RESUMEN
Borderline personality disorder (BPD) is a severe psychiatric condition that affects up to 2.7% of the population and is highly linked to functional impairment and suicide. Despite its severity, there is a lack of knowledge about its pathophysiology. Studies show genetic influence and childhood violence as factors that may contribute to the development of BPD; however, the involvement of neuroinflammation in BPD remains poorly investigated. This article aimed to explore the pathophysiology of BPD according to the levels of brain-derived neurotrophic factor (BDNF), inflammatory cytokines, and oxidative stress substances that exacerbate neuronal damage. Few articles have been published on this theme. They show that patients with BPD have a lower level of BDNF and a higher level of tumor necrosis factor (TNF)-α and interleukin (IL)-6 in peripheral blood, associated with increased plasma levels of oxidative stress markers, such as malondialdehyde and 8-hydroxy-2-deoxyguanosine. Therefore, more research on the topic is needed, mainly with a pre-clinical and clinical focus.
Asunto(s)
Trastorno de Personalidad Limítrofe , Humanos , Niño , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/genética , Trastorno de Personalidad Limítrofe/psicología , Factor Neurotrófico Derivado del Encéfalo/genética , Interleucina-6 , Factor de Necrosis Tumoral alfaRESUMEN
The main aim of this article is to compare the prevalence of four forms of physically self-destructive behavior in the offspring of parents with borderline personality disorder (BPD) and compare them to the offspring of parents with other personality disorders (OPD). At the 4- and 6-year waves in a prospective study of the long-term course of BPD, participants were asked to report on the self-destructive behaviors of their children using the Childhood Self-Destructiveness Scale. A total of 68 parents were interviewed regarding 131 children, 104 of whom were offspring of parents with BPD (n = 55) and 27 were offspring of parents with OPD (n = 13). BPD parents reported significantly more self-injury and substance abuse in their children than OPD parents. The results from this study suggest that both direct and indirect forms of self-destructive behavior are both more common and quite specific for the children of parents with BPD.
Asunto(s)
Trastorno de Personalidad Limítrofe , Conducta Autodestructiva , Trastorno de Personalidad Limítrofe/epidemiología , Niño , Humanos , Padres , Trastornos de la Personalidad , Estudios ProspectivosRESUMEN
Objective: To identify personality disorders comorbid with borderline personality disorder (BPD) that may confer greater risk for the presence of severe dissociative experiences. Method: Three hundred and one outpatients with a primary diagnosis of BPD were evaluated using the Structured Clinical Interview for DSM-IV Axis II personality disorders, the Borderline Evaluation of Severity Over Time (BEST) and the Dissociative Experiences Scale (DES). Results: The most frequent personality disorders comorbid to BPD were paranoid (83.2%, n = 263) and depressive (81.3%, n = 257). The mean BEST and DES total score were 43.3 (SD = 11.4, range 15-69) and 28.6 (SD = 19.8, range 0-98), respectively. We categorized the sample into patients with and without severe dissociative experiences (41% were positive). A logistic regression model revealed that Schizotypal, Obsessive-compulsive and Antisocial personality disorders conferred greater risk for the presence of severe dissociative experiences. Discussion: Our results suggest that a large proportion of patients with BPD present a high rate of severe dissociative experiences and that some clinical factors such as personality comorbidity confer greater risk for severe dissociation, which is related to greater dysfunction and suffering, as well as a worse progression of the BPD.
Asunto(s)
Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/psicología , Trastornos Disociativos/epidemiología , Trastornos Disociativos/psicología , Índice de Severidad de la Enfermedad , Adolescente , Adulto , Anciano , Trastorno de Personalidad Limítrofe/diagnóstico , Comorbilidad , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Trastornos Disociativos/diagnóstico , Femenino , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Trastornos de la Personalidad/diagnóstico , Trastornos de la Personalidad/epidemiología , Trastornos de la Personalidad/psicología , Estudios Retrospectivos , Autoinforme , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the incidence of suicidal outcomes and risk factors for short- and long-term recurrence of suicidal behavior (SB) among high-risk borderline personality disorder (BPD) patients during a 24-month prospective follow-up period. METHODS: A multicenter prospective cohort study was designed to compare data obtained from 136 patients admitted to the emergency department for current suicidal ideation (SI) or a recent suicide attempt (SA). Subjects were clinically evaluated and monitored for a new SA or suicide. RESULTS: The incidence of a new SA was 25.63 events/100 persons-year, and one patient died by suicide. Child sexual abuse (CSA) was the only significant predictor throughout the complete follow-up period. The absence of prior psychiatric treatment predicts the recurrence of SB in the first 6 months of follow-up. Patient age, poor psychosocial functioning before hospitalization, age at first SA, and having multiple suicide attempts increased risk of SB recurrence at the long-term period (24th months). In addition, there was an interaction between CSA and poor psychosocial functioning that increased risk of SB. CONCLUSION: The risk of recurrence was higher during the first 6 months. Risk factors at 6 and 24 months vary. These findings are important for implementing suicide strategies.
