For decades, clinicians and researchers have recognized that borderline personality disorder (BPD) and substance use disorders (SUDs) are often diagnosed within the same person (e.g., (Gunderson JG. Borderline personality disorder: A clinical guide. Washington, D.C.: American Psychiatric Press, 2001; Leichsenring et al., Lancet 377:74-84, 2011; Paris J. Borderline personality disorder: A multidimensional approach. American Psychiatric Pub, 1994; Trull et al., Clin Psychol Rev 20:235-53, 2000)). Previously, we documented the extent of this co-occurrence and offered a number of methodological and theoretical explanations for the co-occurrence (Trull et al., Clin Psychol Rev 20:235-53, 2000). Here, we provide an updated review of the literature on the co-occurrence between borderline personality disorder (BPD) and substance use disorders (SUDs) from 70 studies published from 2000 to 2017, and we compare the co-occurrence of these disorders to that documented by a previous review of 36 studies over 15 years ago (Trull et al., Clin Psychol Rev 20:235-53, 2000).

No abstract

Study Objectives More than half of young adults at risk for alcohol-related harm report symptoms of insomnia. Insomnia symptoms, in turn, have been associated with alcohol-related problems. Yet one of the first-line treatments for insomnia (Cognitive Behavioral Therapy for Insomnia, or CBT-I) has not been tested among individuals who are actively drinking. This study tested (a) the feasibility and short-term efficacy of CBT-I among binge-drinking young adults with insomnia and (b) improvement in insomnia as a predictor of improvement in alcohol use outcomes Methods Young adults (ages 18-30y, 75% female, 73% college students) who met criteria for Insomnia Disorder and reported 1+ binge drinking episode (4/5+ drinks for women/men) in the past month were randomly assigned to five weekly sessions of CBT-I (n=28) or single-session sleep hygiene (n=28). All participants wore wrist actigraphy and completed daily sleep surveys for 7+ days at baseline, post-treatment, and one-month follow-up Results Of those randomized, 43 (77%) completed post-treatment (19 CBT-I, 24 sleep hygiene) and 48 (86%) completed 1-month follow-up (23 CBT-I, 25 sleep hygiene). CBT-I participants reported greater post-treatment decreases in insomnia severity than those in sleep hygiene (56% vs 32% reduction in symptoms). CBT-I did not have a direct effect on alcohol use outcomes; however, mediation models indicated that CBT-I influenced change in alcohol-related consequences indirectly through its influence on post-treatment insomnia severity Conclusion CBT-I is a viable intervention among individuals who are actively drinking. Research examining improvement in insomnia as a mechanism for improvement in alcohol-related consequences is warranted

We compared the diagnostic efficiency of the Child Behavior Checklist (CBCL) Thought Problems subscale and the rationally derived DSM-oriented psychotic symptoms scale (DOPSS) to identify clinically concerning psychosis in a multi-site sample of youths seeking outpatient mental health services (N = 694). We operationally defined clinically concerning psychosis as the presence of clinically significant hallucinations or delusions, assessed by the Schedule for Affective Disorders and Schizophrenia psychosis items. Both the Thought Problems and DOPSS scores showed significant areas under the curve (AUCs = 0.65 and 0.70, respectively), but the briefer DOPSS showed statistically significantly better diagnostic efficiency for any clinically concerning psychosis, but the difference was small enough that it would not be clinically meaningful. The optimal psychosis screening cut-off score (maximizing sensitivity and specificity) was 68.5+ [corresponding diagnostic likelihood ratio (DiLR) = 1.59] for the Thought Problems subscale and 1.67+ (DiLR = 1.97) for the DOPSS. Both the CBCL Thought Problems and DOPSS are clinically useful for identifying psychotic symptoms in children, and although the DOPSS showed statistically better discriminating power, the difference was small so we would not necessarily recommend the DOPSS over standard scoring.

No abstract