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1.
Adv Mind Body Med ; 34(3): 4-10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32931456

RESUMO

Background: This case report illustrates that the use of a series of lifestyle interventions delivered via the "Vital Mind Reset" online program led to the resolution of disabling psychiatric symptoms. Summary: A 40-year-old, married, Caucasian female, with onset of suicidal ideation as a teenager, was treated with antidepressants and was later formally diagnosed with dissociative identity disorder (DID), borderline personality traits, and bipolar disorder (BD). In the ensuing years, the patient was treated with 35 psychiatric medications. Additionally, she experienced numerous hospitalizations and received over 30 electroconvulsive therapy (ECT) treatments. Despite this extensive conventional treatment, she reported limited gains. In October 2017, the patient committed to the Vital Mind Reset (VMR) online program and implemented a series of lifestyle changes over 44 days, starting with 30 days of dietary, meditation, and lifestyle protocols, followed by supplementation. Notably, the patient has since resolved both physical and psychiatric symptoms including fatigue, acne, migraines, cold sweats, dizziness, nausea, blood sugar crashes, resting tremors, brain fog, anxiety, depression, suicidal ideation, auditory hallucinations, and delusions. In this patient's case, hypertension, bradycardia, headaches, increased frequency of mania, tremors, insomnia, and weight gain accompanied her medications. This case exemplifies the dramatic resolution of disabling psychiatric symptoms after engagement in the lifestyle interventions outlined in the VMR program, medication taper, and supplementation. When medication demonstrates limited clinical yield and a plethora of side effects, tapering combined with lifestyle interventions and supplementation should be considered as first-line therapy. This case is evidence of the potential for healing and resolution of severe and persistent psychiatric illness with dietary and lifestyle changes.


Assuntos
Transtorno Bipolar , Transtorno da Personalidade Borderline , Transtorno Dissociativo de Identidade , Eletroconvulsoterapia , Adulto , Transtorno Bipolar/terapia , Transtorno da Personalidade Borderline/terapia , Feminino , Humanos , Estilo de Vida
2.
Artigo em Inglês | MEDLINE | ID: mdl-32604913

RESUMO

Borderline Personality Disorder (BPD) significantly impairs functioning. Fortunately, effective treatments are available for borderline symptoms but their effect on functioning should be assessed. The objective of this meta-analysis is to assess the effect of specifically-designed versus non-specifically designed psychotherapies on function in adult patients with BPD. The reference list of Cristea et al. 2017 was used to identify the randomized controlled trials (RCTs) assessing the BPD-specifically-designed psychotherapy versus non-specific psychotherapies in adult BPD patients. Among those, RCTs assessing post-treatment functioning using the Global Assessment of Functioning, Social Adjustment Scale-Self-Report and Inventory of Interpersonal Problems were included. Ten trials (880 participants) were included. Summary effect size was calculated using the measured Hedge's g. The results indicate the BPD patients in the intervention group had a significantly higher (g = 0.41; 95% CI, 0.09-0.73) level of psychosocial functioning after receiving the specifically-designed psychotherapies in comparison with BPD patients in control groups after receiving non-specific psychotherapies. Specifically-designed psychotherapies can improve psychosocial functioning although improvement in measurement of function (i.e., more objective and universal tools) and improvement in psychotherapies (i.e., more focused on general functioning) will be helpful.


Assuntos
Transtorno da Personalidade Borderline , Transtorno da Personalidade Borderline/terapia , Grupos Controle , Humanos , Psicoterapia , Resultado do Tratamento
3.
Behav Cogn Psychother ; 48(6): 734-738, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32727628

RESUMO

BACKGROUND: Borderline personality disorder (BPD) usually begins in adolescence and manifests itself in adult life. Early intervention can improve the prognosis or reduce its severity. Nevertheless, there are currently few studies of adolescent patients with severe emotion instability and borderline personality traits. AIMS: To evaluate the effectiveness of the Systems Training for Emotional Predictability and Problem Solving (STEPPS) programme in a sample of 21 adolescents (aged 13-17 years) in the Child and Adolescents Mental Health Center of Tarragona in Spain. METHOD: We evaluated BPD traits using the Diagnostic Interview for Borderline Disorder-Revised (DIB-R) and the Global Clinical Impression Scale of Illness Severity for TLP (CGI-TLP). We compared pre- and post-treatment scores for the DIB-R, CGI-GI scale, general psychopathology using the Personality Inventory for Adolescents (PAI-A) and impulsivity with the Barratt Impulsivity Scale (BIS-11). The therapeutic objectives were evaluated with the Borderline Estimate Severity over Time (BEST) scale. RESULTS: There was a statistically significant improvement in the scores for the affective area and in the total score of the DIB-R, a decrease in the percentage of patients who failed to meet criteria for BPD, and an improvement (although not statistically significant) in the scores of the BEST scale throughout the treatment. The results of the CGI-GI scale showed global improvement in almost 72% of patients. CONCLUSION: Our study suggests that STEPPS can be an effective treatment to improve BPD symptoms and is very useful in community settings with limited resources in which efficient treatment alternatives must be sought. However, this conclusion must be interpreted with caution, as there is no comparison control group.


