Psychotherapy serves as the foundation of care for individuals with borderline personality disorder (BPD), with pharmacotherapy being regarded as a supplementary measure to be considered when necessary. In clinical practice, however, most of BPD patients receive medication.

A major problem in the treatment of BPD is the lack of compliance derived from the pathological impulsivity of BPD patients. The use of long-acting antipsychotics (LAI) may be an option.

This work aims to address the use of long-acting injectables in borderline personality disorder.

Non-systematic review of literature using the PubMed ® database, based on terms “Borderline Personality Disorder” and “Long-acting antipsychotics”. Only six articles were found.

Several studies have shown promising results in the treatment of Borderline Personality Disorder (BPD) with long-acting injectable (LAI) antipsychotics. A six-month study using IM risperidone demonstrated significant improvement, while LAI Aripiprazole also exhibited positive outcomes in individuals with BPD and Substance Abuse. Additionally, Palomares et al. (2015) found that palmitate paliperidone LAI reduced impulsive-disruptive behaviors and enhanced overall functioning in BPD patients. Carmona et al. (2021) compared oral and LAI antipsychotics and concluded that LAIs may have a role to play in the management of BPD.

Treatment with LAIs may play an important role in clinical and functional improvement in BPD patients.

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For people with mental illness, internalized stigma, also referred to as self-stigma, is characterized by a subjective perception of devaluation, marginalization, secrecy, shame, and withdrawal. It has many adverse effects on individual’s psychological well-being and clinical outcomes. The iatrogenic effects it has during psychotherapeutic treatment can significantly reduce utilization of mental health care services, reduce quality of life and increase avoidant coping. Overall, internalized stigma is considered a risk factor for poorer mental health prognosis. Although some interventions have recently been developed to specifically intervene on this target as part of psychological recovery goals over the course of treatment, most clinicians are not yet aware or empowered to correctly address this.

Description of a clinical case illustrating the relevance on addressing internalized mental illness related stigma during the recovery process.

Clinical case report and review of the literature on the subject.

We present the case of a 47-year-old female patient, C.S., single, graduated in social work (currently unemployed), who was admitted at the Psychiatry Day Hospital, where she was referred by her Psychiatry Assistant because of abulia, social withdrawal and isolation, depressed mood, thoughts of shame, guilt and self-devaluation and work incapacity. She had been admitted in the Psychiatry ward one year earlier for a first psychotic breakthrough, presenting persecutory and grandiose delusions and auditory hallucinations. After three weeks of inpatient treatment with antipsychotics, a full remission of the symptoms was achieved, without any posterior relapse. Before that first psychotic episode, the patient had been taking anti-depressive medication (escitalopram 20 mg id) for many years, prescribed by her General Practitioner, for mild to moderate depressive symptoms. After being discharged from the Psychiatry ward, C. kept following an outpatient treatment with anti-depressives and behavioural activation-based psychotherapy. She started to believe she was mentally ill and therefore weak, uncapable, and less deserving than her peers or her previous self. These self-stigmatizing ideas were enhanced by the lack of family support and the beliefs that were fostered by her mother, with whom she started to live after the hospitalization. These factors led to a dysfunctional internalization of an illness behaviour, jeopardizing the patient’s ability to reach full recovery.

This case reinforces the importance of targeting mental illness related stigma during the recovery process. Also, involving the family is of extreme importance to achieve support and address shared beliefs and the interchange between social and internalized stigma.

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Obsessive–Compulsive Disorder (OCD) is a disabling and chronic illness defined by the presence of obsessions and/or compulsions. Recently it has been proposed that the perinatal period may act as a trigger in this disorder, leading to its onset or exacerbation.

Variations in pregnancy-related hormones are believed to be one of the main etiological theories for the development of perinatal OCD (pOCD). Perhaps for that reason research has been almost exclusively focused on the development of this disorder in mothers. We aim to investigate pOCD in fathers.

A non-systematic review was conducted via electronic searches of PubMed. The keywords used were “Perinatal”, “Father”, “OCD”, “Obsessive-compulsive disorder”.

Unwanted intrusive thoughts are experienced with a similar prevalence in mothers and fathers. The same seems to be true regarding compulsions. However, it does appear that mothers are more distressed by these symptoms, which tend to be baby-related, usually concerning themes of suffocation, accidents or contamination. It is hypothesized that this seemingly different impact is related to the fact that mothers are more often the primary caregivers than fathers, thus feeling more distress because they are imbued with a greater responsibility. Accordingly, pOCD symptoms tend to be more severe in fathers who consider their baby-related obsessions meaningful, often confusing them as a desire to carry out such thoughts. These findings are consistent with the Cognitive-Behavioral Theory of OCD, highlighting that purely biological theories for the development of pOCD might not suffice.

Research indicates a similar presence of OCD symptoms in postnatal mothers and fathers, although it seems that mothers may experience more distress. Underlying dysfunctional beliefs seem to be responsible for the negative appraisal of these symptoms, predicting the development of the disorder in question. Further research of pOCD should seek to better characterize the onset or exacerbation of this disorder in fathers.

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Transcranial Magnetic Stimulation (TMS) is a non-invasive neuromodulation tool with a growing body of clinical evidence demonstrating positive outcomes in patients with treatment-resistant depression (TRD) as sole or adjuvant therapy. Theta-burst stimulation (TBS), specifically intermittent TBS (iTBS), uses short intermittent pulse trains to cut each session’s duration to 10% of the original repetitive TMS protocol sessions, making it a more appealing option given that it shows similar efficacy. Nevertheless, the number of sessions required remains the same, with a single protocol lasting around 4 to 6 weeks, or longer. However, a new protocol has very recently been approved by the FDA for application in TRD, called the SAINT (Stanford Intelligent Accelerated Neuromodulation Therapy), which reduces treatment duration to 5 days.

