Psychodynamically Oriented Crisis Hospitalisation and Ambulatory Combination Treatement for Borderline Patients: An Introduction

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Andreoli
Keyword(s):  
Psychodynamic Psychotherapy ◽  
Acute Treatment ◽  
Intervention Program ◽  
Stressful Life Events ◽  
Emergency Services ◽  
Psychiatric Treatment ◽  
Heterogeneous Reaction ◽  
Traumatic Experiences ◽  
List Type ◽  
Borderline Patients

The following educational topics will be carefully addressed:a.to establish a coherent model of the borderline syndrome as a complex, heterogeneous reaction resulting from the interaction of psychobiological vulnerabilities, psychosocial stressors and abnormal mental processes;b.to teach how new data from recent investigations of the clinical course of the borderline crisis are changing our view of both the scopes and the limitations of mental health policies for borderline patients;c.to review the several issues associated with adequate acute service provision for borderline patients in order to define a set of well structured recommendations for good quality, comprehensive emergency services organisation and acute treatment delivery;d.to teach a well structured, simple, cost-effective, easy to implement psychodynamic crisis intervention program with specific accent on: case management, risk management, facilitating an alliance, inactivating pathological personality traits triggered from acute traumatic experiences, empathic exploration of distressing feelings, conveying insight on repetitive patterns of ego syntonic masochistic behaviour, active support for problem solving;e.to teach the main aspects of an innovative brief psychodynamic psychotherapy program (mourning focused psychodynamic psychotherapy) model and its relevance to increased cost-effectiveness of psychiatric treatment among acute patients with borderline emotional crisis triggered from traumatic abandonment and other stressful life events.The course is intended for people with an experience in the field of personality disorders and an interest in combining psychobiological science and psychotherapeutic wisdom to improve acute treatment and psychiatric services.

Specific Pathways From Adverse Experiences to BPD in Adolescence: A Criteria-Based Approach of Trauma

2021 ◽  
pp. 1-17
Author(s):  
Marion Robin ◽  
Marie Douniol ◽  
Alexandra Pham-Scottez ◽  
Ludovic Gicquel ◽  
Veronique Delvenne ◽  
...  
Keyword(s):  
Suicide Attempt ◽  
Emotional Abuse ◽  
Stressful Life Events ◽  
Research Network ◽  
Traumatic Experiences ◽  
Parental Suicide ◽  
Adverse Experiences ◽  
Borderline Patients ◽  
Separation From Parents

Within the European Research Network on BPD (EURNET-BPD; n = 85 BPD adolescents, n = 84 healthy controls, aged 13–19), this study explored the combination of three types of adversity—maltreatment, stressful life events (early separation from parents, parental suicide attempt, parental chronic disease) and parental bonding—as predictors of BPD, on a criteria-based approach. Results indicated that cumulative traumatic experiences largely characterize borderline adolescent's history; and, in the multivariate regression models, all adversity experiences were likely to contribute to BPD symptoms. The role of emotional abuse, parental suicide attempt, and a decrease in paternal level of care were particularly prominent. Moreover, adversities combinations were different for each criterion, suggesting that specific sets of traumatic experiences are leading to BPD. These findings argue for a further criteria-based exploration of trauma in borderline patients, as well as a more accurate and efficient prevention.

Utilization of Emergency Departments for Psychiatric Treatment

1978 ◽  
Vol 23 (3) ◽  
pp. 143-148 ◽  
Author(s):  
G.D. Watson
Keyword(s):  
Emergency Department ◽  
Emergency Services ◽  
Suicide Attempts ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Relevant Literature ◽  
Emergency Department Utilization ◽  
Annual Number ◽  
Personal Distress ◽  
Clinical Records

A survey of four Edmonton hospital emergency department records for a one month period was carried out to determine the frequency of utilization by patients suffering from psychiatric disorders. Male attenders outnumbered females and the majority of patients fell into the 21 — 50 year age range. Alcohol-related illness was almost three times more frequent in males than females, whereas females were more frequently categorized as suffering “personal distress” or presented as suicide attempts. Overall, seventy-three percent of the patients were discharged; of those admitted, females outnumbered males. The changing pattern of emergency department utilization was compared by examining data from one hospital for the years 1972, 1974 and 1976. During this four-year period the annual number of visits by psychiatric patients increased by almost eighty percent, largely due to dramatic increases in alcohol related problems in males and those described as “personal distress” in females. The establishment of intoxication recovery centres in 1973 paralleled a drop in the proportion of patients admitted to inpatient wards for alcohol-related, street drugs and overdose problems. The results of the present survey are compared to those reported in the relevant literature, and the methodological problems encountered in carrying out a retrospective study of emergency services from clinical records are described.

