Search

Objective: Methods of cognitive measurements in multiple sclerosis (MS) are not standardized. We aimed to identify the prevalence of cognitive domain‐specific impairment (DSI) in MS by using subtests of the Brief Repeatable Battery of Neuropsychological Tests (BRB‐N) with analyzing different cutoff values. Methods: The systematic review and meta‐analysis were registered on PROSPERO (ID: CRD42021287004). The systematic literature search was performed via PubMed, Embase, and CENTRAL on 24 October 2021. Inclusion criteria were adults of different MS subtypes (CIS, RRMS, PPMS, and SPMS) with the condition of distinct DSI measured by BRB‐N. Pediatric MS, computerized versions of BRB‐N, and patients receiving steroids were excluded. Primary outcome was pooled prevalence rates of impaired patients within each cutoff and MS subtype, with 95% confidence interval, I‐squared statistics for heterogeneity, and chi‐squared test for subgroup differences. Risk of bias was assessed using the "JBI Quality Assessment Tool for Prevalence Studies." Results: In 48 eligible observational studies (n = 3431 patients), the three most prevalent thresholds were the 2.0 SD and 1.5 SD below the mean of normative values, and the score below the fifth percentile of the normative values. A progressively increasing worsening of the overall DSI was observed from CIS, moving toward RRMS, PPMS, and SPMS. Interpretation: Cognitive impairment is observed in all MS phenotypes, with varying degrees. Due to several potential influencing factors, our comprehensive literature review has not revealed consistent findings, and we, therefore, recommend considering a more sophisticated, "individual referencing" approach, acknowledging the diverse clinical and sociodemographic characteristics among populations and disparities in cognitive testing. [ABSTRACT FROM AUTHOR]

The Balint group, a time‐tested and efficacious resource for fortifying resilience among helping professionals, is explored in depth in this article through a case vignette. Despite its demonstrated efficacy in assisting professionals handling challenging cases, the Balint method's adoption remains inexplicably limited. We hypothesize that this restraint is due to a deficient understanding of the method's mechanics, operational processes and outcomes. In response, we offer a contemporary interpretation anchored in the theoretical framework of mentalization, aligning with current psychotherapeutic standards. The article underscores the Balint group's remarkable utility, akin to other mentalization‐based therapeutic methods, in navigating intricate cases, emotionally demanding situations and circumstances that exceed the expertise and experience of the professional. By highlighting this, we hope to broaden the acceptance of the method, enable systematic assessment of its effectiveness and augment training for group leaders and participant commitment. This endeavour represents both a nod to the research‐centric approach originally espoused by Mihály Bálint and an embrace of the growing emphasis on evidence‐based methodology in medicine and psychotherapy. Ultimately, we aim to illuminate the potential of the Balint group and promote its extensive application in support of helping professionals. [ABSTRACT FROM AUTHOR]

Background: Mood instability and risk-taking are hallmarks of borderline personality disorder (BPD). Schema modes are combinations of self-reflective evaluations, negative emotional states, and destructive coping strategies common in BPD. When activated, they can push patients with BPD into emotional turmoil and a dissociative state of mind. Our knowledge of the underlying neurocognitive mechanisms driving these changes is incomplete. We hypothesized that in patients with BPD, affective instability is more influenced by reward expectation, outcomes, and reward prediction errors (RPEs) during risky decision-making than in healthy controls. Additionally, we expected that these alterations would be related to schema modes. Methods: Thirty-two patients with BPD and thirty-one healthy controls were recruited. We used an established behavioral paradigm to measure mood fluctuations during risky decision-making. The impact of expectations and RPEs on momentary mood was quantified by a computational model, and its parameters were estimated with hierarchical Bayesian analysis. Model parameters were compared using High-Density Intervals. Results: We found that model parameters capturing the influence of RPE and Certain Rewards on mood were significantly higher in patients with BPD than in controls. These model parameters correlated significantly with schema modes, but not with depression severity. Conclusions: BPD is coupled with altered associations between mood fluctuation and reward processing under uncertainty. Our findings seem to be BPD-specific, as they stand in contrast with the correlates of depressive symptoms. Future studies should establish the clinical utility of these alterations, such as predicting or assessing therapeutic response in BPD. [ABSTRACT FROM AUTHOR]