To ascertain what evidence supports the SAINT protocol and its efficacy by reviewing available published literature.

A PubMed database search was performed and the main findings of selected studies were summarized.

Three articles were found, which consisted of clinical trials with small study samples of TRD patients. One study found a 90% remission rate after the aforementioned 5-day treatment regimen, with another reporting a 79% response rate after a double-blinded trial. All studies reported no difference in tolerability compared with regular iTBS protocols.

The SAINT protocol shows promising preliminary results, with efficacy, tolerability and safety of use comparable with that of TMS protocols already in use. The reduction in treatment duration that this intensive option is based on is a significant improvement for applicability in clinical practice, which might increase patient compliance and offer quicker results. Further studies are required to evaluate whether the remission rates are maintained in the long term.

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Many conservation initiatives call for ‘transformative change’ to counter biodiversity loss, climate change, and injustice. The term connotes fundamental, broad, and durable changes to human relationships with nature. However, if oversimplified or overcomplicated, or not focused enough on power and the political action necessary for change, associated initiatives can perpetuate or exacerbate existing crises. This article aims to help practitioners deliberately catalyze and steer transformation processes. It provides a theoretically and practically grounded definition of ‘transformative conservation’, along with six strategic, interlocking recommendations. These cover systems pedagogy, political mobilization, inner transformation, as well as planning, action, and continual adjustment.

Calls for ‘transformative change’ point to the fundamental reorganization necessary for global conservation initiatives to stem ecological catastrophe. However, the concept risks being oversimplified or overcomplicated, and focusing too little on power and the political action necessary for change. Accordingly, its intersection with contemporary biodiversity and climate change mitigation initiatives needs explicit deliberation and clarification. This article advances the praxis of ‘transformative conservation’ as both (1) a desired process that rethinks the relationships between individuals, society, and nature, and restructures systems accordingly, and (2) a desired outcome that conserves biodiversity while justly transitioning to net zero emission economies and securing the sustainable and regenerative use of natural resources. It first reviews criticisms of area-based conservation targets, natural climate solutions, and nature-based solutions that are framed as transformative, including issues of ecological integrity, livelihoods, gender, equity, growth, power, participation, knowledge, and governance. It then substantiates six strategic recommendations designed to help practitioners deliberately steer transformation processes. These include taking a systems approach; partnering with political movements to achieve equitable and just transformation; linking societal with personal (‘inner’) transformation; updating how we plan; facilitating shifts from diagnosis and planning to action; and improving our ability to adjust to transformation as it occurs.

Curious about stemming the global biodiversity and climate crises? Browse this article on transformative conservation!

This study aimed to examine factors that may have contributed to community disaster resilience following Hurricane Maria in Puerto Rico.

In April 2018, qualitative interviews (n = 22) were conducted with stakeholders in 7 Puerto Rican municipalities (9% of total). Transcripts were deductively and inductively coded and analyzed to identify salient topics and themes, then examined according to strategic themes from the Federal Emergency Management Association’s (FEMA) Whole Community Approach.

Municipal preparedness efforts were coordinated, community-based, leveraged community assets, and prioritized vulnerable populations. Strategies included (1) multi-sectoral coordination and strategic personnel allocation; (2) neighborhood leader designation as support contacts; (3) leveraging of community leader expertise and social networks to protect vulnerable residents; (4) Censuses of at-risk groups, health professionals, and first responders; and (5) outreach for risk communication and locally tailored protective measures. In the context of collapsed telecommunications, communities implemented post-disaster strategies to facilitate communication with the Puerto Rican Government, between local first responders, and to keep residents informed, including the use of: (1) police radios; (2) vehicles with loudspeakers; (3) direct interpersonal communication; and (4) solar-powered Internet radio stations.

Adaptive capacities and actions of Puerto Rican communities exemplify the importance of local solutions in disasters. Expanded research is recommended to better understand contributors to disaster resilience.

The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries.

Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents.

3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2–4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness.

ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.

COVID-19 pandemic and the consequent containment measures have a negative impact on mental health. Simultaneously, the fear of infection can discourage patients from seeking necessary care.

We aim to compare sociodemographic and clinical characteristics of inpatients admitted during the COVID-19 confinement period in Portugal vs. inpatients admitted in the same period the previous year.

Retrospective observational study of inpatients admitted between March 19th 2020 and May 1st 2020 and the analog period of 2019 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.

During the lockdown period, there were 30 admissions to the psychiatry inpatient unit, 55.2% less than the same period last year (n=67). The proportion of compulsory admissions and the average length of stay did not differ between the two periods. Regarding sociodemographic characteristics, in the confinement period inpatients were similar to the ones in the same period of 2019. In both periods, the majority of patients had previous psychiatric history (lockdown vs. same period last year: 95.5% and 90.0%) and a similar proportion of readmissions rate (previous year) was similar in the two groups (49.9% vs 47.6%). At discharge, the most frequent diagnostic groups were mood disorders (33.3% (n=10) and 34.3% (n=23)) and schizophrenia, schizotypal and delusional disorders (26,7% (n=8) and 31.3% (n=21)).

Although there was an expressive reduction of admissions to the psychiatry inpatient unit during lockdown, the clinical characteristics of these patients were analogous to the same period in the previous year.