (n = 13). We conducted an extensive investigation of history of trauma, clinical status, and measurements of emotional and physiologic responses to recall of personalized aversive experiences.ResultsParticipants with BPD and high PD displayed highest degrees of trauma exposure and clinical symptoms. Their significant heart rate decline during the imagery of personal traumatic events was opposed to the heart rate increases exhibited by the other two groups and may indicate a dissociative reaction pattern. Skin conductance responses did not differentiate between groups. Several emotional responses to imagery provided also support of the idea that PD may play a role in memory processing of traumatic events and thus in the aggravation and maintenance of symptoms in particularly severe forms of BPD.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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A History of Borderline Personality Disorder

10.1093/med/9780199997510.003.0001 ◽

2017 ◽

Author(s):

Antonia S. New ◽

Joseph Triebwasser

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

High Morbidity ◽

Historical Case ◽

Dsm 5 ◽

History Of ◽

Axis I ◽

Insight Into ◽

Shed Light

Borderline personality disorder (BPD) is complex and its phenomenology is hard to define, contributing to the view that it is not a “real” disorder. Yet increasingly powerful research suggests that it is both “real” and disabling, with high morbidity and even mortality. A review of the disorder’s history helps to shed light on the possible confusion surrounding the diagnosis and also provide insight into what has been consistently observed through different iterations of the disorder. The term “borderline personality disorder” has its origins in decades-old responses to a then bewildering, previously unrecognized patient population. This chapter presents the history of the name “borderline personality disorder” as well as historical case descriptions of individuals with symptoms that currently would be classified as BPD. It also considers the implications of the reclassification of “personality disorders” in DSM-5 into “Section 2” alongside disorders that have to date been placed on Axis I.

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Challenging DSM-IV criteria for hypomania: Diagnosing based on number of no-priority symptoms

European Psychiatry ◽

10.1016/j.eurpsy.2006.06.003 ◽

2007 ◽

Vol 22 (2) ◽

pp. 99-103 ◽

Cited By ~ 17

Author(s):

Franco Benazzi

Keyword(s):

Structured Interview ◽

Clin Psychiatry ◽

Mood Change ◽

Bipolar Ii Disorder ◽

Bipolar Ii ◽

History Of ◽

Axis I ◽

Dsm Iv ◽

Almost All ◽

Irritable Mood

AbstractBackgroundDSM-IV definition of hypomania of bipolar-II disorder (BP-II), which includes elevated/irritable mood change as core feature (i.e., it must always be present), is not based on sound evidence.Study aimFollowing classic descriptions of hypomania, was to test if hypomania could be diagnosed on the basis of its number (9) of DSM-IV symptoms, setting no-priority symptom.MethodsConsecutive 422 depression-remitted outpatients were re-interviewed by a mood specialist psychiatrist using the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinician Version [a semi-structured interview modified by Benazzi and Akiskal (J Affect Disord, 2003; J Clin Psychiatry, 2005) to improve the probing for BP-II] in a private practice. History of episodes of subthreshold (i.e., 2 or more symptoms) and threshold (i.e., meeting DSM-IV criteria of elevated mood plus at least 3 symptoms, or irritable mood plus at least 4) hypomania, lasting at least 2 days, and which were the most common symptoms during the episodes, were systematically assessed.ResultsBipolar-II disorder (BP-II) patients (according to DSM-IV criteria, apart from hypomania duration) were 260, and major depressive disorder (MDD) patients were 162. Mood change was present in all BP-II by definition. The most common symptoms were overactivity, which was present in almost all BP-II, followed by elevated mood and racing thoughts. ROC analysis of the number of hypomanic symptoms predicting BP-II found that a cut point of 5 or more symptoms over 9 had the best combination of sensitivity (90%) and specificity (84%), and the highest figure of correctly classified (87%) BP-II. History of episodes of 5 or more hypomanic symptoms was met by almost all BP-II.LimitationsSingle interviewer.ConclusionsFollowing classic descriptions of hypomania, not setting any priority among the three basic domains of hypomania (mood, thinking, behavior), results suggest that a cutoff number of 5 symptoms over 9 (of those listed by DSM-IV) could be used to diagnose hypomania of BP-II. Diagnosing hypomania by counting a checklist of symptoms should make it easier to diagnose BP-II, and should reduce the current high misdiagnosis of BP-II as MDD, significantly impacting the treatment of depression.

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Incidence and comorbidity of personality disorders among first ever admitted psychiatric patients

European Psychiatry ◽

10.1017/s0924933800002030 ◽

1994 ◽

Vol 9 (4) ◽

pp. 175-184 ◽

Cited By ~ 3

Author(s):

O Mors ◽

LV Sørensen

Keyword(s):

Personality Disorder ◽

Catchment Area ◽

Psychiatric Patients ◽

Age Group ◽

Axis Ii ◽

Axis I ◽

Cluster A ◽

One Year ◽

Almost All ◽

State Examination

SummaryDuring a period of one year, 157 first ever admitted psychiatric patients in the age group 18-49 years from a catchment area of 217,649 persons were interviewed with the Present State Examination 10th edition, development version and the Personality Disorder Examination, 1988 version. Of the sample, 23% received at least one DSM III-R personality disorder (PD) diagnosis. Rates avoidant PD, very few borderline PDs were found. Almost all patients with PDs also had major psychiatric disorders and the sample was biased towards younger individuals with more severe Axis I symptomatology compared with first ever admitted psychiatric patients aged 18-49 years in Denmark. Cluster A was associated with schizophrenia, cluster B with alcohol or other substance use disorders, and cluster C with anxiety disorders. Within Axis II, schizotypal PD was associated with avoidant and dependent PD, and paranoid with antisocial and dependent PD.

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Nosological validity of dysthymia. Part II: familial, comorbidity, biological and psychological data

European Psychiatry ◽

10.1016/s0924-9338(98)80002-3 ◽

1998 ◽

Vol 13 (4) ◽

pp. 181-187 ◽

Cited By ~ 1

Author(s):

L Waintraub ◽

JD Guelfi

Keyword(s):

Major Depression ◽

Personality Disorder ◽

Mood Disorders ◽

Complex Nature ◽

Axis Ii ◽

Psychological Correlates ◽

Familial Relationship ◽

Axis I ◽

Depressive Personality ◽

The Relationship

SummaryIf some recent studies seem to reveal a more specific familial relationship for dysthymia in addition to a previously known familial relationship to mood disorders, and if results concerning the relationship between dysthymia and depressive personality as well as the search for possible biological and psychological correlates support the nosological validity of dysthymia, comorbidity studies raise difficult questions. Both comorbidity studies with Axis I and Axis II disorders challenge the validity of dysthymia, but as well they question the categorical model presently in use more than the validity of a definite category.However, there are now enough data confirming some of the hypotheses implied by the nosological construct of dysthymia inside this model for this category not to be discarded. For instance, dysthymia is definitely not a personality disorder, and appears also distinct from major depression. The problem of the complex nature of the relationship between dysthymia and major depression still remains unsolved.

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