Trauma Focused Psychodynamic Psychotherapy

2021 ◽  
Author(s):  
Frederic Busch ◽  
Barbara Milrod ◽  
Cory Chen ◽  
Meriamne Singer
Keyword(s):  
Traumatic Stress ◽  
Psychodynamic Psychotherapy ◽  
Symptomatic Relief ◽  
Traumatic Experiences ◽  
Veterans Administration ◽  
Post Traumatic Stress ◽  
Interpersonal Engagement ◽  
Post Traumatic ◽  
The Impact ◽  
Insight Into

This book, which operationalizes and articulates in detail a unique, brief, tested psychodynamic psychotherapy for Post-Traumatic Stress Disorder, Trauma Focused Psychodynamic Psychotherapy [TFPP], describes how to perform this helpful treatment. The book provides tailored psychodynamic background that underpins these approaches, and explains the different phases of treatment. Additionally, it articulates common underlying dynamics of PTSD that the treatment commonly addresses in patients to bring about symptomatic relief. TFPP is being tested in two diverse populations: military Veterans with PTSD who are receiving care at three Veterans Administration Hospitals, and also among LGBTQ patients with PTSD. The book is focused on the authors’ experiences treating Veterans and many clinical examples are provided demonstrating how to work with these principles and approaches. In general, patients and therapists have found the treatment to be an extremely useful tool. Veterans have gained insight into the impact of traumatic experiences on various aspects of their lives and had improvements in dissociation, interpersonal engagement, anxiety, and anger/hostility. TFPP appears to be particularly effective for patients with prominent avoidance symptoms and those who are unwilling or unable to recount the details of their trauma directly. Patients have been found to be more affectively engaged and better connected to others (including the therapist) following treatment.

Mental Health Treatment over Time

2018 ◽  
pp. 149-160
Author(s):  
Mary C. Zanarini
Keyword(s):  
Outpatient Treatment ◽  
Mental Health Treatment ◽  
Psychiatric Treatment ◽  
Psychotropic Medications ◽  
Evidence Based ◽  
Outpatient Psychotherapy ◽  
Health Treatment ◽  
Treatment As Usual ◽  
Borderline Patients ◽  
Over Time

At baseline, borderline patients reported using high rates of outpatient treatment and more restrictive forms of treatment, such as inpatient psychiatric treatment. Over time, these rates have declined, particularly for more restrictive and costly forms of treatment. However, high rates of borderline patients remain in outpatient psychotherapy and continue taking standing medications in all major classes of psychotropic medications. Perhaps most concerning is that a substantial percentage of borderline patients have been treated with aggressive polypharmacy (three or more standing medications) despite the health consequences, such as obesity, and despite there being no empirical evidence for this common practice. Evidence-based psychosocial treatments are reviewed, and suggestions are made for treatment as usual.

scholarly journals Approach to stress endocrine response: somatization in the context of gastroenterological symptoms: a systematic review

2019 ◽  
Vol 19 (3) ◽  
pp. 2537-2545
Author(s):  
Gülseren Keskin
Keyword(s):  
Stress Responses ◽  
Stressful Life Events ◽  
Physiological Stress ◽  
Gastrointestinal Symptoms ◽  
Endocrine System ◽  
Traumatic Experiences ◽  
Long Term Effects ◽  
Endocrine Response ◽  
Response To Stress

Background: Stress can be defined as an acute threat to the homeostasis of an organism, and in order to manage stress, and maintain stability, the allostatic systems activate an adaptive response. Stress has been shown to have both short - and long-term effects on the function of the gastrointestinal tract, but long-term exposure to stress is more likely to cause endocrine disorders.Objective: The aim of this study was to investigate the endocrine response to stress, and evaluate the relationship between somatization and gastrointestinal symptoms.Methods: A systematic literature search was conducted on several academic databases, which included, Pubmed, EBSCO and Science Direct. The search was performed using the keywords, “endocrine response to stress”, “somatization” and “gastrointestinal symptoms”. Results: The hypothalamic-pituitary-adrenal (HPA) axis is essential in controlling physiological stress responses. Dysfunction is related to several mental disorders, including anxiety and depression, or somatization. Symptoms associated with genetic, or other traumatic experiences of individuals under stress, can lead to a maladaptive response to stress. These stressful life events were found to be associated with digestive system-related chronic diseases. Gastrointestinal disorders significantly affect millions of people worldwide. Conclusion: This study examined how the endocrine system responds to stress, and the effect this has in causing stress-related gastrointestinal distresses. Our findings indicate that stress-related psychological disorders are strongly associated with the severity of gastrointestinal symptoms.Keywords: Stress, endocrine response, somatization, gastrointestinal symptoms.

