Treatment Of Borderline Personality Disorder Research Articles

Clinical Pearls: Good Psychiatric Management for Borderline Personality Disorder and Transference-Focused Psychotherapy.

Good psychiatric management (GPM) for borderline personality disorder is a generalist strategic case management approach used by helping professionals of different training backgrounds to work with patients with borderline personality disorder. GPM includes a flexibly administered once-weekly psychotherapy for which a brief introductory course in GPM alone is considered sufficient preparation. GPM integrates concepts from specialized evidence-based treatments for borderline personality disorder, including transference-focused psychotherapy (TFP). This article describes the TFP elements that John Gunderson acknowledged as influential to his development of GPM. A basic introduction to TFP is provided, and elements in GPM that interweave with TFP's theoretical foundation are elucidated and then illustrated in a clinical vignette that captures the GPM clinician's interventions influenced by these ideas. The vignette is then used to illustrate clinical tools informed by TFP principles and common to both GPM and TFP.

How to Mitigate Risk in the Treatment of Patients with Borderline Personality Disorder.

Clinicians treating patients with borderline personality disorder (BPD) experience concerns about risk for adverse events that can lead to litigation or complaints to administrative boards. This paper's goal is to outline steps to ensure the safety of both the patient and clinician. Review of available data confirms that psychiatry is a subspeciality with relatively low risk for malpractice litigation, but high risk for complaints to administrative agencies. Examination of litigation and complaints suggests that familiar challenges in work with patients with BPD are frequently cited. Risk management considerations have been impacted in recent years by changes in psychiatric training, health care delivery, and regulations about patient information transparency. Concurrently, empirically validated treatments for BPD have been refined and disseminated. Clinicians can address safety concerns by adapting established risk management guidance with an appreciation of key elements of BPD.

Le « Good Psychiatric Management-Adolescents » (GPM-A) : un modèle généraliste et accessible de traitement du trouble de la personnalité borderline chez l’adolescent

The Good Psychiatric Management for Adolescents (GPM-A) is a generalist model of structured care for adolescents with borderline personality disorder. It is based on principles derived from several psychotherapies validated in the treatment of borderline personality disorder and on current good practice data. Borderline personality disorder is conceptualised as the result of a particular sensitivity to relationships (defined with the term interpersonal hypersensitivity). The GPM-A offers clinicians a pragmatic approach based on good practice in the care of adolescents with borderline personality disorder. Developed in the United States, it is currently being disseminated in the French-speaking world. This article provides a summary of the main components of the model and a discussion of the benefits expected from its implementation among French-speaking clinicians.

Gender differences in treatment effectiveness for borderline personality disorder.

Borderline personality disorder (BPD) is a psychological disorder that is diagnosed predominantly in females yet is equally as prevalent in males. Many empirical research studies on the treatment of BPD have been conducted with only female participants. We aimed to investigate the impact of current treatments for BPD on men compared to women. Using data from a larger ongoing longitudinal study, we matched 48 males with 48 females in treatment on age, overall functioning and psychological distress at intake and then accessed their progress in treatment after 12 months. Controlling for the initial scores at baseline, analysis of covariance (ANCOVA) analysis found significant differences in outcome measures at 12-months follow-up. Females had significantly greater improvements in BPD severity and greater improvements in internalizing symptoms such as chronic feelings of emptiness. Females also reported significantly greater satisfaction and ratings of health at follow-up. These findings suggest that current treatment as usual for BPD could be more effective for women compared to men. Results from the study highlight the need for future studies to investigate the experience of males in current BPD treatment and to identify potential areas for modification to better cater to this population.

A randomised study and an extension study of brexpiprazole in patients with borderline personality disorder.