Asunto(s)
Trastorno de Personalidad Limítrofe/psicología , Abuso Sexual Infantil/psicología , Intento de Suicidio/psicología , Adulto , Argentina/epidemiología , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/mortalidad , Estudios de Casos y Controles , Niño , Abuso Sexual Infantil/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Estudios Longitudinales , Masculino , Valor Predictivo de las Pruebas , Estudios Prospectivos , Recurrencia , Factores de Riesgo , Ideación SuicidaRESUMEN
RESUMO Os Transtornos da personalidade são padrões psicológicos de difícil diagnóstico que exigem uma avaliação criteriosa por parte do profissional da saúde mental. A relação médico-paciente também se configura como fator de extrema importância para o manejo destes quadros. Dentro deste contexto, é imprescindível orientar os alunos das áreas de graduação em saúde sobre a existência de tal categoria de transtornos. O presente artigo consiste em uma revisão descritiva, que busca elucidar a definição de transtornos da personalidade; além de discorrer sobre aspectos históricos, nosológicos e epidemiológicos. Nesta publicação ainda serão revisadas as particularidades referentes ao diagnóstico, as comorbidades, ao curso e tratamento destes transtornos. O enfoque maior será no manejo de indivíduos com transtorno da personalidade borderline, dada a maior procura destes por unidades de atendimento psiquiátrico.(AU)
Personality disorders are psychological patterns of difficult diagnosis that require careful evaluations from mental health professionals. The physician-patient relationship is a crucial condition for the management of these disorders. On this view it must be important guide undergraduate students from health care areas through the existence of such a category of disorders. This article consists of a descriptive review aiming at clarifying the definition of personality disorders; furthermore discuss historical, physiological and epidemiological aspects. On this publication will be reviewed some particularities from diagnostic comorbidity, course and treatment of these disorders. The management of individuals with borderline personality disorder will be emphasized in this publication due to increased seek from this public for mental health care units. (AU)
Asunto(s)
Humanos , Relaciones Médico-Paciente , Trastorno de Personalidad Limítrofe/diagnóstico , Suicidio/psicología , Trastorno de Personalidad Limítrofe/epidemiologíaRESUMEN
INTRODUCTION: Personality refers to the individual style in characteristic patterns of thinking, feeling and behaving. Traits may configure a personality disorder when there is a long-lasting rigid pattern of inner experience that deviates from the expectations of the individual's culture, are inflexible and form maladaptative schemes in different interpersonal scenarios. Given the pervasiveness of this structure, they cause impairment of functioning in the affected person. OBJECTIVE: To establish the prevalence of personality traits in all selected adults, using the module-structured interview WHO WHM-CIDI-CAPI for clusters A, B and C of personality traits. METHODS: Colombian National Survey on Mental Health with persons older than 18 years of age. RESULTS: Personality traits that are the most frequently described: Cluster A 46% (95%CI, 45.2-48.1) of people believe they are convinced that there are conspiracies behind many things in the world. Regarding the features of cluster B, 35.6% (95%CI, 34.2-37.0) of the population reports that generally they do not feel bad when offending or upsetting someone and 35.4% (95%CI, 33.9-36.8) refer to show feelings to anyone. The highest proportion of traits were found to the probable borderline personality disorder, as 4.6% (95%CI, 4.1-5.2) of the Colombian population aged 18 and older has 6 or more features of this type, and is the widely reported as an individual entity with similar rates in men and women. CONCLUSIONS: The high prevalence of disruptive personality traits requires more research. The high prevalence reported for borderline personality traits suggests the need to implement measures to improve and integrate a collaborative model of care for people afflicted with a possible borderline personality disorder.