Assuntos
Transtorno da Personalidade Borderline , Psicoterapia de Grupo , Adolescente , Adulto , Transtorno da Personalidade Borderline/terapia , Criança , Regulação Emocional , Humanos , Projetos Piloto , Resultado do Tratamento
4.
Crim Behav Ment Health ; 30(2-3): 141-150, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32483870

RESUMO

Dialectical behaviour therapy (DBT) is a therapy model incorporating elements of Eastern philosophies and cognitive behavioural principles. Originally designed for people struggling with chronic suicidality and borderline personality disorder (BPD), it has been adapted to treat complex, multi-diagnostic presentations, such as those in forensic mental health settings. To date, there has been little evaluation when the primary diagnosis is of psychosis. To explore the effectiveness of DBT, with patients, with multiple comorbidities, including psychosis, in a forensic psychiatric inpatient setting. A descriptive outcome study with a cohort of offender-patients in one specialist forensic mental health unit. Before and after treatment change scores were compared on anger, aggression, hopefulness, coping abilities, emotional intelligence, insight and subjective symptom severity scales, as well as staff-rated risk, and length of stay. Nine men and five women residents in one Canadian secure hospital completed a standard DBT programme, and self-ratings, over about 1 year. Scale scores indicated significantly increased insight and acknowledgment of problems. Apparently increased anger and vengeance scores were clinically associated. Independent staff ratings indicated reductions in risk and most patients achieved early release. This study provides support for extension of the use of DBT to offender-patients with psychosis among the complex mix in their presentation. It suggests that a randomised controlled trial with cost-benefit analysis is warranted, as well as further work, to promote understanding of mechanisms of effectiveness.


Assuntos
Transtorno da Personalidade Borderline/terapia , Criminosos/psicologia , Terapia do Comportamento Dialético/métodos , Psiquiatria Legal/métodos , Prisioneiros/psicologia , Violência/prevenção & controle , Adaptação Psicológica , Adulto , Agressão , Ira , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/psicologia , Canadá , Inteligência Emocional , Emoções , Feminino , Esperança , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Transtornos Psicóticos , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento
5.
Curr Psychiatry Rep ; 22(8): 41, 2020 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-32519017

RESUMO

PURPOSE OF REVIEW: The present review summarizes the current state of the art in psychotherapy processes during treatments for clients with personality disorders. We outline some methodological challenges in the discipline of process research, give a brief historical account on process research, and then focus on specific processes studied from an empirical perspective. RECENT FINDINGS: The current review acknowledges the centrality of the therapeutic relationship, in particular the therapeutic alliance, therapist empathy, and responsiveness in explaining outcome across treatment modalities for personality disorders. The review describes evidence from three overall and overlapping lines of inquiry that have garnered scientific interest in the past years. For emotional change (regulation, awareness, and transformation), socio-cognitive change (mentalizing, meta-cognition, and interpersonal patterns), and increase in insight and change in defense mechanisms, evidence is moderate to strong for these processes to contribute to healthy change in treatments for personality disorders, in particular borderline personality disorder. Avenues of future studies are outlined.


Assuntos
Transtorno da Personalidade Borderline , Psicoterapia , Transtorno da Personalidade Borderline/terapia , Emoções , Humanos , Transtornos da Personalidade/terapia , Processos Psicoterapêuticos
6.
Nervenarzt ; 91(9): 863-871, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32542432

RESUMO

Personality disorders (PD) occur frequently and show high remission rates in the long term, while psychosocial recovery remains unsuccessful in a substantial proportion of cases. In ICD-11 the traditional view that PDs have a high stability is abandoned. Instead, the minimum duration is 2 years. The diagnostic process differentiates between three degrees of severity (mild, moderate, severe) and five prominent personality trait domains. Optionally, a borderline qualifying factor can be additionally codified. There is sufficient empirical evidence only for the treatment of borderline PD (BPD). Disorder-specific psychotherapy, in particular dialectic behavioral therapy (DBT) and mentalization-based therapy (MBT) have proven to be effective. Therapy modules targeting functional impairments and prominent personality trait domains could close the existing gaps in the disorder-specific treatment of PD.


