Inpatient treatment of borderline personality disorder in adults with intellectual disability: reflections on practice

2019 ◽  
Vol 13 (2) ◽  
pp. 67-75
Author(s):  
Trine Elisabeth Iversen ◽  
Kristin Horndalsveen ◽  
Espen Matre ◽  
Tine Finstad Henriksen ◽  
Sarah Fusche ◽  
...  
Keyword(s):  
Mental Health ◽  
Intellectual Disability ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Inpatient Treatment ◽  
Borderline Personality ◽  
Behaviour Problems ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Content Type

Purpose There are few publications on personality disorder in adults with intellectual disability (ID), and on borderline personality disorder (BPD) specifically. Publications concerning treatment are sparse, despite the high symptom burden in these patients. This paper aims to discuss these issues. Design/methodology/approach Six patients with BPD and ID were recruited from the same inpatient unit. Behaviour problems and mental health symptoms were scored on admission and discharge. Information about treatment, length of stay, etc. was taken from case files. Findings Both mental health symptoms measured by the SCL-90-R, and behaviour problems measured by the Aberrant Behaviour Checklist were significantly reduced on discharge. In the active treatment period, the two main aspects of treatment were validation and practicing new solutions when emotional and behavioural problems occur, i.e. skills training. Research limitations/implications The limitations related to this study are that the study is conducted in one milieu only. Another limitation is that the patients were admitted over a five-year period, where, some changes were made in the treatment approach. Practical implications Inpatient treatment of this patient group seems to be effective if individually adjusted to the patient’s psychopathology, ID and communication style. Close co-operation between the individual therapist and milieu therapists is essential. Originality/value There is a need for intervention studies on BPD in ID. This study may be a valuable contribution.

scholarly journals Pharmacotherapy of borderline personality disorder: what has changed over two decades? A retrospective evaluation of clinical practice

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Charles Timäus ◽  
Miriam Meiser ◽  
Borwin Bandelow ◽  
Kirsten R. Engel ◽  
Anne M. Paschke ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychotropic Drug ◽  
Inpatient Treatment ◽  
Medical Center ◽  
Borderline Personality ◽  
Mood Stabilizers ◽  
Main Diagnosis ◽  
Tetracyclic Antidepressants ◽  
Prescription Rates

Abstract Background The purpose of this study was to assess the pharmacological treatment strategies of inpatients with borderline personality disorder between 2008 and 2012. Additionally, we compared pharmacotherapy during this period to a previous one (1996 to 2004). Methods Charts of 87 patients with the main diagnosis of borderline personality disorder receiving inpatient treatment in the University Medical Center of Goettingen, Germany, between 2008 and 2012 were evaluated retrospectively. For each inpatient treatment, psychotropic drug therapy including admission and discharge medication was documented. We compared the prescription rates of the interval 2008–2012 with the interval 1996–2004. Results 94% of all inpatients of the interval 2008–2012 were treated with at least one psychotropic drug at time of discharge. All classes of psychotropic drugs were applied. We found high prescription rates of naltrexone (35.6%), quetiapine (19.5%), mirtazapine (18.4%), sertraline (12.6%), and escitalopram (11.5%). Compared to 1996–2004, rates of low-potency antipsychotics, tri−/tetracyclic antidepressants and mood stabilizers significantly decreased while usage of naltrexone significantly increased. Conclusions In inpatient settings, pharmacotherapy is still highly prevalent in the management of BPD. Prescription strategies changed between 1996 and 2012. Quetiapine was preferred, older antidepressants and low-potency antipsychotics were avoided. Opioid antagonists are increasingly used and should be considered for further investigation.

Primary care and suicidality among psychiatric outpatients: The patient-doctor relationship matters

2020 ◽  
pp. 009121742097799
Author(s):  
Krista Schultz ◽  
Sharan Sandhu ◽  
David Kealy
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Primary Care Physician ◽  
Population Based ◽  
Borderline Personality ◽  
Care Physician ◽  
Cross Sectional

Objective The purpose of the current study is to examine the relationship between the quality of the Patient-Doctor Relationship and suicidality among patients seeking mental health care; specifically, whether patients who perceive having a more positive relationship with primary care physician will have lower levels of suicidality. Method Cross-sectional population-based study in Greater Vancouver, Canada. One-hundred ninety-seven participants were recruited from three Mental Health Clinics who reported having a primary care physician. Participants completed a survey containing questions regarding items assessing quality of Patient-Doctor Relationship, general psychiatric distress (K10), borderline personality disorder, and suicidality (Suicidal Behaviours Questionnaire-Revised-SBQ-R). Zero-order correlations were computed to evaluate relationships between study variables. Hierarchical regression analysis was used to control for confounding variables. Results The quality of the patient doctor relationship was significantly negatively associated with suicidality. The association between the quality of the patient-doctor relationship and suicidality remained significant even after controlling for the effects of psychiatric symptom distress and borderline personality disorder features. Conclusions The degree to which patients’ perceive their primary care physician as understanding, reliable, and dedicated, is associated with a reduction in suicidal behaviors. Further research is needed to better explicate the mechanisms of this relationship over time.

Predicting recidivism for offenders in UK substance dependence treatment: do mental health symptoms matter?