Asunto(s)
Trastorno de Personalidad Limítrofe/epidemiología , Trastornos de la Personalidad/epidemiología , Personalidad , Adolescente , Adulto , Trastorno de Personalidad Limítrofe/diagnóstico , Colombia/epidemiología , Femenino , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Trastornos de la Personalidad/diagnóstico , Prevalencia , Adulto JovenRESUMEN
The objective of this study was to characterize admissions to an emergency hospital due to suicide attempts and verify outcomes in 2 years. Data were collected from medical records and were analyzed using descriptive statistics and logistic regression. The sample consisted of 412 patients (58.7% women; mean age = 32.6 years old, SD = 14.3). Self-poisoning was the most frequent method (84.0%), and they were diagnosed mainly as depressive (40.3%) and borderline personality disorders (19.1%). Previous suicide attempts and current psychiatric treatment were reported by, respectively, 32.0% and 28.4%. Fifteen patients (3.6%, 9 males) died during hospitalization. At discharge, 79.3% were referred to community-based psychiatric services. Being male (OR = 2.11; 95% CI = 1.25-3.55), using violent methods (i.e., hanging, firearms, and knives) (OR = 1.96; 95% CI = 1.02-3.75) and psychiatric treatment history (OR = 2.58; 95% CI = 1.53-4.36) were predictors for psychiatric hospitalization. Of 258 patients followed for 2 years, 10 (3.9%) died (3 suicide), and 24 (9.3%) undertook new suicide attempts. Patients with a history of psychiatric treatment had higher risks of new suicide attempts (OR = 2.46, 95% CI = 1.07-5.65). Suicide attempters admitted to emergency hospitals exhibit severe psychiatric disorders, and despite interventions, they continue to present high risks for suicide attempts and death.
Asunto(s)
Trastorno de Personalidad Limítrofe/epidemiología , Trastorno Depresivo/epidemiología , Intoxicación/epidemiología , Intento de Suicidio/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Servicios Comunitarios de Salud Mental , Servicio de Urgencia en Hospital , Femenino , Hospitalización , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Recurrencia , Derivación y Consulta , Estudios Retrospectivos , Factores Sexuales , Suicidio/estadística & datos numéricos , Centros de Atención Terciaria , Violencia , Adulto JovenRESUMEN
INTRODUCTION: Four studies have found a smaller amygdalar volume in patients with borderline personality disorder (BPD) relative to controls, whereas four other studies have found similar amygdalar volume in BPD patients relative to controls. This study aims to compare amygdalar volumes of BPD patients with controls, and also to compare BPD patients with and without post-traumatic stress disorder (PTSD) with controls in order to determine whether PTSD can explain the heterogeneity of findings. METHOD: Systematic review and meta-analysis of magnetic resonance imaging studies that measured amygdalar volumes in BPD patients and healthy controls. FINDINGS: A significant reduction of amygdalar volumes in BPD patients was confirmed (p < .001). However, data from the studies that discriminated BPD patients with and without PTSD indicated that amygdalar volumes were significantly smaller in BPD patients without PTSD relative to controls (left: p = .02; right: p = .05), but not in BPD patients with PTSD relative to controls (left: p = .08; right: p = .20). CONCLUSION: This meta-analysis suggests that amygdalar volumes are reduced in patients with BPD. This pattern is confirmed in BPD patients without PTSD, but not in BPD patients with PTSD, raising the possibility that reduced amygdalar volume in BPD patients cannot be explained by comorbid PTSD.
Asunto(s)
Amígdala del Cerebelo/patología , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/patología , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/patología , Comorbilidad , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Humanos , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: Several studies have found a reduction in hippocampal volume in borderline personality disorder (BPD) patients. METHODS: In order to investigate the degree to which comorbid posttraumatic stress disorder (PTSD) could account for reduction in hippocampal volume in these patients, we conducted a systematic review and meta-analysis of studies that compared hippocampal volume in BPD patients with and without PTSD relative to healthy controls. RESULTS: Seven articles, involving 124 patients and 147 controls, were included. We found a statistically significant reduction for the left and right hippocampus. Data from the four studies that discriminated BPD patients with and without PTSD indicate that hippocampal volumes were reduced bilaterally in BPD patients with PTSD, relative to healthy controls, but that results were mixed for BPD patients without PTSD, relative to healthy controls. CONCLUSIONS: Results from this meta-analysis suggest that hippocampal volumes are reduced in patients with BPD, relative to healthy controls, but particularly in cases in which patients are diagnosed with comorbid PTSD.