Assuntos
Transtorno da Personalidade Borderline , Classificação Internacional de Doenças , Terapia Comportamental , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/terapia , Humanos , Psicoterapia , Resultado do Tratamento
7.
Cochrane Database Syst Rev ; 5: CD012955, 2020 May 04.
Artigo em Inglês | MEDLINE | ID: mdl-32368793

RESUMO

BACKGROUND: Over the decades, a variety of psychological interventions for borderline personality disorder (BPD) have been developed. This review updates and replaces an earlier review (Stoffers-Winterling 2012). OBJECTIVES: To assess the beneficial and harmful effects of psychological therapies for people with BPD. SEARCH METHODS: In March 2019, we searched CENTRAL, MEDLINE, Embase, 14 other databases and four trials registers. We contacted researchers working in the field to ask for additional data from published and unpublished trials, and handsearched relevant journals. We did not restrict the search by year of publication, language or type of publication. SELECTION CRITERIA: Randomised controlled trials comparing different psychotherapeutic interventions with treatment-as-usual (TAU; which included various kinds of psychotherapy), waiting list, no treatment or active treatments in samples of all ages, in any setting, with a formal diagnosis of BPD. The primary outcomes were BPD symptom severity, self-harm, suicide-related outcomes, and psychosocial functioning. There were 11 secondary outcomes, including individual BPD symptoms, as well as attrition and adverse effects. DATA COLLECTION AND ANALYSIS: At least two review authors independently selected trials, extracted data, assessed risk of bias using Cochrane's 'Risk of bias' tool and assessed the certainty of the evidence using the GRADE approach. We performed data analysis using Review Manager 5 and quantified the statistical reliability of the data using Trial Sequential Analysis. MAIN RESULTS: We included 75 randomised controlled trials (4507 participants), predominantly involving females with mean ages ranging from 14.8 to 45.7 years. More than 16 different kinds of psychotherapy were included, mostly dialectical behaviour therapy (DBT) and mentalisation-based treatment (MBT). The comparator interventions included treatment-as-usual (TAU), waiting list, and other active treatments. Treatment duration ranged from one to 36 months. Psychotherapy versus TAU Psychotherapy reduced BPD symptom severity, compared to TAU; standardised mean difference (SMD) -0.52, 95% confidence interval (CI) -0.70 to -0.33; 22 trials, 1244 participants; moderate-quality evidence. This corresponds to a mean difference (MD) of -3.6 (95% CI -4.4 to -2.08) on the Zanarini Rating Scale for BPD (range 0 to 36), a clinically relevant reduction in BPD symptom severity (minimal clinical relevant difference (MIREDIF) on this scale is -3.0 points). Psychotherapy may be more effective at reducing self-harm compared to TAU (SMD -0.32, 95% CI -0.49 to -0.14; 13 trials, 616 participants; low-quality evidence), corresponding to a MD of -0.82 (95% CI -1.25 to 0.35) on the Deliberate Self-Harm Inventory Scale (range 0 to 34). The MIREDIF of -1.25 points was not reached. Suicide-related outcomes improved compared to TAU (SMD -0.34, 95% CI -0.57 to -0.11; 13 trials, 666 participants; low-quality evidence), corresponding to a MD of -0.11 (95% CI -0.19 to -0.034) on the Suicidal Attempt Self Injury Interview. The MIREDIF of -0.17 points was not reached. Compared to TAU, psychotherapy may result in an improvement in psychosocial functioning (SMD -0.45, 95% CI -0.68 to -0.22; 22 trials, 1314 participants; low-quality evidence), corresponding to a MD of -2.8 (95% CI -4.25 to -1.38), on the Global Assessment of Functioning Scale (range 0 to 100). The MIREDIF of -4.0 points was not reached. Our additional Trial Sequential Analysis on all primary outcomes reaching significance found that the required information size was reached in all cases. A subgroup analysis comparing the different types of psychotherapy compared to TAU showed no clear evidence of a difference for BPD severity and psychosocial functioning. Psychotherapy may reduce depressive symptoms compared to TAU but the evidence is very uncertain (SMD -0.39, 95% CI -0.61 to -0.17; 22 trials, 1568 participants; very low-quality evidence), corresponding to a MD of -2.45 points on the Hamilton Depression Scale (range 0 to 50). The MIREDIF of -3.0 points was not reached. BPD-specific psychotherapy did not reduce attrition compared with TAU. Adverse effects were unclear due to too few data. Psychotherapy versus waiting list or no treatment Greater improvements in BPD symptom severity (SMD -0.49, 95% CI -0.93 to -0.05; 3 trials, 161 participants), psychosocial functioning (SMD -0.56, 95% CI -1.01 to -0.11; 5 trials, 219 participants), and depression (SMD -1.28, 95% CI -2.21 to -0.34, 6 trials, 239 participants) were observed in participants receiving psychotherapy versus waiting list or no treatment (all low-quality evidence). No evidence of a difference was found for self-harm and suicide-related outcomes. Individual treatment approaches DBT and MBT have the highest numbers of primary trials, with DBT as subject of one-third of all included trials, followed by MBT with seven RCTs. Compared to TAU, DBT was more effective at reducing BPD severity (SMD -0.60, 95% CI -1.05 to -0.14; 3 trials, 149 participants), self-harm (SMD -0.28, 95% CI -0.48 to -0.07; 7 trials, 376 participants) and improving psychosocial functioning (SMD -0.36, 95% CI -0.69 to -0.03; 6 trials, 225 participants). MBT appears to be more effective than TAU at reducing self-harm (RR 0.62, 95% CI 0.49 to 0.80; 3 trials, 252 participants), suicidality (RR 0.10, 95% CI 0.04, 0.30, 3 trials, 218 participants) and depression (SMD -0.58, 95% CI -1.22 to 0.05, 4 trials, 333 participants). All findings are based on low-quality evidence. For secondary outcomes see review text. AUTHORS' CONCLUSIONS: Our assessments showed beneficial effects on all primary outcomes in favour of BPD-tailored psychotherapy compared with TAU. However, only the outcome of BPD severity reached the MIREDIF-defined cut-off for a clinically meaningful improvement. Subgroup analyses found no evidence of a difference in effect estimates between the different types of therapies (compared to TAU) . The pooled analysis of psychotherapy versus waiting list or no treatment found significant improvement on BPD severity, psychosocial functioning and depression at end of treatment, but these findings were based on low-quality evidence, and the true magnitude of these effects is uncertain. No clear evidence of difference was found for self-harm and suicide-related outcomes. However, compared to TAU, we observed effects in favour of DBT for BPD severity, self-harm and psychosocial functioning and, for MBT, on self-harm and suicidality at end of treatment, but these were all based on low-quality evidence. Therefore, we are unsure whether these effects would alter with the addition of more data.