No drugs are currently approved for the treatment of borderline personality disorder (BPD). These studies (a randomised study and its open-label extension) aimed to evaluate the efficacy, safety and tolerability of brexpiprazole for the treatment of BPD. The Phase 2, multicentre, randomised, double-blind, placebo-controlled, parallel-group study enrolled adult outpatients with BPD. After a 1-week placebo run-in, patients were randomised 1:1 to brexpiprazole 2-3 mg/day (flexible dose) or placebo for 11 weeks. The primary endpoint was change in Zanarini Rating Scale for BPD total score from randomisation (Week 1) to Week 10 (timing of randomisation and endpoint blinded to investigators and patients). The Phase 2/3, multicentre, open-label extension study enrolled patients who completed the randomised study; all patients received brexpiprazole 2-3 mg/day (flexible dose) for 12 weeks. Safety assessments included treatment-emergent adverse events (TEAEs). Brexpiprazole was not statistically significantly different from placebo on the primary endpoint of the randomised study (N = 324 randomised; N = 110 analysed per treatment group; least squares mean difference -1.02; 95% confidence limits -2.75, 0.70; p = 0.24). Numerical efficacy advantages for brexpiprazole were observed at other time points. The most common TEAE in the randomised study was akathisia (brexpiprazole, 14.0%; placebo, 1.2%); data from the open-label study (N = 199 analysed) suggested that TEAEs were transient. The primary endpoint of the randomised study was not met. Further research on brexpiprazole in BPD is warranted based on possible efficacy signals at other time points and its safety profile.ClinicalTrials.gov identifiers: NCT04100096, NCT04186403. Funding: Otsuka, Lundbeck.

Prefrontal cortex engagement during an fMRI task of emotion regulation as a potential predictor of treatment response in borderline personality disorder.

Borderline personality disorder (BPD) is a severe mental illness, with high rates of co-morbid depression and suicidality. Despite the importance of optimizing treatment in BPD, little is known about how neural processes relate to individual treatment response. This study examines how baseline regional brain blood oxygen level dependent (BOLD) activation during a functional magnetic resonance imaging (fMRI) task of emotion regulation is related to treatment response following a six-month randomized clinical trial of Dialectical Behavior Therapy (DBT) or Selective Serotonin Reuptake Inhibitor (SSRI) treatment. Unmedicated females with BPD (N = 37), with recent suicidal behavior or self-injury, underwent an fMRI task in which negative personal memories were presented and they were asked to distance (i.e., downregulate their emotional response) or immerse (i.e., experience emotions freely). Patients were then randomized to DBT (N = 16) or SSRI (N = 21) treatment, with baseline and post-treatment depression and BPD severity assessed. BOLD activity in prefrontal cortex, anterior cingulate, and insula was associated with distancing. Baseline BOLD during distancing in dorsolateral, ventrolateral, and orbital prefrontal cortex (dlPFC, vlPFC, OFC) differentially predicted depression response across treatment groups, with higher activity predicting better response in the SSRI group, and lower activity predicting better response in the DBT group. All female samples. Findings indicate that greater prefrontal engagement during emotion regulation may predict more antidepressant benefit from SSRIs, whereas lower engagement may predict better response to DBT. These results suggest different mechanisms of action for SSRI and DBT treatment, and this may allow fMRI to guide individualized treatment selection.

Physical Activity in young female outpatients with BORderline personality Disorder (PABORD): a study protocol for a randomized controlled trial (RCT)

BackgroundCurrent treatments for mental disorders, like pharmacotherapy or psychological approaches, do not lead to full remission in all individuals. Physical activity (PA) is effective at improving psycho-physical health in major depressive and anxiety disorders. However, the efficacy of PA as an adjunctive treatment for borderline personality disorder (BPD) has not been studied. To date, there are no approved pharmacological treatments for this severe condition and limited accessibility to effective psychotherapeutic interventions. This study tests the efficacy of a structured PA programme as an additional treatment for BPD outpatients.MethodsThe PABORD is a randomised controlled trial for female outpatients (18–40 years) with a BPD diagnosis. The intervention group (n = 32) will participate in a 12-week structured PA programme supervised by a sport medicine physician and preceded by three psychoeducation sessions on healthy eating habits. The control group (n = 32) will receive a 12-week psychoeducation programme on PA, diet, and health risks of a sedentary lifestyle for a total of 8 sessions. The study aims to determine if the PA intervention is superior to the control in reducing BPD symptoms. Secondary aims include improving PA levels and physical and psychological health. Assessments will be conducted at baseline, post-intervention, and 3 months post-intervention.DiscussionThe structured PA programme is expected to outperform the control group in terms of health and PA outcomes at the end of the intervention. Repeated assessments will also help to identify psychosocial factors that influence PA maintenance. Findings will support the potential widespread implementation of PA programmes for BPD treatment.Trial registrationClinicalTrials.gov NCT06461104. Registered on 6 June 2024 {2a}.

