This article reports a delayed-treatment randomized controlled trial of a mentalization-based intervention for families or significant others living with or supporting a person with borderline personality disorder (BPD). In all, 56 family members/significant others living with/supporting people with a diagnosis of BPD were randomized either to immediate mentalization-based Families and Carers Training and Support, a supportive and skills-based program consisting of five 1.5- to 2-hr evening meetings, delivered by trained family members, or to delayed intervention. The primary outcome was adverse incidents reported by the family member in relation to the person with BPD. Secondary outcomes included self-reported family well-being, empowerment, burden, and levels of anxiety and depression. Family members randomized to immediate intervention showed a significant reduction in reported adverse incidents between themselves and the identified patient in the second phase of treatment compared with those randomized to delayed intervention. Analysis of the rate of change indicated a significantly steeper decline for the immediate-treatment group compared with the delayed-intervention group (β = -1.07, 95% confidence interval [-1.40, -0.74], z = -6.3, p < .000). Secondary outcome measures showed family functioning and well-being improved more in the immediate-treatment group; changes were maintained at follow-up. There were no differences in depression, total anxiety, and total burden; both groups showed improvement on all these measures. Findings show that the mentalization-based Families and Carers Training and Support program delivered by families to families supporting a person with BPD reduces reported adverse incidents within the family. Further studies are needed to show whether this reduction improves outcomes for the individual with BPD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

/pdf/a-randomized-controlled-trial-of-a-mentalization-based-3ips74b3dk.pdf

A randomized controlled trial of a mentalization-based intervention (MBT-FACTS) for families of people with borderline personality disorder.

Unrecognized bipolar disorder in patients with depression managed in primary care: A systematic review and meta-analysis.

We conducted a meta-analysis to review the diagnostic accuracy of the Mood Disorder Questionnaire (MDQ) among patients with mood disorders. We used a bivariate random effects model to calculate summary sensitivity and specificity. Twenty-one studies were included. At the standard or modified cutoff value of 7, summary sensitivity was .62 and summary specificity was .85. When we pooled 11 studies including both patients with bipolar disorder (BD) and those with unipolar depression, the summary sensitivity was .76 and summary specificity was .81. However, among the six studies that excluded patients with known BD, the summary sensitivity was significantly reduced to .37 and summary specificity was .88. There were no significant differences on the diagnostic accuracy of the MDQ between studies from Eastern and Western countries after adjusting for various clinical correlates. The overall diagnostic accuracy of the MDQ was relatively good. However, when the MDQ is applied among patients with depression without previous diagnoses of BD, its sensitivity was significantly reduced. This suggests that when the MDQ is applied among this population, its optimal cutoff value should be adjusted to enhance its sensitivity.

The validity of the mood disorder questionnaire for screening bipolar disorder: a meta-analysis.

The frequent misdiagnosis of bipolar disorder (BD) is associated with detrimental consequences and inappropriate treatments. The 32-item Hypomania Checklist (HCL-32) and the Mood Disorder Questionnaire (MDQ) are widely used self-report screening instruments for BD. This is a systematic review and meta-analysis to compare the psychometric properties of the HCL-32 and the MDQ based on the same patient samples. Two reviewers systematically and independently searched PubMed, PsycINFO, EMBASE, Web of Science, and Cochrane Library databases. Studies using the HCL-32 and MDQ concurrently and reporting their psychometric properties were included. Eleven studies that met the entry criteria were included in the systematic review, and 9 studies with relevant data were included in the meta-analysis. Using study-defined cutoffs, summary sensitivities were 82% (95% CI: 72%-89%) and 80% (95% CI: 71%-86%), while specificities were 57% (95% CI: 48%-66%) and 70% (95% CI: 59%-71%) for the HCL-32 and the MDQ respectively. Both the HCL-32 and the MDQ have acceptable psychometric properties to identify BD and appear to be useful screening tools for BD.

Comparison of the screening ability between the 32-item Hypomania Checklist (HCL-32) and the Mood Disorder Questionnaire (MDQ) for bipolar disorder: A meta-analysis and systematic review

Background: Individuals with psychiatric disorders incur an increased risk of morbidity and mortality, with higher prevalence of cardio-metabolic risk factors s largely contributing to a significan...

Psychoeducational intervention focused on healthy living improves psychopathological severity and lifestyle quality in psychiatric patients: preliminary findings from a controlled study.

Objective. To describe the prevalence of patients who screen positive for bipolar disorder (BD) symptoms in primary care comparing two screening instruments: Mood Disorders Questionnaire (MDQ) and Hypomania Checklist (HCL-32). Participants. Adult patients presenting to their primary care practitioners for any cause and reporting current depression symptoms or a depressive episode in the last 6 months. Methods. Subjects completed MDQ and HCL-32, and clinical diagnosis was assessed by a psychiatrist following DSM-IV criteria. Depressive symptoms were evaluated in a subgroup with the Patient Health Questionnaire (PHQ-9). Results. A total of 94 patients were approached to participate and 93 completed the survey. Among these, 8.9% screened positive with MDQ and 43.0% with HCL-32. MDQ positive had more likely features associated with BD: panic disorder and smoking habit (P < .05). The best test accuracy was performed by cut-off 5 for MDQ (sensitivity = .91; specificity = .67) and 15 for HCL-32 (sensitivity = .64; specificity = .57). Higher total score of PHQ-9 was related to higher total scores at the screening tests (P < .001). Conclusion. There is a significant prevalence of bipolar symptoms in primary care depressed patients. MDQ seems to have better accuracy and feasibility than HCL-32, features that fit well in the busy setting of primary care.

/pdf/screening-for-bipolar-disorder-symptoms-in-depressed-primary-27rrql8dwm.pdf

Screening for Bipolar Disorder Symptoms in Depressed Primary Care Attenders: Comparison between Mood Disorder Questionnaire and Hypomania Checklist (HCL-32).

SUMMARY. Aim . The scientific literature focused on factors involved in the onset of borderline personality disorder (BPD) h as given a cen tral role to the families of these patients. The role of the family in understanding the disorder has gradually changed thanks to research that investigated the interaction of several factors in the development of this psychopathology. Recently, scientific literature on DBP has allowed to consider parents as no longer “responsible” for the development of the disorder, but as directly involved in interpersonal problems of pa tients and therefore a potential “ally” in the management of crisis. The aim of this study is to describe and quantify the family burden of BPD patients and browse specific interventions for the family of these patients. Methods. PubMed and PsycINFO have been used for review with the following keywords: “borderline personality disorder”, “family”, “psychopathology”, “burden”, “psychoeducation”, “caregiver”, “care taker”. Results. Studies on family burden of BPD patients are still few. Research shows that the family burden of BPD patients is compa rable with that of families of patients with schizophrenia. Clinical trials of interventions for caregivers of patients with BPD show that spe cific strategies can reduce the family burden and improve their self-efficacy. Discussion. Scientific literature highlights the relevance of prob lems of families with a BPD member and the importance of involving them in the treatment of these patients.

[The family of a patient with borderline personality disorder: burden of illness and interventions for caregivers].

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Screening for Bipolar Disorder Symptoms in Depressed Primary Care Attenders: Comparison between Mood Disorder Questionnaire and Hypomania Checklist (HCL-32).

[The family of a patient with borderline personality disorder: burden of illness and interventions for caregivers].