Assuntos
Transtorno da Personalidade Borderline/terapia , Psicoterapia/métodos , Adolescente , Adulto , Depressão/terapia , Terapia do Comportamento Dialético/estatística & dados numéricos , Feminino , Humanos , Masculino , Mentalização , Pessoa de Meia-Idade , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Psicoterapia/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento Autodestrutivo/terapia , Suicídio/prevenção & controle , Resultado do Tratamento , Listas de Espera , Adulto Jovem
8.
Curr Psychiatry Rep ; 22(5): 25, 2020 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-32335771

RESUMO

PURPOSE OF REVIEW: We review recent research concerning the diagnosis and treatment of borderline personality disorder (BPD) in young people. We examine evidence for the need to define an appropriate age for detection, and the suitability of current classification methods and treatment. RECENT FINDINGS: Evidence supports early detection and intervention for subsyndromal borderline pathology or categorical BPD across an extended developmental period. A range of structured treatments are effective for BPD in young people, although the role of treatment components in successful outcomes is unclear. Substantial evidence suggests that a stronger focus on functional outcomes, especially social and vocational outcomes, is warranted. Effective treatments for BPD are rarely available internationally. There is a need to assess whether less complex interventions might be developed that are scalable across health systems. A clinical staging model should be considered, addressing clinical distress and co-occurring psychopathology, as well as diagnosis.


Assuntos
Transtorno da Personalidade Borderline , Adolescente , Transtorno da Personalidade Borderline/diagnóstico , Transtorno da Personalidade Borderline/terapia , Diagnóstico Precoce , Humanos , Psicopatologia , Resultado do Tratamento
9.
J Consult Clin Psychol ; 88(6): 570-581, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32162931

