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Rosdorf bei Gottingen, Germany

Salzer S.,University of Gottingen | Streeck U.,Asklepios Fachklinikum Tiefenbrunn | Jaeger U.,Asklepios Fachklinikum Tiefenbrunn | Masuhr O.,Asklepios Fachklinikum Tiefenbrunn | And 3 more authors.
Journal of Nervous and Mental Disease

Borderline personality disorder (BPD) is characterized by a wide variety of interpersonal problems. We examined whether there are different characteristic interpersonal patterns in BPD and how these patterns are related to symptom distress and therapeutic alliance. In 228 inpatients with diagnoses of BPD, interpersonal subtypes based on the Inventory of Interpersonal Problems (Horowitz et al., Inventar zur Erfassung Interpersonaler Probleme, 2000) were examined through cluster analyses. The global symptom severity and therapeutic alliance were also assessed. We identified five characteristic interpersonal patterns, which we labeled as follows: Cluster 1, "Vindictive"; Cluster 2, "Moderate Submissive"; Cluster 3, "Nonassertive"; Cluster 4, "Exploitable"; and Cluster 5, "Socially Avoidant." The clusters differed significantly in terms of interpersonal distress, interpersonal differentiation, and severity of global symptoms. The ratings of the therapeutic alliance by therapists during treatment significantly differed between the interpersonal subtypes, and the lowest ratings for patients were in the "Socially Avoidant" cluster. Our results stress the impact of interpersonal style on the appearance and treatment of BPD. Copyright © 2013 by Lippincott Williams &Wilkins. Source

Hinkelmann K.,Charite - Medical University of Berlin | Muhtz C.,University of Hamburg | Dettenborn L.,University of Hamburg | Agorastos A.,University of Hamburg | And 6 more authors.
Psychological Medicine

Background While impaired memory and altered cortisol secretion are characteristic features of major depression, much less is known regarding the impact of antidepressant medication. We examined whether the cortisol awakening response (CAR) is increased in depressed patients with and without medication compared with healthy controls (HC) and whether CAR is associated with memory function in each group. Method We examined 21 patients with major depression without medication, 20 depressed patients on antidepressant treatment, and 41 age-, sex-and education-matched healthy subjects. We tested verbal (Auditory Verbal Learning Task) and visuospatial (Rey figure) memory and measured CAR on two consecutive days. Results Patient groups did not differ in severity of depression. We found a significant effect of group (p = 0.03) for CAR. Unmedicated patients exhibited a greater CAR compared with medicated patients (p = 0.04) with no differences between patient groups and HC. We found a significant effect of group for verbal (p = 0.03) and non-verbal memory (p = 0.04). Unmedicated patients performed worse compared with medicated patients and HC in both memory domains. Medicated patients and HC did not differ. Regression analyses revealed a negative association between CAR and memory function in depressed patients, but not in HC. Conclusions While in unmedicated depressed patients the magnitude of CAR is associated with impaired memory, medicated patients showed a smaller CAR and unimpaired cognitive function compared with HC. Our findings are compatible with the idea that antidepressants reduce CAR and partially restore memory function even if depressive psychopathology is still present. © 2014 Cambridge University Press . Source

Crises in adolescence can be explained at least in part by the neurobiological restructurings of the brain that take place in that period. This applies particularly to problems caused by defective control of behaviour and feelings, a lack of control that is associated with defective mentalisation and immediate gratification. Goal-oriented behaviour requires the control of impulses and the delay of gratification, abilities that frequently have to be developed in psychotherapy for this stage of life to turn into a «second chance». The problems referred to are illustrated with reference to the case of a 15-year-old adolescent diagnosed with ADHD. In addition, the author describes the materialisation of a therapeutic process that had a beneficial effect on the young patient. Source

Wingenfeld K.,Franklin University | Wingenfeld K.,University of Hamburg | Driessen M.,Ev. Hospital Bielefeld Bethel | Terfehr K.,University of Hamburg | And 7 more authors.
Psychological Medicine

Background Stress and cortisol administration are known to have impairing effects on memory retrieval in healthy humans. These effects are reported to be altered in patients with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD) but they have not yet been investigated in borderline personality disorder (BPD). Method In a placebo-controlled cross-over study, 71 women with BPD and 40 healthy controls received either placebo or 10Â mg of hydrocortisone orally before undertaking a declarative memory retrieval task (word list learning) and an autobiographical memory test (AMT). A working memory test was also applied. Results Overall, opposing effects of cortisol on memory were observed when comparing patients with controls. In controls, cortisol had impairing effects on memory retrieval whereas in BPD patients cortisol had enhancing effects on memory retrieval of words, autobiographical memory and working memory. These effects were most pronounced for specificity of autobiographical memory retrieval. Patients with BPD alone and those with co-morbid PTSD showed this effect. We also found that co-morbid MDD influenced the cortisol effects: in this subgroup (BPDÂ +Â MDD) the effects of cortisol on memory were absent. Conclusions The present results demonstrate beneficial effects of acute cortisol elevations on hippocampal-mediated memory processes in BPD. The absence of these effects in patients with co-morbid MDD suggests that these patients differ from other BPD patients in terms of their sensitivity to glucocorticoids (GCs). © 2012 Cambridge University Press. Source

Kuehl L.K.,Charite - Medical University of Berlin | Hinkelmann K.,Charite - Medical University of Berlin | Muhtz C.,University of Hamburg | Dettenborn L.,University of Hamburg | And 5 more authors.

Findings on the association between hypothalamic-pituitary-adrenal (HPA) axis activity and metabolic risk are equivocal. Different methods of measuring HPA activity might indicate adverse vs. beneficial effects of HPA activity on metabolic risk thus contributing to heterogenous findings. In this study, we aimed to determine whether (1) the salivary cortisol awakening response (CAR) as a marker of awakening-induced activation of the HPA axis and (2) hair cortisol as a marker of long-term cortisol secretion are associated with criteria of the metabolic syndrome. Therefore, we recruited 41 healthy individuals (26 women, mean age: 41.2 years) and 44 patients with major depression (28 women, 41.4 years) and assessed CAR and hair cortisol values as well as all criteria of the metabolic syndrome (abdominal obesity, blood pressure, plasma glucose, triglycerides and high-density cholesterol levels) according to the International Diabetes Federation. CAR and hair cortisol values were divided into tertiles. Across groups, participants with hair cortisol or hair cortisone in the highest tertile showed significantly more criteria of the metabolic syndrome compared to participants in the medium or low tertile (F2,64=3.37, p=.04). These results were corroborated by significant positive correlations between mean hair cortisol values with waist circumference (r=.29, p=.03), triglycerides (r=.34, p=.01) and systolic blood pressure (r=.29, p=.04) and between mean hair cortisone and triglycerides (r=.46, p<.01). In contrast, mean CAR values correlated negatively with diastolic (r=-.29, p=.03) and systolic blood pressure (r=-.32, p=.02). Our results indicate that higher hair cortisol and hair cortisone levels but lower CAR values are associated with an unfavorable metabolic and cardiovascular risk profile. © 2014 Elsevier Ltd. Source

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