[Borderline personality disorder is easy to treat: are we ready to accept this good news?]. / Le trouble de la personnalité borderline est facile à traiter: sommes-nous prêts à relever le défi?

Recent research indicated that the outcome of borderline patients is better than previously reported. We assessed the impact of co-morbid personality disorders (PD) on response to treatment and 1-year outcome among 206 borderline patients assigned to crisis intervention program. An overwhelming majority (89%) of borderline patients without supplementary Axis 11 psychopathology exhibited good to very good treatment response at acute treatment discharge as well as good to very good global outcome at 1-year followup (85%). Borderline patients meeting criteria for paranoid, schizotypal, antisocial, narcissistic and dependant personality disorder showed, contrarily, significantly more treatment failures.

[New ways of treatment of borderline patients with suicidal crisis]. / Nouvelles orientations du traitement de la crise suicidaire borderline.

Suicidal attempts are not rare in the general population (about 4.5%) and the presence of personality disorder aggravates the clinical issue of these patients who also repeat suicidal attempts. Caring for these patients is particularly difficult for physicians and other caregivers, in the means of choice of specific treatment and prevention of relapse. Despite the existence of many psychiatric facilities that can welcome these patients, there is a high rate of treatment failure or drop-out. This constitutes a major issue for systems of care politics. This article describes a specific form of treatment, psychotherapeutic and risk-management oriented, of borderline patients with suicidal attempt admitted at the ER.

[Increased referral to psychiatric hospitalization: a challenge for better mental health policies]. / Augmentation des admissions psychiatriques: un enjeu majeur de politique de soins.

This paper aims at investigating causes and potential remedies of increased psychiatric hospitalization in this country. The data suggest that there was growing pressure on psychiatric hospitals from 1950 to 2000. This may result from inappropriate management of a new type of acute psychiatric patient rather than severed epidemiology of acute psychiatric disorders. More focus on innovative crisis intervention programs emphasizing the central role of the general hospital in contemporary psychiatry may strongly contribute to better mental care. Despite significant advances in psychotherapy and medical research such an evolution is contended from the exquisite entropy of psychiatric systems. Those cultural and psychological factors associated with this issue require careful consideration and further studies.

Disappointed Love and Suicide: A Randomized Controlled Trial of "Abandonment Psychotherapy" Among Borderline Patients.

To determine whether ambulatory psychotherapy targeted to abandonment experiences and fears can reduce suicidality and improve outcome in borderline patients referred to the emergency room with major depressive disorder and self-destructive behavior severe enough to require medical/surgical treatment and a brief psychiatric hospitalization. A total of 170 subjects were randomized at hospital discharge into three treatment groups: treatment as usual (TAU), abandonment psychotherapy delivered by certified psychotherapists, and abandonment psychotherapy delivered by nurses. Assessments were performed before randomization and at 3-month follow-up. Continued suicidality and other outcome measures were significantly worse in the treatment-as-usual as compared to both abandonment psychotherapy groups, but there were no differences between the two psychotherapy groups. These results suggest the efficacy of manualized psychotherapy that specifically targets the abandonment fears and experiences that are so common as precipitants to suicidal and self-destructive acts in borderline patients. It does not appear that formal psychotherapy training is associated with better outcomes.