RESUMO

OBJECTIVE: Suicide remains a leading cause of death in the United States, and recent reports have suggested the suicide rate is increasing. One of the most robust predictors of future suicidal behavior is a history of attempting suicide. Despite this, little is known about the factors that reduce the likelihood of reattempting suicide. This study compares theoretically derived suicide risk indicators to determine which factors are most predictive of future suicide attempts. METHOD: We used data from a randomized, controlled trial comparing 3 forms of dialectical behavior therapy (DBT; Linehan et al., 2015). Participants (N = 97, mean age = 30.3 years, 100% female, 71% White) met criteria for borderline personality disorder and had repeated and recent self-injurious behavior. Assessments occurred at 4-month intervals throughout 1 year of treatment and 1 year of follow-up. Time-lagged generalized linear mixed models (GLMMs) were used to evaluate relationship satisfaction, emotion dysregulation, and coping styles as predictors of suicide attempts. RESULTS: Both univariate and multivariate models suggested that higher between-person variance in problem-focused coping and lack of access to emotion regulation strategies were weakly associated with additional suicide attempts over the 2-year study. Within-person variance in the time-lagged predictors was not associated with subsequent suicide attempts. CONCLUSIONS: Among individuals with a recent suicide attempt, problem-focused coping and specific deficits in emotion regulation may differentiate those likely to reattempt from those who stop suicidal behavior during and after psychotherapy. These results suggest that treatments for recent suicide attempters should target increasing problem-focused coping and decreasing maladaptive emotion regulation skills. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Transtorno da Personalidade Borderline/psicologia , Comportamento Autodestrutivo/psicologia , Ideação Suicida , Tentativa de Suicídio/psicologia , Adaptação Psicológica/fisiologia , Adolescente , Adulto , Transtorno da Personalidade Borderline/terapia , Terapia do Comportamento Dialético , Regulação Emocional/fisiologia , Feminino , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
10.
Expert Opin Pharmacother ; 21(1): 47-61, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31693423

RESUMO

Introduction: The treatment of borderline personality disorder (BPD) remains an open question for clinicians. There is scarce evidence available and the guidelines' conclusions diverge. Together with these factors, the complexity of BPD generates uncertainty in day-to-day practice. This narrative review aims to provide an overview of advances in BPD treatment and posit a critical opinion based on clinical evidence and practice.Areas covered: The authors review the clinical trials concerning the efficacy of the main classes of drugs in BPD: antidepressants, mood stabilizers, first-, second-, and third-generation antipsychotics, and other agents (opiate antagonists, clonidine, oxytocin, omega-3 fatty acids). They also include in this review studies on combinations of drugs and psychotherapies.Expert opinion: An individualized, tailored pharmacotherapy for BPD that targets the prominent symptom clusters can improve relevant aspects of the clinical picture. However, no medication is indicated to treat the global psychopathology of BPD. Polypharmacy should be avoided or strictly limited. To date, pharmacotherapy alone does not suffice to manage the complexity of BPD. Combining medication with psychotherapy may improve specific BPD symptom dimensions. In particular, it may help those aspects that respond slowly or not at all to monotherapy.


Assuntos
Transtorno da Personalidade Borderline/terapia , Psicoterapia/métodos , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Antimaníacos/uso terapêutico , Antipsicóticos/uso terapêutico , Ácidos Graxos Ômega-3/uso terapêutico , Humanos , Polimedicação
11.
Alcohol Res ; 40(1)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886107

RESUMO

Alcohol use disorder (AUD) frequently co-occurs with other psychiatric disorders, including personality disorders, which are pervasive, persistent, and impairing. Personality disorders are associated with myriad serious outcomes, have a high degree of co-occurrence with substance use disorders, including AUD, and incur significant health care costs. This literature review focuses on co-occurring AUD and personality disorders characterized by impulsivity and affective dysregulation, specifically antisocial personality disorders and borderline personality disorders. Prevalence rates, potential explanations and causal models of co-occurrence, prognoses, and the status of existing treatment research are summarized. Several important future research considerations are relevant to these complex, co-occurring conditions. Research assessing mechanisms responsible for co-occurring AUD and antisocial personality disorder or borderline personality disorder will further delineate the underlying developmental processes and improve understanding of onset and courses. In addition, increased focus on the efficacy and effectiveness of treatments targeting underlying traits or common factors in these disorders will inform future prevention and treatment efforts, as interventions targeting these co-occurring conditions have relatively little empirical support.


