Pandemic Impacts on Cluster B Personality Disorders in the U.S. Navy: A Case Study in Context

ABSTRACT This paper is a brief description of the impact that the SARS-CoV-2 global pandemic has had on both mental health and U.S. Navy policies through the narrative of a deployed enlisted sailor, medically evacuated from Japan. Although the introduction of vaccines and loosening of state-specific mandates have signaled a slow return to our “normal,” pre-pandemic, way of life, there is now an opportunity to look back and understand how the situation impacted the presentation and outcome of certain cases. We believe that the sailor presented introduces a discussion about the impacts of heightened restrictions on some personality types. As the pandemic has continued to impact and reshape every facet of force health protection, we believe that understanding the impact of public health orders on individuals with specific personality disorders or traits will help us provide care and leadership counsel going forward. The discussion within our case report provides insight and an opportunity for healthcare providers to reflect.

A-85 Differences in Cerebral Blood Perfusion with Individuals Diagnosed with Cluster B Personality Disorders

Objective To identify regional cerebral blood flow (rCBF) differences between individuals with DSM-IV diagnosis of Cluster B Personality Disorders (PDB) and healthy controls. Method Healthy controls (n = 81, Mage = 41.9, 53.0% female, 42.0% Caucasian) and persons diagnosed by psychiatric examination with PDB (n=, Mage = 34.12, 71.5% female, 69.8% Caucasian) were selected from a deidentified adult clinical outpatient database. Those with comorbid diagnoses were included. Significant differences (alpha = 0.005) were found for age [t(195) = −3.62], gender [χ2(2) = 7.1], and race [χ2(12) = 23.82] between groups. Mean age [t(523) = 2.09, p = 0.037) and gender [t(532) = −2.653, p = 0.008] different significantly between groups. No significant mean difference was found for education [t(523) = 0.832, p = 0.406]. Results Significant rCBF differences were noted in the cerebellum [left:F(1,192) = 10.5; right:F(1,192) = 4.6], limbic system [left:F(1,192) = 7.8; right:F(1,192) = 5.0], and basal ganglia [left:F(1,192) = 12.3; right:F(1,192) = 6.7]. Group means comparisons indicated higher perfusion in the cerebellum for the PDB group. Lower perfusion was found in the limbic system and basal ganglia in the PDB group. Conclusion Results observed in this study are concurrent with previous literature. PDB demonstrates higher activity in the cerebellum which contains inhibitory neurotransmitters, like Purkinje cells. The increased blood flow to cerebellar circuits may be related to the explicit self-recognition of negative emotion reported in PDB. Hypoperfusion found in the limbic system could be linked to impaired emotional responses. Apathy experienced in PDB may be accounted for by the low perfusion in the highly dopaminergic pathway in the basal ganglia. Further research should assess how different comorbidities with PDB affect perfusion.

The influence of therapy alliance and treatment motivation in patients with Cluster B personality disorders on incidents in forensic hospitals

Purpose Nonspecific factors such as therapy alliance and treatment motivation have been shown to be predictive of therapy outcome. However, research investigating these factors among patients with personality disorders, or studies in the context of mandated treatment showed mixed results. A new theory furthermore speculates there may be differences between early formed therapeutic alliance (trait-like) versus alliance formed on the longer term (state-like). This paper aims to investigate the effects of therapy alliance and treatment motivation in 103 Dutch male forensic psychiatric patients with Cluster B personality disorders. Design/methodology/approach The authors used incidents as a measure of treatment outcome. They studied the effect of nonspecific factors on incidents in two phases, namely, 0 – 18 months and 18 – 36 months, along with known predictors of incidents (age, Historical items of the HCR-20 and psychopathy) as covariates. Findings Regression models predicting incidents in the first 18 months of treatment were nonsignificant. Incidents in the second 18 months were significantly predicted by models including alliance and motivation measured at the start of treatment, but not measures at 18 months and covariates. Predictors, except for age, were all nonsignificant. Practical implications These findings lend tentative support for the trait-like vs state-like theory of change through nonspecific factors. However, it may also be that other factors are more important in predicting therapy outcome in forensic psychiatric patients with Cluster B personality disorders. Originality/value The current study represents the first effort to study the effects of non-specific factors on therapeutic discourse in hospitalized offenders with Cluster B personality disorders.

Impact of Cluster B Personality Disorders in Drugs Therapeutic Community Treatment Outcomes: A Study Based on Real World Data

Background: The impact of dual pathology on treatment outcomes is unclear, with the literature reporting both favorable and unfavorable evidence. The main aim of this study was to determine how dual pathology affects treatment outcomes using real world data obtained from inpatients that began treatment in therapeutic communities. Method: The data of 2458 inpatients were used. Clinical information was obtained from electronic medical records. Reliability of diagnosis was checked and revealed a mean kappa value of 0.88. Results: Of the sample, 41.8% were discharged after achieving the therapeutic objectives. Patients diagnosed with Cluster B personality disorders were found to have a higher risk of dropping out of treatment (HR = 1.320; z = 2.61; p = 0.009). Conclusions: Personality traits exhibited by Cluster B patients can interfere with treatment in therapeutic communities. There is a need to develop specific interventions for these inpatient groups, which could be implemented in therapeutic communities.

The Complex Associations Between Early Childhood Adversity, Heart Rate Variability, Cluster B Personality Disorders, and Aggression

Early childhood adversity can cause an imbalance in the autonomic function, which may in turn lead to the development of trauma-spectrum disorders and aggressive behavior later in life. In the present study, we investigated the complex associations between early adversity, heart rate variability (HRV), cluster B personality disorders, and self-reported aggressive behavior in a group of 50 male forensic inpatients ( M age = 41.16; SD = 10.72). Structural Equation Modeling analysis revealed that patients with cluster B personality disorders were more likely to have adverse early childhood experiences and reduced sympathetic dominance in response to a threat than patients without cluster B personality disorders. In addition, HRV and cluster B personality disorders did not significantly mediate the association between early childhood adversity and self-reported aggressive behavior. These findings are important for clinical practice to facilitate specific treatment programs for those affected.