Oxymoron or Perspective PDF Material (Vienna)
The ‘Oxymoron or Perspective’ Powerpoint, presented at the Vienna EPA in 2011, is downloadable in PDF format (see link above). The most relevant presentations in Vienna from other authors who are engaged in similar research are set out in the posts in this Overview Section. The blogsite is set up to encourage exchange of ideas from visitors to the site, in response to these presentations, or for any other reason.
The PRISM Programme
Week 1 Identity Exploration
Week 2 Dilemmas, Traps, Snags
Week 3 Roadmaps
Week 4 Planned Behaviours
Week 5 Mood Diary
Week 6 Actions and Consequences
Week 7 Problem Targeting
Week 8 Finding Your Place
Week 9 Finding Other People’s Place
Week 10 The Big Picture
Week 11 Putting it All Together
Week 12 Rapping It All Up
The only assessment tool needed, other than the standard mental state assessment procedure common to all mental health practitioners, can be accessed at
http://www.identityexploration.com/Ipseus_-_Software_for_Identity_Exploration.asp
PRISM 
From Gordana Dedic, Serbia
There are three well-known theories of psychodynamic of suicide: Freud’s (suicide as a result of displacement of murderous impulses from a love object that are directed toward an internalized object), Menninger’s (wish to destroy the lives of the survivors) and Fenichel’s (fulfillment of reunion wish with a lost loved figure). To put suicide attempt in a psychodynamic context, clinicians must understand psychodynamic of suicide behavior, which can help them in their work with patients’ crisis intervention
From Lieke Nentjes, Netherlands
50 to 90 percent of criminal offenders have personality disorders (PDs), with cluster B PDs being the most prevalent in forensic settings. The latter type of PD is associated with an increased risk of violence and recidivism. Among forensic patients with a cluster B diagnosis, psychopathic offenders are at particularly high risk for re-offending. Psychopaths are believed to be untreatable, but evidence for this view is weak.
The current study aimed at determining the effectiveness of Schema Focused Therapy (SFT) versus ‘treatment as usual’ in male forensic patients (including psychopaths) with Antisocial, Borderline, Narcissistic, and Paranoid PDs, within a 3-year multi-center randomized clinical trial. SFT is an integrative form of psychotherapy combining cognitive, behavioral, psychodynamic object relations, and humanistic/existential approaches, and was developed as a treatment for PDs and other longstanding problems. SFT aims at changing early maladaptive schema modes, thereby producing changes on a structural, emotional level. The goal of a second study was to assess various affective capacities (moral emotion, emotional expressive behavior, cognitive and emotional empathy.
From Mirela Delalle, Croatia
The general interpretation of the etiology of various psychopathological symptoms in adolescence does not talk about causes, but the risk factors. We tried to determine whether traumatic experiences among adolescents represent a risk factor for suicide. In the suicidal group 38 patients (76%) reported traumatic experiences, mostly in the family context, while in the nonsuicidal group, 27 patients (54%).
In daily psychiatric work we must focus on adolescents who have experienced traumatic experiences and is therefore extremely important in anamnesis always ask for the lived traumatic experience. Family practitioners, specialists in educational institutions, parents and adolescents themselves have a role in early recognition of these risk factors.
From Rudy Bowen, Canada
Affective instability in patients with BPD appears to be composed of several elements. As measured by changes in mood amplitude, over time, mood variability appears to be related to trait impulsivity. The presence of negative mood intensity and mood variability seems to define a subgroup of BPD patients that might be at elevated risk for suicidal behaviour.
In addition to being a symptom of BPD, affective instability (or emotional dysregulation) may in fact be the driving force behind many additional behaviors seen in the disorder. Linehan has postulated that in BPD, emotional vulnerability and inability to regulate emotions lead to maladaptive attempts to regulate intense affective states or to control problematic outcomes associated with these affective states.
Impulsive behavior (including suicidal behavior) may be seen as a maladaptive solution to painful negative affect, identity disturbance may result from a lack of emotional consistency and predictability, and disturbed interpersonal relationships may be the product of the difficulty in regulating emotional states and impulses, as well as the inability to tolerate painful stimuli.
The Affective Lability Scale is a robust predictor of suicidal thoughts. Mood Instability is a more clinically useful concept than neuroticism and questions about mood instability should be part of the clinical interview. So, although mood instability has been seen as a feature of the borderline personality disorder, mood instability should be recognised as common in patients with mood and anxiety disorders, especially those who are suicidal.
