ABSTRACTS - World Psychiatric Association

affective states and to increase interpersonal and social function, all
of which are impaired in BPD in the long term. MBT was initially
shown to be more effective than treatment as usual at reducing the
acute symptoms of BPD in the context of a partial hospital programme
over 18-months treatment and after 36 months follow-up.
Patients from the partial hospital programme have now been followed
up for 8 years after entry into treatment. MBT offered in an outpatient
context has also recently been studied in a randomised controlled
trial. Replication of results is needed and some data from independent
researchers studying MBT are presented.
RS7.3.
TRANSFERENCE-FOCUSED PSYCHOTHERAPY
FOR BORDERLINE PERSONALITY ORGANIZATION:
CLINICAL AND STRUCTURAL CHANGE
M.H. Stone, J.F. Clarkin
Department of Clinical Psychiatry, Columbia College
of Physicians and Surgeons, New York, NY; Weill Medical College
of Cornell University, White Plains, NY, USA
Transference-focused psychotherapy (TFP) is an empirically supported
long-term (1 year) individual treatment for those diagnosed with
borderline personality disorder (BPD). This structured treatment has
been constructed and described utilizing an object relations conception
of the borderline pathology. An object relation consists of a particular
affect state linked to an image of a specific interaction between
the self and another person. Object relations are integrated and hierarchically
organized to form the higher-order structures that motivate
personality and personality functioning. Whereas fully consolidated
identity - subjective experience of a stable and realistic sense of self
and others - is the hallmark of normal personality, identity diffusion is
at the core of severe personality pathology. The focus and target of
treatment for severe personality disorder such as BPD is an in depth
exploration of the patients’ internalized object relations as manifested
in interpersonal behavior between patient and therapist. From this
conceptualization, it is hypothesized that successful treatment of borderline
patients with TFP would result in not only symptom change
(e.g., reduction of depression and anxiety, reduction in suicidal
ideation and behavior), but also conceptions of self and others that are
more positive in affective tone and integrated. Our empirical findings
suggest that TFP results in significant clinical changes, and in positive
changes in the conceptions of self and others, as measured by a reflective
functioning scale obtained from the Adult Attachment Interview.
RS8.
CLASSIFICATION OF PSYCHOSES: ARE DISEASE
SPECTRA AND DIMENSIONS MORE USEFUL
FOR RESEARCH AND TREATMENT PURPOSES
RS8.1.
THE PSYCHOTIC CONTINUUM: FIVE SYNDROMES
REQUIRE TWO BRAIN DIMENSIONS
T.J. Crow, R. Gimenes
Warneford Hospital, Oxford, UK
Since the formulation of the type 1 and type 2 syndrome hypothesis,
there has been continued interest in dimensional approaches to schizophrenia.
But these need to take account also of the continuum concept
that schizophrenia is not a discrete entity. From a review of the literature
on syndromes and precursors, we conclude that five syndromes
(positive, negative, incoherence, depression, mania) are necessary,
and each can be related to the components of language. We
now propose that these syndromes can be understood in terms of the
four quadrants of association cortex that are defined by the cerebral
torque, the bias from right frontal to left occipital across the anteroposterior
axis. The torque constitutes relative thinning of the cortex on
one side compared to the other, an anatomical change that gives directionality
to inter-hemispheric connections and separates thought, the
precursor of speech, from speech production, and meaning from
speech perception. According to this concept, the syndromes of psychosis
are the extremes of variation in brain structure related to the
species faculty for language. This faculty depends upon the language
circuit created by the torque, an anatomical feature that has its genetic
origin in the Homo sapiens speciation event.
RS8.2.
CATEGORICAL VERSUS DIMENSIONAL
DIAGNOSTICS IN PSYCHIATRY
M. Musalek
Anton Proksch Institute, Vienna, Austria
One of the main reasons for the dragging progress in treatment and
research strategies in psychiatry are the differing standpoints of leading
psychiatrists to classify major psychiatric disorders. The analysis
of the historical development of the currently used classification systems
indicates that sticking to established terms and methodologies
more and more develops to an obstacle in research and treatment. In
the light of the development of DSM-V and ICD-11, the urgent question
is raised: can we overcome this dilemma Is the concept of a psychotic
continuum really incompatibly opposed to the concept of different
diseases or is there a not yet known link between them
Should we focus research and treatment better on well defined psychopathological
syndromes than on distinct diagnoses Is the differentiation
of disease spectra and dimensions of more heuristic value
for modern research methodologies than to stick on established disease
entities like bipolar (affective) disorders and schizophrenic disorders
The prerequisites for the development of a new generation of
classification systems are going back to clinical ground and empirical
realities and leaving dogmatic ideation aside.
RS8.3.
CYCLOID PSYCHOSES FILL THE GAP BETWEEN
SCHIZOPHRENIC AND (BIPOLAR) AFFECTIVE
DISORDERS
E.J. Franzek
Bouman Mental Health Care, Rotterdam, The Netherlands
The concept of cycloid psychoses is traced back to the beginning of
the 20th century, and since then many scientists and clinical psychiatrists
have been dealing with these “atypical psychoses”. There is a
body of research showing that cycloid psychoses have a low heritability
and are mainly caused by neurodevelopmental disturbances.
There are no prodromal negative symptoms before the onset of the
disease and there is a liability of developing psychotic symptoms triggered
by stress, life events and stimulating drugs. The onset is acute,
within days or within a few weeks; the course is mostly bipolar, with
depressive and manic features and remittent in the long run. There
are no long lasting positive and negative symptoms. However, after
several psychotic episodes, strategies of coping with stress are often
diminished and little or even normal psychosocial stress situations
can provoke psychotic relapse. Operational criteria to distinguish
cycloid psychoses from schizophrenia and bipolar affective psychoses
are presented. Recent research points out that it is worthwhile to
38 World Psychiatry 8:S1 - February 2009