Assuntos
Alcoolismo/epidemiologia , Transtorno da Personalidade Antissocial/epidemiologia , Transtorno da Personalidade Borderline/epidemiologia , Alcoolismo/psicologia , Alcoolismo/terapia , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Antipsicóticos/uso terapêutico , Transtorno da Personalidade Antissocial/psicologia , Transtorno da Personalidade Antissocial/terapia , Terapia Comportamental , Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Comorbidade , Humanos , Comportamento Impulsivo , Transtornos da Personalidade/classificação , Transtornos da Personalidade/diagnóstico , Prognóstico
14.
Psychiatr Danub ; 31(Suppl 3): 282-289, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488741

RESUMO

Emotionally Unstable Personality Disorder (EUPD) causes significantly impaired personality functioning to include feeling of emptiness, lack of identity, unstable mood and relationships, intense fear of abandonment and dangerous impulsive behaviour including severe episodes of self-harm. The vast majority of EUPD patients are managed in the community, and have less contact with specialist psychiatric services when compared to patients with other mental illnesses. Despite the burden of this condition on primary care, the academic literature focuses on EUPD in psychiatric inpatients. This paper therefore aims to redress this balance through, first, establishing the key themes present in the available body of work on EUPD in the community, and second, highlighting areas for future research. Further, in the spirit of reducing stigma surrounding mental illness, the authors present a novel and non-pejorative toolkit for the recognition of EUPD in primary care.


Assuntos
Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Atenção Primária à Saúde , Sintomas Afetivos , Humanos , Características de Residência , Comportamento Autodestrutivo , Estigma Social
15.
Psychiatr Danub ; 31(Suppl 3): 626-631, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31488804

RESUMO

BACKGROUND: Springbank Ward, Fulbourn Hospital, Cambridgeshire and Peterborough NHS Foundation Trust, is a Borderline Personality Disorder (BPD) unit employing positive risk-taking, allowing for relevant psychological therapies to be carried out. The aim of this survey was to identify staff and patient attitudes to Springbank Ward. Previous research has not addressed the question of patient and staff perception of these therapeutic approaches. SUBJECTS AND METHODS: We used a qualitative open-ended semi-structured survey of staff and patients (n=2+4, respectively). We gathered information on the perception of the unit, staff, safety and the positive and negative aspects of the ward. Interview transcripts and participation notes were coded and categorised for emerging themes. RESULTS: The four main themes were: views on the unit: 'safe space', 'opportunity', 'community'; views on the programme: 'successful', 'skills-based', involving patients in their own recovery; views on staff: important part of the therapeutic process by delivering elements of dialectical behaviour therapy (DBT); views on safety: patients and staff feel safe in the context of positive risk-taking. CONCLUSIONS: The long-term therapeutic programme offered at Springbank is perceived positively by both patients and staff. Involving patients actively in their recovery remains a powerful tool. The delivery of DBT by nursing staff contributes significantly to the positive perception of the unit. Positive risk-taking is perceived to be a good and safe strategy.


Assuntos
Atitude do Pessoal de Saúde , Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Unidades Hospitalares , Satisfação do Paciente , Pesquisa Qualitativa , Inquéritos e Questionários , Terapia do Comportamento Dialético , Unidades Hospitalares/normas , Humanos
16.
J Consult Clin Psychol ; 87(11): 975-988, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31556655

RESUMO

OBJECTIVE: To examine conformity to prototypical therapeutic principles and its relation with change in reflective functioning in 3 treatments for borderline personality disorder (BPD). METHOD: Early phase videotaped sessions from a randomized-controlled trial of year-long transference-focused psychotherapy (TFP; n = 27), dialectical behavior therapy (DBT; n = 26), and supportive psychodynamic therapy (SPT; n = 29) were coded using the Psychotherapy Q-sort (Jones, 1985). Ratings were compared to experts' ratings of ideal TFP, DBT, and mentalizing-enhancing principles to quantify conformity to ideal treatments. Reflective functioning was assessed at pre- and posttreatment. Differences among treatments in conformity and its relation with change in reflective functioning were examined. RESULTS: Conformity to TFP and mentalizing-enhancing principles was highest in TFP (ps < .01) while conformity to DBT principles was high in DBT and SPT (DBT vs. SPT: p > .40), but lower in TFP (ps < .01). Larger improvements in reflective functioning were predicted by higher conformity to TFP principles during TFP (p = .04) and higher conformity to mentalizing-enhancing principles during SPT (p = .02). CONCLUSIONS: Treatments for BPD differ in conformity to unique principles of specific modalities. Treatments also differ in the processes that predict increase in reflective functioning. The findings point to specificity and multiple pathways in increasing reflective functioning in the treatment of BPD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Fidelidade a Diretrizes , Psicoterapia/métodos , Adulto , Terapia Comportamental/métodos , Feminino , Humanos , Masculino , Mentalização , Pessoa de Meia-Idade , Transferência Psicológica , Resultado do Tratamento , Adulto Jovem
17.
Addict Sci Clin Pract ; 14(1): 28, 2019 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-31412957