References Available: P Links, TJ Trull, D Watson et.al.
From Zahra Aalayi, Iran
There is significant relation between general just world belief and obsessive -compulsive disorder, interpersonal sensitivity, depression, hostility and paranoia. Depression, interpersonal sensitivity and paranoia also predict unjust word belief.
From Paola Solano, Italy
Data for 3614 cases of suicidal behaviours performed by individuals aged between 18 to 24 occurring between 2001 and 2008 was provided by the Italian Institute for Statistical Analysis (ISTAT). Peaks were found in January, March and May. Males have a significantly greater regularity of the peaks than females.
From Yossi Levi, Israel
The study of near fatal suicide attempters may provide insight into the minds of persons who die by suicide. 35 suicide attempters bjects who made medically serious suicide attempts were compared with 67 non- medically serious suicide attempters. All answered questions about mental pain, communication difficulties, and seriousness of the suicide intent.
The suicidal person who suffers from depression and hopelessness and cannot signal his pain to others because of communication difficulties can be a risk for a serious suicide attempt – which is more planned, with more precautions against discovery and without communication before or during the attempts.
From George Konstantakopoulos, Greece
Studies have provided evidence for Theory of Mind (ToM) impairment in bipolar disorder (BD). Three different ToM tests were used: First Order False Belief Stories, Hinting Test, Faux Pas Recognition Test. WAIS looked at Vocabulary, Block design, and Digit span, Stroop Test, Rey Auditory Verbal Learning Test, Trail Making Test, Wisconsin Card Sorting Test.
Patients showed significant impairments on ToM tasks which did not persist beyond mood episode, except for patients’ poor performance on Faux Pas.
From Nikolaos Kokras, Greece
Evidence suggests a relationship between sleep disturbances and suicidal ideation. The temporal appearance of insomnia has been proposed as a warning sign of imminent suicidal acts. However, there is little information on the temporal relation of insomnia with acts of deliberate self-poisoning (DSP).
Patients with an Axis I diagnosis were significantly more likely to present insomnia than patients with an Axis II diagnosis. Interestingly, when the number of previous DSP acts was included into the analysis, patients with an Axis I diagnosis with and without previous DSP acts had an equal prevalence of insomnia. On the contrary, in patients with an Axis II diagnosis and previous DSP acts, insomnia was three times more prevalent than in those with no previous DSP acts. These results suggest that insomnia may be a valid proximal warning sign, particularly in patients with personality disorders and previous DSP acts.
From Matthew Impey, UK
Attention Deficit Hyperactivity Disorder (ADHD) and suicidal behaviour are common psychiatric conditions with significant social and emotional morbidity.
In populations completing suicide,ADHD was present in 4 to 25.9%. In suicide attempt and ideation populations, 1.6 to 65% and 10.5-31.8% respectively had ADHD. Attention deficit disorders were diagnosed more frequently in suicidal males than females.
In those with diagnosed ADHD, 9.1-70% had attempted suicide and 15.8-66.3% described suicidal ideation. Higher rates were seen in prison inmates and drug dependent subjects. Although there is a positive relationship between ADHD and risk to self, the magnitude can vary greatly between different populations.
From Joo Alcafache, Portugal
90.6% of women use pills as suicide method. 63.2% of men use drugs, 10.5% phlebotomy and 26.8% resorts to violent methods. Individuals with moderate or severe depression have a higher probability (91x) of suicidal risk compared with individuals with no depression or mild depression. Individuals vulnerable to stress have a higher probability (5.7X) of attempting suicide. Individuals with external influence suicidal behaviour have a higher likelihood of suicide risk (4x), compared to individuals without external influence. Individuals with personality disorder (particularly cluster B) have a higher probability (25x) for suicide risk in people without personality disorder.
The para-suicidal prototype seems to be a 36 year old woman, low level of literacy, married, with previous para-suicidal gestures, from ingestion of drugs, at home, following an emotional conflict. The suicidal will probably be a 40 year old man, divorced, low financial resources, unemployed, having prepared a previous plan that consummated suicide by violent methods.
From Reitske Meganck, Belgium
The concept of alexithymia refers to difficulties in identifying and verbalizing emotions, an externally oriented thinking style and a paucity of fantasy.