scholarly journals Impacts of Stressful Life Events and Traumatic Experiences on Onset of Obsessive-Compulsive Disorder

2020 ◽  
Vol 11 ◽  
Author(s):  
Keitaro Murayama ◽  
Tomohiro Nakao ◽  
Aikana Ohno ◽  
Sae Tsuruta ◽  
Hirofumi Tomiyama ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Life Events ◽  
Clinical Characteristics ◽  
Stressful Life Events ◽  
Stressful Life ◽  
Traumatic Experiences ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Contamination Fear ◽  
Original Meaning

Not a few patients with obsessive-compulsive disorder (OCD) have experienced events that affected the onset. The onset of OCD is not limited to the original meaning of trauma; rather, traumatic experiences such as unexpected exposure to contaminants or various stressful life events often cause the onset of OCD. It would be useful to understand the experiences surrounding the onset, including stressful life events and traumatic experiences, for comprehension of the pathophysiology of OCD. In the present study, we investigated the onset conditions of 281 patients with OCD and compared clinical characteristics among groups with or without stressful life events including traumatic experiences. As a result, 172 (61.2%) participants had experienced various stressful life events, and 98 (34%) participants had had traumatic experiences before the onset. Furthermore, the participants who had had stressful life events showed more contamination/fear symptoms compared with those without such life events. Meanwhile, the patients who had had specific traumatic experiences showed a tendency toward hoarding obsessions. To comprehend the pathophysiology of OCD, it is important to understand the stressful life events that precede its onset.

GXE interaction as a protective factor: 5HTTR and bad environment

2011 ◽  
Vol 26 (S2) ◽  
pp. 2163-2163
Author(s):  
V. Carli ◽  
L. Mandelli ◽  
L. Zaninotto ◽  
V. Gatta ◽  
L. Stuppia ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Protective Factor ◽  
Stressful Life Events ◽  
Traumatic Experiences ◽  
Psychopathological Symptoms ◽  
Gxe Interaction ◽  
Gene Coding ◽  
Genetic Risk Variant ◽  
S Allele ◽  
Childhood Traumas

Early traumatic experiences have been consistently associated with a higher risk to develop psychopathological symptoms in adulthood. Resilience, a trait reflecting tolerance of negative affect, positive acceptance of change and an action-oriented approach to problem solving, has been hypothesized to be a protective factor against stressors. Genetic aspects have been also hypothesized influencing resilience to stress and risk to develop psychopathological symptoms in response to both early and recent adverse events. In particular, a common polymorphism within the gene coding for serotonin transporter (5-HTTLPR s/l) has been consistently associated to the risk to develop depressive-anxious symptoms in response to stressful life events. In the present study we aimed to investigate the role of childhood traumas and 5-HTTLPR on measures of resilience and depression in a sample of individuals at a high risk for psychological distress.A large sample of male prisoners was investigated (n = 1516). 5-HTTLPR genotype was available for 762 individuals. Overall, childhood traumas were significantly correlated to poor resilience and more severe depressive symptoms. 5-HTTLPR genotype did not influence resilience and depressive severity. However, a significant interaction was observed between 5-HTTLPR and childhood traumas on both resilience and depressive severity. Contrary to expectations, s/s individuals exposed to a high number of early traumas had a current higher resilience and less depressive symptoms than l-allele carriers. Present data did not confirm the 5-HTTLPR s-allele as the genetic risk variant for psychopathology in individuals exposed to stressors.

Psychiatric management of drug overdose: Risk factors, diagnosis and treatment

2011 ◽  
Vol 26 (S2) ◽  
pp. 1612-1612
Author(s):  
D. de la Vega Sánchez ◽  
P. Sánchez Páez ◽  
M.R. Gómez Soler ◽  
P. Artieda Urrutia ◽  
J. Gómez Arnau ◽  
...  
Keyword(s):  
Risk Factors ◽  
Personality Disorder ◽  
Suicide Attempt ◽  
Emergency Services ◽  
List Type ◽  
Toxic Substances ◽  
Common Diagnosis ◽  
Psychiatric Units ◽  
Ambulatory Services ◽  
Substance Related Disorders