RESUMO

BACKGROUND: Treating severe emotional dysregulation and co-occurring substance misuse is challenging. Dialectical behaviour therapy (DBT) is a comprehensive and evidence-based treatment for borderline personality disorder (BPD). It has been hypothesised that the skills training, which is a facet of the full DBT programme, might be effective for people with severe emotional dysregulation and other co-occurring conditions, but who do not meet the criteria for BPD. However, there is limited research on standalone DBT skills training for people with substance misuse and emotional dysregulation. METHODS: A mixed methods study employing an explanatory sequential design was conducted where participants with a dual diagnosis (n = 64) were recruited from a community-based public addiction treatment service in Ireland between March 2015 and January 2018. DBT therapists screened potential participants against the study eligibility criteria. Quantitative self-report measures examining emotion regulation, mindfulness, adaptive and maladaptive coping responses including substance misuse, and qualitative feedback from participants were collected. Quantitative data were summarised by their mean and standard deviation and multilevel linear mixed effects models were used to estimate the mean change from baseline to post-intervention and the 6-month follow-up period. Thematic analysis was used to analyse the qualitative data. RESULTS: Quantitative results indicated reductions in binge drinking and use of Class A, B and C drug use from pre-intervention (T1) to the 6-month follow-up (T3). Additionally, significant improvements were noted for mindfulness practice and DBT skills use from T1 to T3 (p < 0.001). There were also significant reductions in dysfunctional coping and emotional dysregulation from T1 to T3 (p < 0.001). Significant differences were identified from pre to post intervention in reported substance use, p = 0.002. However, there were no significant differences between pre-intervention and 6-month follow up reports of substance use or at post-intervention to 6 month follow up. Qualitative findings indicated three superordinate themes in relation to participants' experiences of a DBT skills training programme, adapted from standard DBT: (1) new lease of life; (2) need for continued formal aftercare and (3) programme improvements. Participants described reductions in substance misuse, while having increased confidence to use the DBT skills they had learned in the programme to deal with difficult emotions and life stressors. CONCLUSIONS: This DBT skills training programme, adapted from standard DBT, showed positive results for participants and appears effective in treating people with co-occurring disorders. Qualitative results of this mixed methods study corroborate the quantitative results indicating that the experiences of participants have been positive. The study indicates that a DBT skills programme may provide a useful therapeutic approach to managing co-occurring symptoms.


Assuntos
Transtorno da Personalidade Borderline/terapia , Terapia do Comportamento Dialético/métodos , Transtornos Relacionados ao Uso de Substâncias/terapia , Adaptação Psicológica , Adulto , Diagnóstico Duplo (Psiquiatria) , Emoções , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Plena
18.
Brain Behav ; 9(9): e01384, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31414575

RESUMO

INTRODUCTION: Individualized treatment prediction is crucial for the development and selection of personalized psychiatric interventions. Here, we use random forest classification via pretreatment clinical and demographical (CD), functional, and structural magnetic resonance imaging (MRI) data from patients with borderline personality disorder (BPD) to predict individual treatment response. METHODS: Before dialectical behavior therapy (DBT), 31 female patients underwent functional (three different emotion regulation tasks) and structural MRI. DBT response was predicted using CD and MRI data in previously identified anatomical regions, which have been reported to be multimodally affected in BPD. RESULTS: Amygdala and parahippocampus activation during a cognitive reappraisal task (in contrasts displaying neural activation for emotional challenge and for regulation), along with severity measures of BPD psychopathology and gray matter volume of the amygdala, provided best predictive power with neuronal hyperractivities in nonresponders. All models, except one model using CD data solely, achieved significantly better accuracy (>70.25%) than a simple all-respond model, with sensitivity and specificity of >0.7 and >0.7, as well as positive and negative likelihood ratios of >2.74 and <0.36 each. Surprisingly, a model combining all data modalities only reached rank five of seven. Among the functional tasks, only the activation elicited by a cognitive reappraisal paradigm yielded sufficient predictive power to enter the final models. CONCLUSION: This proof of principle study shows that it is possible to achieve good predictions of psychotherapy outcome to find the most valid predictors among numerous variables via using a random forest classification approach.