Alexithymia was positively related to avoidant defenses and negatively to reality focused responses. We found relationships with for example self-destructive behavior and dissociation, items referring to the inability to use self-talk to cope with distress and the inability to anticipate problems and develop realistic plans for them, and finally a negative relation with ‘responds to potentially distressing situations by talking directly to the people involved.’
From Ivo Marx, Germany
It has been shown that subjects with attention-deficit/hyperactivity disorder (ADHD) show deficits in executive functioning, i.e. in cognitive functions that subserve planning, monitoring and control of goal-directed behaviour, as well as in emotion regulation.
In comparison to healthy controls, subjects with ADHD displayed a deficit in working memory performance in terms of prolonged reaction times and decreased performance accuracy. Beyond this, we found that whereas healthy controls did not display performance deficits until they were presented with high-arousal background pictures, subjects with ADHD were already impaired when presented with medium-arousal background pictures.
From Mahassine Touhami, Morocco
The borderline personality disorder is the most frequent personality disorder in psychiatry. It causes significant changes in social, family and professional functioning, which can be severe enough to cause an alteration of quality of life.
In 92% of our sample, there was a social impact, represented by social and family isolation (64% of cases), separations, divorces (28%). 40% of patients were at a good economical level. 56% of the sample had no education beyond high school, only 36% were able to attend college. In 96% of cases, the symptoms had affected education and occupation, with dropout in 56%, fragile employability in 28% and job loss in 12%.
From Blanca Reneses, USA
Four psychotherapies have been recognized as effective with scientific evidence for the treatment of BPD, but are long term techniques. It is necessary to explore new time limited psychotherapies in order to be more accessible. We have developed a specific manualized psychotherapy for BPD named Psychic Representation focused Psychotherapy (PRFP).
60 subjects with BPD were randomized to one of the two treatment groups. The study group received PRFP with 20 sessions on a weekly basis; the control group received treatment as usual. Both groups could receive psychopharmacological treatment. Preliminary results of the first 30 patients (control group 17, experimental group 13, without significant differences, Age 18-35 years; 70% women) assessed at the baseline and at the end of the intervention (six months) showed that the experimental group reached a statistically significant clinical improvement over the controls in all measured variables: SCL-90; MDRS; Barrat; STAI anxiety state; Rosemberg self-esteem and SASS social adaptation.
From Jiten Mistry, UK
Psychopathy comprises affective (lack of empathy, superficial charm, shallow emotions) and antisocial lifestyle features (criminal behaviour, impulsivity). The nature of the deficits in empathic responding remain poorly understood but recently authors have claimed that psychopaths know right from wrong but do not care.
We used a number of online questionnaires to assess key features of psychopathy including primary and secondary psychopathy (Levenson’s Psychopathy Scale), moral judgement (Moral Judgement Test), impulsivity (Barratt Impulsivity Scale), life history of aggression (Life History of Aggression questionnaire), and cognitive and affective empathy (Questionnaire of Cognitive and Affective Empathy) in a healthy student population.
Primary psychopathy correlated with cognitive empathy. However, we did not observe any significant correlations between moral judgement scores and psychopathy scores. In this healthy control population, moral judgment scores do not show a significant relationship with psychopathy scores. Low empathy and high impulsivity scores observed in individuals with high psychopathy scores may not be related to a lack of understanding of moral concepts.
From Susana Oliveira, Portugal
The Borderline Personality (BP) disorder is defined as a limit state between neurosis and psychosis. The symptomatology observed in such disorder seems to be correlated with the dysfunction of specific areas of the human brain, such as cortical and sub-cortical ones.
The stress response of patients with BP disorder seems to be associated with a low-responsive pituitary gland. The frontolimbic abnormalities observed in recent studies seems associated with the difficulty in the emotional management and impulsivity. The findings suggest a reduction of parietal cortex metabolism which appears to be associated to lack of insight and easy hypnotic induction.
The disfunction of the amygdala, hippocampus and prefrontal cortex was found to be lateralized on the left hemisphere, whether the structures with increased activation on the right hemisphere were the temporal lobe, ventrolateral prefrontal cortex and posterior parietal lobe. Finally, the aggressive and impulsive behavior of such patients seems to be related with low levels of cortical serotonin.
From all the relations found, the fronto-limbic deficit is the one with a more relevant influence for the consequent emotional disturbance, a major symptom of this disorder.
From Daria Karaklic, France
For quite a long time, borderline personality disorder (BPD) has been viewed as a chronic disorder and borderline patients as extremely difficult to treat. However, those views are changing and there is an increasing recognition that the BPD has a far more benign course than previously thought, but predictors of its outcome remain poorly explored.