Asunto(s)
Trastorno de Personalidad Limítrofe/patología , Hipocampo/patología , Trastornos por Estrés Postraumático/patología , Adulto , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/psicología , Comorbilidad , Interpretación Estadística de Datos , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Pruebas Neuropsicológicas , Tamaño de los Órganos , Escalas de Valoración Psiquiátrica , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicologíaRESUMEN
The relationship between bipolar disorder and borderline personality disorder remains controversial since in both conditions there are overlapping and similar symptomatic dimensions. Symptomatic dimensions suitable to subserve differential diagnosis are: mood, mood variability mode, and personal and family history. Characteristics of psychotic symptoms may also be useful in the differentiation. On the other hand, anxiety symptoms, neuropsychological profiles, neuro-imaging procedures and biomarkers seem not to contribute to differentiate between both diseases. The presentation of nonsuicidal self mutilation behavior can offer some differences between bipolar and borderline personality disorders, but both can coexist in clinical comorbid forms and do not significantly contribute to the differential diagnosis. Differential diagnosis is complicated by the fact that a low percentage of patients can experience comorbidity of both conditions. In this work we review all these issues, and particularly emphasize the importance of sitematically take into account the patient background, the course that follows his or her disorder, together with the outcome in response to medical decisions.
Asunto(s)
Trastorno Bipolar/diagnóstico , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno Bipolar/epidemiología , Trastorno Bipolar/genética , Trastorno Bipolar/terapia , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/genética , Trastorno de Personalidad Limítrofe/terapia , Comorbilidad , Diagnóstico Diferencial , Femenino , Humanos , Estudios Longitudinales , Masculino , Fenotipo , Prevalencia , Automutilación , Resultado del TratamientoRESUMEN
Objetivo: Describir un grupo de pacientes desde un punto de vista demográfico, psicopatológico y terapéutico que presentan Estructura Limítrofe de Personalidad. Esta organización de personalidad subyace en varios de los trastornos de personalidad más graves, que demandan altos costos en su atención. Se tomaron 488 fichas de la Unidad de Trastornos de Personalidad del Hospital del Salvador que corresponden a un seguimiento de los pacientes ingresados entre los años 2006 y 2008. De estas se seleccionaron las 256 que presentaron Estructura Limítrofe de Personalidad (diagnóstico clínico) y luego se consideraron las 64 que se encontraban activas. Resultados: Destaca un promedio de edad de 39,3 años. Mayor porcentaje de mujeres (94 por ciento). El 51 por ciento tiene trabajo o está estudiando al momento del ingreso a la Unidad. Estado civil de los pacientes: 19 por ciento casado(a), 11 por ciento convive, 31 por ciento separado(a), 39 por ciento soltero (a). Nivel educacional: 6 por ciento educación básica, 53 por ciento educación media y 14 por ciento nivel universitario. El 56 por ciento ha presentado al menos una hospitalización. Discusión: El reconocimiento clínico de estos pacientes, la precisión de los síntomas más prevalentes que ellos presentan nos permite generar estrategias terapéuticas multidisciplinarias en el corto plazo, y planificar a partir de criterios de selección en algunos pacientes de psicoterapias más prolongadas que permitan un cambio más permanente. Se discuten algunos criterios terapéuticos y desafíos futuros para su tratamiento.