2014 ◽  
Vol 4 (2) ◽  
pp. 102-115 ◽  
Author(s):  
Josefien J.F. Breedvelt ◽  
Lucy V. Dean ◽  
Gail Y. Jones ◽  
Caroline Cole ◽  
Hattie C.A. Moyes
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Substance Dependence ◽  
Mental Health Symptoms ◽  
Health Symptoms ◽  
Content Type ◽  
Health Factors ◽  
Substance Dependence Treatment ◽  
One Year ◽  
Mental Health Factors

Purpose – The purpose of this paper is to assess whether mental health symptoms affect one-year reoffending rates upon release from prison for participants engaging in substance dependence treatment in the UK. Design/methodology/approach – A retrospective cohort study was used to assess reconviction outcomes upon release. The Comprehensive Addiction and Psychological Evaluation (CAAPE) was administered to 667 inmates admitted to the programme. The effect of mental health, drug use, and static risk factors on reoffending was assessed at one-year post release. Findings – Logistic regression analysis showed that symptoms of Major Depressive Disorder at the start of substance dependence treatment increased the likelihood to reoffend, whilst Obsessive Compulsive Disorder symptoms and length of sentence decreased the likelihood to reoffend. Antisocial Personality Disorder symptoms show a trend towards increasing the likelihood to reoffend. In addition, previously established risk factors for reoffending, including dependence on heroin, crack/cocaine, and poly drug use significantly increased the likelihood of reconviction. Practical implications – Depressive symptomatology pre-treatment could affect reoffending outcomes for participants in substance dependence treatment in prison. An integrative approach addressing both substance misuse and mental health factors is pivotal. Future efforts to address both simultaneously can be made to improve assessment, training, treatment, and through care for prisoners in substance dependence treatment. Originality/value – Few studies have assessed the effect of mental health factors on reoffending outcomes for offenders in substance dependence treatment. A large sample was studied in an understudied population of UK prisoners in substance dependence treatment. The results have implications for clinical settings where mental health symptoms are not addressed concurrently with substance dependence. This finding can inform policy makers and practitioners who provide substance dependence treatment in prison.

Effects of a modified DBT Skills Group for military personnel and Veterans with OSIs and borderline personality disorder or traits

2021 ◽  
pp. e20190067
Author(s):  
Pamela L. Holens ◽  
Jeremiah N. Buhler ◽  
Stephanie Yacucha ◽  
Alyssa Romaniuk ◽  
Brent Joyal
Keyword(s):  
Mental Health ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Military Personnel ◽  
Group Treatment ◽  
Stress Disorder ◽  
Borderline Personality ◽  
Behaviour Therapy ◽  
Negative Thoughts ◽  
Skills Group

LAY SUMMARY This study looked at the use of a group treatment known as dialectical behaviour therapy skills group (DBT-SG) to see if it was helpful for military personnel and veterans who had a variety of mental health disorders related to their service. The results of the study showed improvements in symptoms of borderline personality disorder, reductions in negative thoughts and feelings, and reductions in unhelpful behaviours. Results also showed improvements in all examined areas of functioning among participants, with the largest change occurring in the area of social functioning. The presence of posttraumatic stress disorder (PTSD), depression, or chronic pain did not impact results, but the presence of a substance abuse disorder did. Overall, the results provide preliminary support for DBT-SG as an intervention for borderline personality disorder symptoms among military and veterans, and perhaps particularly for persons who also have other mental health challenges, or persons considered inappropriate for other treatment.

Evaluation of a novel risk assessment method for self-harm associated with Borderline Personality Disorder

2017 ◽  
Vol 25 (5) ◽  
pp. 460-465 ◽  
Author(s):  
Sathya Rao ◽  
Jillian H Broadbear ◽  
Katherine Thompson ◽  
Anna Correia ◽  
Martin Preston ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Assessment ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Case Vignette ◽  
Management Options ◽  
Specific Risk ◽  
Self Harm ◽  
Chronic Risk

Objectives: Borderline personality disorder (BPD) is associated with frequent self-harm and suicidal behaviours. This study compared physician-assessed self-harm risk and intervention choice according to a (i) standard risk assessment and (ii) BPD-specific risk assessment methods. Methods: Forty-five junior and senior mental health physicians were assigned to standard or BPD-specific risk training groups. The assessment utilized a BPD case vignette containing four scenarios describing high/low lethality self-harm and chronic/new patterns of self-harm behaviour. Participants chose from among four interventions, each corresponding to a risk category. Results: Standard and BPD-specific groups were alike in their assessment of self-harm risk. Divergence occurred on intervention choice for assessments of low lethality, chronic risk ( p<.01) and high lethality, chronic risk ( p<.005). Overall, psychiatrists were more likely than their junior colleagues to correctly assess risk and management options. Conclusions: Although standard and BPD-specific methods are well aligned for assessing self harm-associated risk, BPD-specific training raised awareness of BPD-appropriate interventions, particularly in the context of chronic patterns of self-harm behaviour. Wider dissemination of BPD-specific risk training may enhance the confidence of mental health clinicians in identifying the nature of self-harm risk as well as the most clinically appropriate interventions for clients with BPD.

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