Change in emotion-based narrative as a potential mechanism of change in a brief treatment for borderline personality disorder

Background: The move from inconsistent and problematic autobiographical narrative to a more coherent and reality-based narrative construction of the Self has been discussed as potential mechanism of change in psychotherapies for personality disorders. So far, little empirical evidence exists that demonstrates in a time-dependent design the role of narrative construction in the treatment of borderline personality disorder, in particular when it comes to understanding the integration of body-related information from the affective system with the autobiographical narrative. The present study aims at demonstrating change in emotion-based narrative markers over brief psychiatric treatment and to assess the impact of these changes on subsequent symptom change. Methods: A total of N = 57 clients with borderline personality disorder were assessed at three timepoint over the course of four months of brief psychiatric treatment, within the context of a secondary process-outcome analysis of a randomized controlled trial. Symptom change was assessed using the OQ-45.2 and emotion-narrative change was assessed using the Narrative-Emotion Process Coding System to code client’s in-session speech in terms of problem, transition and change markers. Results: All three emotion-based marker categories evidenced significant changes in the assumed direction. The reduction in problem emotion-based narrative markers (e.g., empty story telling) between session 1 and 5 into the treatment predicted the symptom reduction assessed between session 5 and 10. Conclusions: Emotion-based narrative construction may be a suitable method to study the pathway of change toward a more coherent and reality-based narrative construction of the Self-in-interaction-with-the-Other. Reduction of emotion-based problem-marker may be a promising candidate for a mechanism of change in treatments for personality disorders which should be tested in a time-dependent controlled design.

A Novel Approach to Examining Working Alliance Instability During Psychotherapy for Borderline Personality Disorder.

This study aimed to quantify the instability of psychotherapy process variables by using a novel data-analytic approach. The study explored instability of the working alliance over 10 treatment sessions and its relationship with self-esteem. Data were extracted from a randomized controlled trial, conducted in Switzerland, of a short-term intervention for borderline personality disorder. Sixty clients diagnosed as having borderline personality disorder were randomly assigned to receive either 10 sessions of good psychiatric management-brief version (GPM-BV) or GPM-BV combined with a relational principle called motive-oriented therapeutic relationship. Square successive differences were calculated for client and therapist ratings of alliance instability. Multilevel models were used to test within- and between-person associations of alliance instability with self-esteem. Although some preliminary analyses showed an association between a more stable alliance and higher self-esteem at the start of psychotherapy, the alliance did not become more stable over time. Alliance instability was not associated with self-esteem at either the within- or between-person level. This study highlights the advantages, procedures, and challenges of applying square successive differences to psychotherapy research data. The results suggest that the working alliance develops in complex ways and indicate the importance of continuing to use novel methods to capture dynamic psychotherapy processes.

The complexity of interpersonal physiology during rupture and repair episodes in the treatment of borderline personality disorder: a proof-of-concept multimethod single case study of verbal and non-verbal interactional dynamics.

The aim of this proof-of-concept multimethod exploratory single case study is to increase knowledge of the underlying mechanisms of alliance ruptures and repairs in Borderline Personality Disorder treatment across and within the psychotherapeutic treatment process. The multimethod includes outcome assessment of patient self-reporting questionnaires (the Affect Integration Inventory, the Hopkins Symptom Checklist), observation-based ratings of sessions with the Rupture Resolution Rating System, quantitative analysis of heart rate variability using recurrence quantification analysis, and a qualitative multimodal interaction analysis of within-session dynamics. Results reveal how patterns of heart rate synchrony between patient and therapist reflect periodical patterns of emotional interaction corresponding to key therapeutic alliance processes throughout the treatment process. Particularly, heart rate synchronization and desynchronization correspond with increasing rupture resolution ratings and positive outcome measures in the last part of the therapy process, indicating increased productivity, affectivity, and positive change. The qualitative microanalysis highlights context sensitivity to alliance management within sessions. Physiological arousal is found to underlie important alliance processes, including emotion regulation, relatedness, security, empathic responding, sense-making, and validation in correspondence with different therapist verbal and non-verbal markerbs. Clinical implications and study limitations are discussed. Recommendations are made for future directions in relation to applying multimethod approaches when studying rupture and repair processes in psychotherapy.