Objective: To describe a group of Borderline Personality Structure patients from demographic, psychopatologic and therapeutic perspectives. This anomalous personality organization behind several more serious personality disorders demanding high cost of its assistance. We consider 488 clinic sheets of the Personality Disorder Unit, Del Salvador Hospital, Santiago, Chile, which corresponded to a follow-up of patients admitted between 2006 to 2008. From these we selected 256 ones who presented Borderline Personality Structure (clinical diagnosis) and then considered the 64 active cases. Results: The group had 39.3 years of average age, with higher women percentage (94 percent). The 51 percent had job or were studying at admission time. Marital status: 19 percent married, 11 percent coexists, 31 percent separated, 39 percent single. Educational level: 6 percent basic, 53 percent secondary and 14 percent university level. The 56 percent had submitted one hospitalization at least. Discussion: The better clinical recognition of these patients, as well as the accuracy of the most prevalent symptoms they presented, the more we could generated multidisciplinary therapeutic strategies in the short time, and to plan selection criteria for more protracted psychotherapy for some of them to allow a more permanent change. Finally we discuss some therapeutic criteria and future challenges for the treatment of these patients.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Servicio de Psiquiatría en Hospital/estadística & datos numéricos , Trastorno de Personalidad Limítrofe/epidemiología , Epidemiología Descriptiva , Estudios de Seguimiento , Hospitalización , Intento de Suicidio/estadística & datos numéricos , Psicoterapia , Psicotrópicos/uso terapéutico , Factores Socioeconómicos , Teoría de la Mente , Trastorno de Personalidad Limítrofe/etiología , Trastorno de Personalidad Limítrofe/terapiaRESUMEN
Clinical material from the analysis of a young patient diagnosed with borderline personality disorder and heavily dependent on drugs was examined to identify changes in setting that may be necessary to enable the psychoanalytical treatment of this type of patient. The article describes a lack of truth in the patient's life and the absence of a good enough space for thinking in her mind. In order to enhance the development of the capacity for symbolization in the patient's mind, the analyst had to become an object the patient needed. In order to do this the analyst had to manage setting alteration. Theoretical frameworks proposed by Ferenczi, Winnicott and Bion were used to guide the psychoanalyst's approach to this patient. The survival of the capacity for thinking psychoanalytically inside the analyst's mind when the setting has been significantly distorted by the disruptive behavior of the patient is guaranteed by the trueness of their link. It is suggested that maybe this is decisive for a successful psychoanalytical treatment of this type of patient.
Asunto(s)
Trastorno de Personalidad Limítrofe/terapia , Terapia Psicoanalítica/métodos , Trastornos Relacionados con Sustancias/terapia , Pensamiento , Actuación (Psicología) , Adulto , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/psicología , Comorbilidad , Femenino , Humanos , Modelos Psicológicos , Relaciones Profesional-Paciente , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/psicología , Transferencia Psicológica , Inconsciente en PsicologíaRESUMEN
OBJECTIVE: To assess the frequency of some psychiatric comorbidities found to be associated with suicidal behavior in previous studies and to evaluate their influence on suicidal behavior in a sample of patients with bipolar disorder. METHOD: We assessed 239 bipolar patients from January 2005 to January 2007. Axis I diagnosis was performed according to the DSM-IV using a structured interview (the Mini-International Neuropsychiatric Interview-Plus), and borderline personality disorder was assessed using the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Lifetime suicide history was assessed using a semistructured interview in addition to a review of medical records. RESULTS: There were 99 patients (41.4%) with a history of previous suicide attempts. The psychiatric comorbidities associated with suicidal behavior were borderline personality disorder (chi(2) = 36.008, p = .0001), panic disorder (chi(2) = 5.537, p = .019), alcoholism (chi(2) = 12.820, p = .001), other drug addictions (chi(2) = 10.055, p = .02), generalized anxiety disorder (chi(2) = 10.216, p = .001), and smoking (chi(2) = 9.070, p = .003). However, when logistic regression analyses were used, only the diagnosis of border-line personality disorder remained significant (Wald chi(2) = 19.13, p = .0001). When analyzing the subtypes of suicide attempts, we found that borderline personality disorder and alcoholism were associated with violent suicide attempts. CONCLUSION: A diagnosis of borderline personality disorder or alcoholism (only for violent sub-type of suicidal behavior) was the only comorbidity independently associated with suicide in patients with bipolar disorder. For suicide prevention, screening to identify patients at high risk for suicidal behavior should be performed routinely in patients with bipolar disorder.
Asunto(s)
Trastorno Bipolar/epidemiología , Trastornos Mentales/epidemiología , Adulto , Alcoholismo/epidemiología , Alcoholismo/psicología , Trastornos de Ansiedad/epidemiología , Trastornos de Ansiedad/psicología , Trastorno Bipolar/psicología , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/psicología , Comorbilidad , Estudios Transversales , Femenino , Humanos , Masculino , Trastornos Mentales/psicología , Persona de Mediana Edad , Factores de Riesgo , Fumar/epidemiología , Fumar/psicología , Violencia/psicología , Violencia/estadística & datos numéricosRESUMEN
Bipolar disorder presents with symptoms that overlap with other, often comorbid, psychiatric disorders, such as borderline personality disorder, substance use disorder, and unipolar depression, and also often co-occurs with medical disorders. Appropriate screening for manic and hypomanic symptoms may lessen the frequency of misdiagnosis of bipolar disorder as unipolar depression, which has serious treatment implications. Further, following the appropriate guidelines for monitoring the physical health of patients with bipolar disorder, especially those treated with mood stabilizers and atypical antipsychotic agents, is important to achieve optimal outcomes.