Borderline patients (n=75) were compared to patients with other personality disorders (n= 40). At 18-month follow up, 57 BPD patients and 22 with OPD were evaluated. 45% of borderline subjects and 50% of the OPD subjects achieved remission. Low impulsivity, low alexithymia, good global functioning, and older age at onset of symptoms were found to be significant predictors of good outcome of BPD. 45% of patients with BPD are likely to improve in 18-months. Specific factors, such as impulsivity, alexithymia, life events and quality of current relationships, determine the short-term outcome of this disorder.
From Ruth Inslegers, Belgium
The concept of alexithymia refers to problems in experiencing and regulating affects; clinical study as well as empirical research suggests that alexithymia is related to cold and socially inhibited interpersonal functioning.
The Toronto Structured Interview for Alexithymia (TSIA) was administered, also the Toronto Alexithymia Scale (TAS-20) and the Inventory of Interpersonal Problems (IIP-64). Dimensional affiliation and dominance scores of the IIP-64 were computed.
Our results confirm that alexithymia is related to a cold interpersonal style but, since our findings converge for both measurements of alexithymia, the link between alexithymia and interpersonal style can not be explained.
From Sara Germans, Norway
Assessment of the personality is an essential part of initial psychiatric examination. It would be useful to provide clinicians a powerful screening tool for personality disorders that is ‘quick and dirty’.
Nine screening instruments were studied, using the SCID-II as the gold standard. There were three short questionnaires (Standardized Assessment of Personality-Abbreviated Scale (SAPAS), Iowa Personality Disorder Screen (IPDS), Short version of the SCID-II, three longer questionnaires (the SCID-II Personality Questionnaire, the NEO Five-Factor Inventory (NEO-FFI), Inventory of Interpersonal Problems (IIP-PD/C;) one short semi structured interview (Quick Personality Assessment Schedule (PAS-Q.) and two informant interviews (Standardised Assessment of personality (SAP), the Standardized Assessment of Personality- Abbreviated Scale for informants (SAPAS-INF).
The three short questionnaires and the semi structured interview were very useful for determining the presence/absence of PD. The other instruments can be used in particular situations for example to determine a specific PD or if the patient is not able to accomplish the test.
From Ulrike Willinger, Austria
“Theory of mind (ToM) refers to the capacity to attribute certain independent mental states, contents and processes to others – such as desires, concepts, intentions, beliefs and emotions.
A new instrument, called ToM-Stories, was compared with the established ToM-Picture-Test and to cognitive functioning by using the Trail Making Test. Our ToM-Stories consist of brief stories, each describing a real life situation of various degree of complexity. All of them involve unintended misapprehensions which led to false belief. Comprehension required mindreading at different levels of intentionality.
The findings provided evidence that cognitive flexibility is an important competence in promoting representational understanding in the mind.”
From Peter Almos, UK
Response inhibition (RI) is a basic component of human behaviour responsible for suppressing actions or thoughts which are inappropriate in a certain context. There is limited data how it is influenced by emotional context and psychosocial stress.
The effect of emotional factors on RI were investigated with an emotional go/nogo task, while psychosocial stress was induced with the Trier Social Stress Test (TSST). Electroencephalography (EEG) is an excellent method for studying the neural correlates of RI: the two major event-related potentials (ERPs) implicated in the process are the frontal N2 and P3 components.
ERPs were not affected by positive or negative emotional context in the baseline condition. In contrast, after TSST a significantly enhanced valence effect was observed on the go-related N2 amplitude and a greater go vs. nogo N2 latency difference was detected. Conclusions: These findings highlight the importance of the stress-regulating system on emotionally modulated RI.
From Mohammad Pour Abdol Isardroud, Iran
200 students between ages of 19-26 were randomly selected from three universities and Coudron’s Stress Inventory (CSI) and Hogan-Champagne’s Personal Style Inventory (PSI) were administered. PSI assesses eight personality dimensions based on Jungian personality types (introversion-extroversion E/I, intuition- sensing N/S, thinking-feeling T/F, perceiving-judging P/J).