The family alliance as a facilitator of therapeutic change in systemic relational psychotherapy for borderline personality disorder: A case study.

Managing the Therapeutic Alliance is often complex when it comes to the treatment of borderline personality disorder (BPD), but the alliance is crucial for the success of the therapy. Combined individual and family interventions have been shown to be very useful in treating of these cases. This study has two objectives. First, to describe how the family therapeutic alliance facilitates therapeutic change through family psychotherapy for families with a member diagnosed with BPD. Second, to analyze how the therapeutic change achieved through combined individual and family systemic relational psychotherapy affects the individual functioning of the patient with BPD. This single case study used the System of Observation of Family Therapy Alliances (SOFTA-o) to analyze the therapeutic alliance, along with two semi-structured clinical interviews, one at the beginning and one at the end of therapy. Results show a dynamic and positive evolution of the therapeutic alliance throughout the therapeutic process and how this alliance facilitated therapeutic change, both reducing the symptomatology of the patient with BPD and improving family communication and functioning. Results contribute to highlighting the importance of including family therapy as an intervention unit in protocols for patients with BPD.

Therapeutic alliance rupture and resolution in a brief psychiatric treatment for borderline personality disorder

AbstractBackgroundThe focus of this case study was to explore the development of the therapeutic alliance in relation to alliance rupture and resolution and the effect of motive‐focussed psychotherapeutic techniques on this process in the treatment of borderline personality disorder (BPD).MethodsTherapeutic alliance rupture and resolution processes were analysed in relation to outcomes over the course of a 10 week, short‐term generalist psychiatric treatment for BPD in two patients, hereby referred to as Clara and Rebecca. Clara received treatment in the form of good psychiatric management (GPM) with the addition of motive‐oriented therapeutic relationship (MOTR) techniques. Rebecca received treatment in the form of GPM.ResultsBoth patients experienced a clinically significant reduction in symptoms. Ruptures and resolution processes occurred at low frequencies in Clara's treatment, while ruptures and resolution processes were numerous in Rebecca's treatment. The focus in Clara's treatment was on rupture prevention because of the added presence of MOTR techniques, while the focus in Rebecca's treatment was on rupture identification and resolution.DiscussionResults support the hypothesis that symptom reduction was achieved through two distinct pathways of change as a function of the treatment condition, which suggests the potential presence of multiple effective psychotherapeutic techniques for alliance development. Limitations of this study and clinical implications for the treatment of BPD in psychotherapy, with a special focus on the therapeutic alliance, are discussed.

Exploring Margaret Mahler's Theory: Applications in Borderline Personality Disorder Treatment within Psychiatric Wards.

This article delves into fundamental themes within Margaret Mahler's separation-individuation theory, placing particular emphasis on the rapprochement phase. It illustrates how these themes are crucial for comprehending and effectively managing inpatients grappling with borderline personality disorder. Mahler's conceptual framework offers valuable insights for caregivers and staff, equipping them to navigate the clinical and emotional complexities inherent in the treatment of this distinct patient population during their stay in psychiatric wards.

A General Review of Borderline Personality Disorder

Borderline Personality Disorder (BPD) is a pervasive psychological personality disorder that features affective instability, interpersonal dysfunction, and distorted self-concept, often leading to significant psychological distress and impaired functioning. This literature review synthesizes current research on the epidemiology, diagnosis controversies, symptomatology, etiology, and treatment of BPD. Notable findings indicate a high prevalence of BPD, with diagnostic challenges due to symptom overlap with other mental disorders. Etiologically, studies underlined the detrimental impact of childhood trauma and adverse family dynamics. Treatment modalities like Dialectical Behavior Therapy (DBT), Mentalization-Based Treatment (MBT), and Transference-Focused Psychotherapy (TFP) show efficacy in managing symptoms and improving function. This review highlights the complexity of BPD and the need for tailored therapeutic approaches to effectively address the multifaceted nature of the disorder.