Assuntos
Transtorno da Personalidade Borderline/fisiopatologia , Transtorno da Personalidade Borderline/terapia , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Terapia do Comportamento Dialético/métodos , Imagem por Ressonância Magnética/métodos , Adulto , Mapeamento Encefálico/métodos , Feminino , Humanos , Imagem Multimodal , Neuroimagem/métodos , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Resultado do Tratamento
19.
Psychiatry Res ; 280: 112485, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31408773

RESUMO

Borderline personality disorder (BPD) is a psychological disorder characterized by dysregulation across multiple domains. While selected mindfulness-based interventions are effective in addressing symptoms of BPD, less is known regarding the effects of engaging in brief mindfulness practices on affective correlates of BPD. The present study investigated the effects of engaging in brief, daily mindfulness practice in a sample of young adults with elevated BPD symptoms. Ninety-two participants were recruited and randomly assigned to 2 weeks of daily mindfulness meditation or relaxation practice (active control), or to a no-practice control condition. Participants completed measures assessing depression, anxiety, stress, shame, difficulties with emotion regulation, trait mindfulness, and self-compassion before and after the practice period. Compared to the no-practice control condition, mindfulness practice resulted in significant improvements in trait mindfulness and self-compassion, whereas relaxation practice led to reductions in emotion regulation difficulties. No significant differences were found on any of the other outcomes between the mindfulness and relaxation conditions. The findings suggest that while both mindfulness and relaxation-based practices are effective in targeting selected transdiagnostic processes associated with BPD, more intensive interventions may be required for the practices to induce changes at the level of psychological symptoms.


Assuntos
Afeto/fisiologia , Transtorno da Personalidade Borderline/psicologia , Transtorno da Personalidade Borderline/terapia , Atenção Plena/métodos , Adulto , Transtorno da Personalidade Borderline/diagnóstico , Feminino , Humanos , Masculino , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
20.
Artigo em Russo | MEDLINE | ID: mdl-31329185

RESUMO

BACKGROUND: Child disability, especially as a result of nervous system diseases, affects all aspects of family life, causing extreme emotional and physical exhaustion in parents. However, today there is not enough scientific evidence on the features of development of nonpsychotic mental disorders in parents raising children with cerebral palsy and on the possibilities of using modern physiotherapy methods to correct these conditions and comorbidities. Considering that sanatorium-resort rehabilitation in children with cerebral palsy is accompanied by their parents, it is urgent to optimize clinical and functional approaches to treating mothers with borderline mental disorders with the simultaneous rehabilitation of children in sanatorium-resort conditions. AIM: To study the efficiency of sanatorium-resort treatment aimed at the psychological correction of mothers accompanying children with cerebral palsy to a sanatorium. MATERIAL AND METHODS: The study enrolled 151 mothers who had borderline mental disorders and raised children with cerebral palsy. A study group included 103 women aged 33.2±0.6 years; a comparison group consisted of 48 mothers aged 31.8±0.5 years. The examination was conducted before sanatorium-resort treatment and after a therapy cycle. The mothers underwent clinical and psychodiagnostic examinations via the standardized Minnesota Multiphasic Personality Inventory (a short form) MMPI-mini (adapted by L.N. Sobchik, 2000); emotional and motivational sphere study the WAM (well-being, activity, mood) questionnaire, the Spielberger-Khanin Inventory, and the Depression Rating Scale (adapted by T.I. Balashova). The patients of both groups received combination treatment: the comparison group (n=48) had a general sanatorium-resort therapeutic complex and group psychotherapy; the study group (n=103) additionally took valerian-bromine baths based on sodium chloride water with a mineralization of 20 g/dm3), and a transcranial magnetic therapy cycle. RESULTS: The general sanatorium-and-resort complex with psychotherapy predominantly affected the quality of night sleep (p<0.01) and reduced personality disorders according to the hypochondria scale (from 74.60±7.52 to 52.91±4.04 scores, p<0.01). The additional use of transcranial magnetic therapy and valerian-bromine baths based on sodium chloride water in the mothers had a psychocorrecting effect recorded according to basic (hysteria, psychopathy, psychasthenia) scales. Reduced depression was noted in 36.4% of the mothers (7% in the comparison group). CONCLUSION: Transcranial magnetic therapy used in combination with valerian-bromine baths based on sodium chloride water and with psychotherapy in mothers with borderline mental disorders, by taking into account psychological dysregulation, contributed to increases in the body's clinical and functional reserves within 6-8 months and to the preservation of psychological adaptation in 54.7% of cases. Incorporation of a maternal psychocorrective complex into the sanatorium-resort treatment of a child with cerebral palsy is a promising method for improving the quality of treatment outcomes in a sanatorium.


Assuntos
Balneologia/métodos , Transtorno da Personalidade Borderline/terapia , Paralisia Cerebral/reabilitação , Mães/psicologia , Modalidades de Fisioterapia , Adulto , Criança , Feminino , Humanos , Mães/estatística & dados numéricos , Resultado do Tratamento
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