Asunto(s)
Antipsicóticos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Trastorno Bipolar/epidemiología , Trastorno de Personalidad Limítrofe/epidemiología , Estado de Salud , Trastornos Relacionados con Sustancias/epidemiología , Trastorno Bipolar/diagnóstico , Trastorno de Personalidad Limítrofe/diagnóstico , Comorbilidad , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/epidemiología , Diagnóstico Diferencial , Errores Diagnósticos , Guías como Asunto , Humanos , Trastornos Relacionados con Sustancias/diagnósticoRESUMEN
In the last decade, literature concerning gender and borderline personality disorder has aroused much controversy and little lightness. Recently, borderline personality disorder has been characterized as the "bad girl" of the psychiatric terms; this implies a bigger use of this diagnose in women and a biased gender in the identification of this disorder. The Diagnostic and Statistical Manual of Mental Disorders states that borderline personality disorder is mostly diagnosed in women (75%). The essential question to discuss is whether the larger prevalence in women is due to a biased sample or a biased diagnoses or it reflects a sociocultural and biological difference between men and women. The aim of this paper is to analyze some issues about the difference 3:1 women and men in this disorder.
Asunto(s)
Trastorno de Personalidad Limítrofe/epidemiología , Personalidad , Prejuicio , Adulto , Mujeres Maltratadas , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/etiología , Niño , Abuso Sexual Infantil , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Masculino , Relaciones Madre-Hijo , Factores Sexuales , Delitos Sexuales , Derechos de la MujerRESUMEN
PURPOSE OF REVIEW: Individuals with personality disorders have difficulties in finding specific institutions or services that are designated to bind this kind of problem. These are people who are required to go through many diagnoses and consult many professionals before someone produces the correct diagnosis for their condition. This article reviews the new evidence in the management of personality disorders and incorporates reliable data to determine global clinical recommendations for treatment. RECENT FINDINGS: This review suggests that, although pharmacotherapy forms the cornerstone of the management, utilization of adjunctive psychosocial treatments and incorporation of a model that involves a healthcare team are required to provide optimal management for patients with personality disorders. SUMMARY: The authors related the experience obtained in the Personality Disorder Ambulatory of the Department of Psychiatry of Sao Paulo University Medical School in the handling of the people with personality disorders and proposed the use of gabapentin as a coactuator in the treatment of persons with these conditions.
Asunto(s)
Guías como Asunto , Cooperación Internacional , Trastornos de la Personalidad/terapia , Edad de Inicio , Trastorno de Personalidad Antisocial/epidemiología , Trastorno de Personalidad Antisocial/terapia , Trastorno Bipolar/epidemiología , Trastorno Bipolar/terapia , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/terapia , Humanos , Servicios de Salud Mental/organización & administración , Trastornos de la Personalidad/epidemiologíaRESUMEN
The authors examined the discriminant efficiency of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ) criteria for borderline personality disorder (BPD) and antisocial personality disorder (APD). Subjects were 74 men admitted to an outpatient substance abuse program for monolingual Hispanic adults. All were reliably assessed with the Spanish-language version of the Diagnostic Interview for DSM-IV Personality Disorders. Conditional probabilities were calculated to determine the diagnostic efficiency and discriminant efficiency of BPD and APD symptoms. Twenty-five (34%) subjects met diagnostic criteria for BPD, and 16 (22%) met criteria for APD. The diagnostic co-occurrence of these disorders was statistically significant. Whereas the diagnostic efficiency of the BPD criterion set was comparable to that reported in other clinical studies, these criteria were not significantly more efficient in diagnosing BPD than APD. By contrast, the APD criteria were more efficient in diagnosing APD than BPD; this was true for both the "adult" and the "conduct disorder" APD criterion subsets. In male Hispanic outpatients with substance use disorders, BPD and APD show significant diagnostic overlap. The APD criteria are useful in discriminating these 2 disorders, whereas the BPD criteria are not. These findings have implications for the discriminant validity of the BPD and APD criteria and support the value of the conduct disorder criteria in predicting APD in adulthood.