Morita Therapy: Potential Treatment for Borderline Personality Disorder

Borderline personality disorder (BPD) is a cluster-B personality disorder known for its complexity and difficulty to cure, and was once considered untreatable. At present, the mainstream treatment is represented by dialectical behavior therapy (DBT), but there are problems such as the shortage of therapists and the high cost of training. In order to increase the therapeutic possibility of BPD, it is necessary to find a new treatment method. Morita Therapy originated in Japan and is based on eastern philosophy and Buddhism, emphasizing the oneness of man and nature. Due to the lack of clinical data on the direct application of Morita therapy to BPD and the lack of related studies, a definite conclusion cannot be drawn. But the concept and core features of Morita therapy are compatible with the core symptoms of BPD, and the potential efficacy of Morita therapy in the treatment of BPD and the potential as adjuvant therapy are possible. This study explores the potential efficacy of Morita therapy on BPD, and provides a new direction and idea for the research and practice of BPD psychotherapy.

The Therapeutic Role of Lamotrigine in Borderline Personality Disorder: A Comprehensive Review of Outcomes, Mechanisms, and Treatment Strategies.

Borderline personality disorder (BPD) is a severe mental health condition characterized by pervasive instability in mood, self-image, and interpersonal relationships, significantly impacting individuals' personal, social, and occupational functioning. Current treatment strategies primarily include psychotherapy and pharmacotherapy, but there remains a need for more effective and targeted pharmacological options. This review examines the therapeutic role of lamotrigine in BPD, focusing on its efficacy, safety, mechanisms of action,and practical treatment strategies. A comprehensive review of the existing literature was conducted, including clinical trials, observational studies, and relevant pharmacological data. Key focus areas included lamotrigine's impact on BPD symptoms, pharmacological profile, and comparative effectiveness with other treatments. Lamotrigine has shown promise in managing BPD symptoms, particularly in stabilizing mood and reducing emotional dysregulation and impulsivity. Clinical trials suggest that lamotrigine can effectively address core symptoms of BPD, with a safety profile generally comparable to other treatments. The medication's mechanism of action, which involves modulation of glutamate release and mood stabilization, aligns with the therapeutic goals for BPD. Lamotrigine represents a potential adjunctive treatment for BPD, offering benefits in mood stabilization and symptom management. Integrating psychotherapy and other pharmacological options should be considered within a multimodal treatment approach. Further research is needed to better understand its long-term efficacy and safety and its role in combination therapy.

Different routes to the same destination? Comparing Diagnostic and Statistical Manual of Mental Disorders, fifth edition Section II- and alternative model of personality disorder-defined borderline personality disorder.

Borderline personality disorder (BPD) is defined by the presence of at least five of nine symptoms in Section II of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition. In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, Section III Alternative Model of Personality Disorders (AMPD), BPD is defined by deficits in self and/or interpersonal functioning (Criterion A), elevated negative affectivity, and elevated antagonism and/or disinhibition (Criterion B). However, it is unclear if these definitions describe the same people and if the AMPD criteria explain unique variability in treatment outcomes in this population. In a treatment-seeking sample of adult participants diagnosed with BPD according to Section II criteria (n = 65, Mage = 27.60, 70.8% female, 76.9% White), we found a majority (66.2%) would have also received the diagnosis based on AMPD criteria. Those meeting AMPD criteria reported more severe Section II BPD symptoms than those who did not, ps < .02, ds > 0.60, and the presence or severity of Section II fears of abandonment and inappropriate anger uniquely predicted AMPD BPD diagnoses, ps < .03, ORs ≥ 2.31. Changes in AMPD dimensions explained 34% of the variability in change in work/social adjustment (p = .13) and quality of life (p = .22), respectively, over and above changes in Section II symptoms during a novel cognitive-behavioral treatment for BPD. These results suggest that AMPD criteria capture a more severe subset of BPD than Section II criteria and may be important predictors of treatment outcomes. We discuss the potential trade-offs of this shift in diagnosis. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The interplay between borderline personality disorder and oxytocin: a systematic narrative review on possible contribution and treatment options.