IntroductionSuicidal behaviours are commonly found at increased rates among individuals with psychiatric disorders.ObjectivesTo identify risk factors of suicide among the population attended in our area, describe the characteristics of the attempt and the management.MethodsReview of the drug overdosings attended in our Hospital from July to December of 2009.ResultsWe identified 112 drug overdosings. 80′4% of the patients had psychiatric history: Mood-Anxiety disorders 60′7%, Substance-Related Disorders 41′1%, Personality disorder 30′4% and Psychotic disorder 10′7. Previous attempts were found in 43′8% of the patients. The most common drug used were benzodiacepines (73% of the cases), followed by antypsychotics (17′9%). Up to 32′1% of the patients used non psychiatric drugs. 64′3% of the patients consumed alcohol and 13′4% cocaine. Moreover, 15′2% of the patients took other toxic substances such us bleach, soap and other chemical products.We did not find significant differences when studying triggers (family, partnership, economical or others)The most common diagnosis was suicide attempt (41′1%), followed by parasuicide attempt. 41′4% of the drug overdosings were not considered as self injurious behavior. 64% were referred to ambulatory services, 22′5% needed hospitalization in psychiatric units, and 5′4 were hospitalized in medical services. Although those diagnosed of personality disorder were more often diagnosed of parasuicide (50% Vs 32′1%), they needed more hospitalizations (41% Vs 21%)Conclusions-Self-injurious behavior is one of the most common causes of consulting in the emergency services.-Patients diagnosed of personality disorder are more commonly hospitalized after making a suicide attempt.

scholarly journals Epidemic Thunderstorm Asthma

2019 ◽  
Vol 34 (s1) ◽  
pp. s7-s7
Author(s):  
Alison McMillan
Keyword(s):  
Emergency Departments ◽  
Public Hospital ◽  
Emergency Services ◽  
Lessons Learned ◽  
List Type ◽  
Hospital Emergency ◽  
Forecasting System ◽  
Management Recommendations ◽  
Hospital Emergency Departments ◽  
Thunderstorm Asthma

Introduction:On November 21 and 22 of 2016, Victoria witnessed an unprecedented epidemic thunderstorm asthma emergency event in size acuity and impact. This scenario was never exercised nor contemplated. The event resulted in a 73% increase in calls to the Emergency Services Telecommunications Authority and 814 ambulance cases in the six hours from 6 pm on November 21, 2016. A 58% increase in people presented to public hospital emergency departments in Melbourne and Geelong on November 21 and 22, 2016 (based on the three-year average). 313 calls were made to the nurse on call from people with breathing, respiratory, and allergy problems (compared to an average of 63 calls for the previous month). Tragically, ten deaths are linked to this event.Methods:A substantial amount of work has been completed, much of which goes towards addressing the Inspector-General for Emergency Management recommendations following a review of the event, including: Release of an epidemic thunderstorm asthma campaign and education programs which were rolled out across Victoria for the community and health professionals from September through November 2017;Development of a new epidemic thunderstorm asthma forecasting system on 1 October 2017 and updated warning protocols during the 2017 grass pollen season;Implementation of a Real-time Health Emergency Monitoring System to alert the department of demands on public hospital emergency departments on the system; andIntroduction of a new State Health Emergency Response Plan in October 2017 to improve coordination and communications before and during a health emergency.Discussion:The presentation will concentrate on the lessons learned more than two years down the track from the event in November 2016.

scholarly journals Unusual presentation of pheochromocytoma: thirteen years of anxiety requiring psychiatric treatment

2018 ◽  
Vol 2018 ◽  
Author(s):  
Catherine Alguire ◽  
Jessica Chbat ◽  
Isabelle Forest ◽  
Ariane Godbout ◽  
Isabelle Bourdeau
Keyword(s):  
Panic Disorder ◽  
Psychiatric Treatment ◽  
Hepatic Metastases ◽  
Panic Attacks ◽  
Benign Tumors ◽  
Common Symptom ◽  
List Type ◽  
Presenting Symptoms ◽  
Severe Anxiety

Summary Pheochromocytoma is a rare tumor of the adrenal gland. It often presents with the classic triad of headache, palpitations and generalized sweating. Although not described as a typical symptom of pheochromocytoma, anxiety is the fourth most common symptom reported by patients suffering of pheochromocytoma. We report the case of a 64 year old man who had severe anxiety and panic disorder as presenting symptoms of pheochromocytoma. After 13 years of psychiatric follow-up, the patient was diagnosed with malignant pheochromocytoma. After surgical resection of his pheochromocytoma and his hepatic metastases, the major panic attacks completely disappeared, the anxiety symptoms improved significantly and the psychiatric medications were stopped except for a very low maintenance dose of venlafaxine. We found in our cohort of 160 patients with pheochromocytoma 2 others cases of apparently benign tumors with severe anxiety that resolved after pheochromocytoma resection. These cases highlight that pheochromocytoma should be included in the differential diagnosis of refractory anxiety disorder. Learning points: Anxiety and panic disorder may be the main presenting symptoms of pheochromocytoma. The diagnosis of pheochromocytoma should be excluded in cases of long-term panic disorder refractory to medications since the anxiety may be secondary to a catecholamine-secreting tumor. Surgical treatment of pheochromocytoma leads to significant improvement of anxiety disorders.

Sign in / Sign up

Export Citation Format

Share Document