Findings showed negative correlation between extroversion and stress and positive correlation between introversion and stress. Males were shown to have more intuition than females but females were more sensing than male. Based on these findings and bearing in mind that introverted persons are quiet, diligent at working alone and socially reserved, the inference is that they make decisions somewhat independently and removed from situations, cultures, people, or things around them. If faced with stress factors that interrupt their own internal world, this causes them to reduce their functionality, cause erratic variability in how they respond to a situation and symptoms of stress emerge.
From Konstantina Magklara, Hungary
Thoughts of feeling life is not worth living is often an initial stage of a continuum that might end in a suicide.
Out of 5614 adolescents aged 16-18 years old attending 25 senior high schools in Greece, a stratified random sample of 2431 subjects was selected for detailed interview at the second phase. Psychiatric morbidity and thoughts of life not being worth living were assessed with the revised Clinical Interview Schedule (CIS-R). 3.72% of the adolescents (girls:5.11%, boys:2.36%, reached significance levels.
From Sylvia Kauer, Australia
Behavioural therapy often involves self-monitoring techniques to increase awareness about mood and stressful events. In turn, emotional self-awareness is likely to decrease symptoms of depression. Self monitoring also has potential as an early intervention tool for young people, particularly when mobile phones are used as a medium. Previous qualitative research indicates that self-monitoring via mobile phones increase emotional self-awareness with five categories proposed: awareness, identification, communication, contextualisation and decision-making.
Young people (between 14 and 24 years of age) were identified by their GP as being at risk of depression and were recruited by GPs in rural and metropolitan Victoria. They were randomly assigned to the intervention group (where they monitored their mood, stress and daily activities) or the comparison group (where questions about mood and stress were excluded). Participants completed baseline and follow-up measures of depression as well as measures of emotional self-awareness.
Results showed that emotional self-awareness is a mediator in the relationship between self-monitoring and depression.
From Judit Balazs, Hungary
Suicide among adults has been associated with subthreshold psychiatric illness, however it is little known how it relates to subthreshold mental disorders in suicide risk among children/adolescents.
We examined 105 hospitalized children/adolescents in the Vadaskert Child Psychiatric Hospital, Budapest. Current suicide behavior was defined as giving a positive answer to any of the following questions: In the past month did you: think you would be better off dead or wish you were dead? want to hurt yourself? think about killing yourself? attempt suicide?
From 76 (72.4%) boys and 29 (27.6%) girls, with a mean age of 11.4 years, current suicide behavior was present in 18 cases (17.1%). There was one person with current suicide behavior, who did not have any current DSM-IV disorder, but he/she had current subthreshold disorder. The majority of children/adolescents with suicide behavior had both current subthreshold and DSM-IV disorders. Eight children/adolescents (44.4%) with current suicide behavior had current DSM-IV major depressive episode and further 5 children/adolescents (27,8%) had current subthreshold major depressive episode.
The prevalence of DSM-IV and subthreshold major depressive episode was significantly higher among hospitalized children with suicide behavior than among hospitalized children without suicide behavior. Subthreshold forms of pediatric psychiatric disorders need to be taken into account as well in suicide prevention.
From Alireza Homayouni, Iran
Emotional intelligence (E / I) consists of appraisal of emotion in the self and others, regulation of emotion in the self and others and utilization of emotion in solving problems. Subsumed under these branches are functions such as verbal and non verbal appraisal and expression of emotion and using emotions to motivate as part of the utilization of emotions. Emotional intelligence components are important in psychological functions such as problem-solving, happiness, stress-tolerance, self-actualization and interpersonal relationship.
73 addicted people and 73 non-addicted people were randomly selected and were requested to complete Schutte’s Self-Report E / I Test. The test measures ability of E/I in three fields: Appraisal of emotion, regulation of emotion and utilization of emotion.Findings indicated significant differences between two groups in components of emotional intelligence. Nonaddicted people had more scores in appraisal of emotion, utilization of emotion and general score of emotional intelligence. But there was no significant difference in regulation of emotion in two groups.
A library of PDF papers on how to effect personal change can be downloaded from the Rochester Site.
Length of Intervention
In accordance with the complexity of a case, a regimented adherence to a twelve-session programme may not always be possible but the general content and sequence will be the norm. For more complicated cases, the duration of intervention may be 1.5x, 2x or some other multiple.
Some of the ground to be covered is – Knowing when and where Problems started; Rediscovering lost Confidence; Zoning in on Solutions; Understanding Moods; Selecting reasonable Goals; Being Satisfied; Dealing with Disappointment; Taking Time-out; Cooperating and Sharing; Getting to know Self; Being kind to Self.