Borderline personality disorder (BPD) is a complex mental health condition marked by instability in mood, relationships, self-image, and behavior. Individuals with BPD often struggle with intense emotions, impulsivity, and maintaining stable relationships. Oxytocin, known as the "love hormone" or "bonding hormone," plays a crucial role in social bonding, trust, empathy, and emotional regulation and its dysregulation may contribute to BPD difficulties. This systematic review aims to analyze existing literature, examining the intricate interplay and encouraging future research and treatment strategies. A systematic search of Literature in PubMed, Embase and Psychinfo, without any language or time restriction, was performed until March 2024 combining thesaurus and free-search indexing terms related to "borderline personality disorder" and "oxytocin", producing 310 results (77 in PubMed, 166 in Embase and 67 in Psychinfo). Ninety-four full texts were analyzed, and 70 articles were included in qualitative analysis. Oxytocin may influence attachment styles, parental behaviors, and stress responses, particularly in individuals with a history of childhood trauma. The interaction between oxytocin, genetics, early life experiences, and environmental factors contributes to the complexity of BPD. Genetic variations in the oxytocin receptor gene may influence social and emotional abilities and contribute to the development of psychopathology. Additionally, early adverse experiences, such as childhood maltreatment, can alter oxytocin functioning, impacting social cognition and emotional regulation.However, oxytocin's role in BPD treatment remains uncertain, with some studies suggesting potential benefits for specific symptoms like social threat avoidance, while others indicate adverse effects on nonverbal behavior and mentalizing. Understanding oxytocin's role in BPD offers insights into potential therapeutic interventions. While oxytocin-based treatments may hold promise for addressing specific symptoms, further research is needed.

Comorbidity of bipolar disorder and borderline personality disorder: Phenomenology, course, and treatment considerations.

Bipolar disorder (BD) and borderline personality disorder (BPD) are both serious psychiatric conditions that elevate the risk for harmful outcomes. Although these conditions represent distinct diagnostic entities, existing research suggests that approximately 20% of individuals with BD meet the criteria for comorbid BPD. Individuals with comorbid BD/BPD appear to have a markedly more severe and phenomenologically distinct clinical course when compared with those with BD alone. However, treatments have generally not been tested in this specific population, and currently, no formal treatment guidelines exist for this subgroup of patients. In the current paper, we review the epidemiological and descriptive research characterizing those with comorbid BD/BPD and discuss the impact of this comorbidity on psychosocial treatment. We also review current findings on evidence-based treatments for BD and BPD that show promise in treating those with comorbid BD/BPD. In our review of the literature, we highlight the importance of recognizing this comorbidity and discuss avenues for developing and integrating evidence-based treatment approaches for this understudied clinical population. Although formal trials of interventions targeted to comorbid BD/BPD are limited, there is promising evidence regarding the possibility of using or integrating existing evidence-based approaches for this population. There are also several areas of clinical practice improvement and future research directions that stem from this literature.

The Effectiveness of Dialectical Behavior Therapy Compared to Schema Therapy for Borderline Personality Disorder: A Randomized Clinical Trial

Introduction: In the treatment of borderline personality disorder (BPD), there is empirical support for both dialectical behavior therapy (DBT) and schema therapy (ST); these treatments have never been compared directly. This study examines whether either of them is more effective than the other in treating patients with BPD. Methods: In this randomized, parallel-group, rater-blind clinical trial, outpatients aged between 18 and 65 years with a primary diagnosis of BPD were recruited in a tertiary outpatient treatment center (Lübeck, Germany). Participants were randomized to DBT or ST with one individual and one group session per week over 1.5 years. The primary outcome was the BPD symptom severity assessed with the mean score of the Borderline Personality Disorder Severity Index at 1-year naturalistic follow-up. Results: Between November 26, 2014, and December 14, 2018, we enrolled 164 patients (mean age = 33.7 [SD = 10.61] years). Of these, 81 (49.4%) were treated with ST and 83 (50.6%) with DBT, overall, 130 (79.3%) were female. Intention-to-treat analysis with generalized linear mixed models did not show a significant difference at 1-year naturalistic follow-up between DBT and ST for the BPDSI total score (mean difference 3.32 [95% CI: –0.58–7.22], p = 0.094, d = −24 [–0.69; 0.20]) with lower scores for DBT. Pre-to-follow-up effect sizes were large in both groups (DBT: d = 2.45 [1.88–3.02], ST: d = 1.78 [1.26–2.29]). Conclusion: Patients in both treatment groups showed substantial improvements indicating that even severely affected patients with BPD and various comorbid disorders can be treated successfully with DBT and ST. An additional non-inferiority trial is needed to show if both treatments are equally effective. The trial was retrospectively registered on the German Clinical Trials Register, DRKS00011534 without protocol changes.