Asunto(s)
Alcoholismo/psicología , Trastorno de Personalidad Antisocial/diagnóstico , Trastorno de Personalidad Limítrofe/diagnóstico , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Hispánicos o Latinos/psicología , Trastornos Relacionados con Sustancias/psicología , Adulto , Alcoholismo/epidemiología , Alcoholismo/rehabilitación , Trastorno de Personalidad Antisocial/epidemiología , Trastorno de Personalidad Antisocial/psicología , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/psicología , California , Centros Comunitarios de Salud Mental , Comorbilidad , Trastorno de la Conducta/diagnóstico , Trastorno de la Conducta/epidemiología , Trastorno de la Conducta/psicología , Diagnóstico Diferencial , Hispánicos o Latinos/estadística & datos numéricos , Humanos , Masculino , Psicometría/estadística & datos numéricos , Puerto Rico/etnología , Reproducibilidad de los Resultados , Estadística como Asunto , Trastornos Relacionados con Sustancias/epidemiología , Trastornos Relacionados con Sustancias/rehabilitaciónRESUMEN
INTRODUÇÃO: Os transtornos de personalidade são uma classe diagnóstica em Psiquiatria cujo tratamento não está ainda claramente definido. Devido ao grande número de alterações que o transtorno de personalidade borderline ocasiona na vida de seus portadores, propomos um atendimento interdisciplinar integrado. Esta proposta organiza-se em quatro eixos: psicoterapia individual de orientação analítica, grupoterapia de orientação analítica, psicofarmacoterapia e intervenções sociais. METODOLOGIA: Este estudo baseia-se na descrição da experiência obtida pelos autores na implantação de um Programa de Abordagem Interdisciplinar no Tratamento do Transtorno de Personalidade Borderline, utilizando como exemplo dois relatos de caso sucintos, a respeito de duas pacientes com transtorno de personalidade borderline. Foram avaliados critérios qualitativos para descrever a melhora obtida pelas pacientes através do Programa (relacionamento interpessoal, interesses e atividades ocupacionais e de lazer, autonomia) e quantitativos (número de internações, tentativas de suicídio, procura por serviços de emergência). RESULTADOS E DISCUSSÃO: As intervenções sociais mostraram-se eficazes ao incrementar as terapêuticas já tradicionalmente colocadas. Houve melhoras relacionadas aos critérios acima colocados. CONCLUSÃO: Os resultados encontrados alertam-nos para a necessidade de observarmos os pacientes em seus diversos contextos, de forma a apresentar intervenções que dêem conta dessas múltiplas dimensões.
Asunto(s)
Humanos , Masculino , Femenino , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/epidemiología , Trastorno de Personalidad Limítrofe/fisiopatología , Trastorno de Personalidad Limítrofe/patología , Trastorno de Personalidad Limítrofe/psicología , Trastorno de Personalidad Limítrofe/terapia , Grupo de Atención al Paciente , Vías ClínicasRESUMEN
Se analizó las historias de los pacientes ambulatorios que consultaron en la Clínica Psiquiátrica Universitaria en tres meses consecutivos. Se seleccionó las historias clínicas con diagnóstico de Trastorno de Personalidad. Se les aplicó los criterios diagnósticos del DSM-III-R para Trastorno Límite de Personalidad y de la CIE-10 para Trastorno de Inestabilidad Emocional de la Personalidad, Tipo Límite. Se estudió la comorbilidad según las categorías de eje I del DSM-III-R. De 1.488 consultas, 193 (13 por ciento) correspondieron a trastornos de personalidad. El 25,4 por ciento de los casos cumplía los criterios del DSM-III-R para Trastorno Límite y el 11,3 por ciento los criterios de la CIE-10 para Trastorno de Inestabilidad Emocional de la Personalidad de Tipo Límite. Los diagnósticos adicionales del eje I mas frecuentes fueron los Trastornos delñ Estado de Animo y los Trastornos Adaptativos. No obstante, hubo diferencias en la frecuencia de comorbilidad entre los pacientes con diagnóstico de Trastorno Límite y los pacientes con otro tipo de Trastorno de Personalidad. Se discuten los resultados en relación con la literatura y con trabajos previos de los autores