scholarly journals The outcomes of home treatment for borderline personality disorder

2016 ◽  
Vol 40 (6) ◽  
pp. 306-309 ◽  
Author(s):  
Sibel Turhan ◽  
Mark Taylor
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Service Use ◽  
Scientific Evidence ◽  
Borderline Personality ◽  
Home Treatment ◽  
High Rate ◽  
Crisis Resolution ◽  
Treatment Services ◽  
Number Of Patients

Aims and methodThere is currently no trial or other scientific evidence informing the efficacy of any crisis intervention for people with borderline personality disorder (BPD). We aimed to assess the patterns of service use by patients with BPD taken on for crisis resolution and home treatment between 2010 and 2013. Patients with a diagnosis of BPD were identified and demographic and clinical data were collected.ResultsAll patients were female, and a high proportion had recurrent presentations to crisis and home treatment services in Edinburgh. Many appeared to benefit from intensive home treatment, as measured by the Clinical Global Impression scale. A small number of patients (n = 5) were responsible for more than half of all referrals. Polypharmacy, or regular use of multiple medications, was common, with 62% of all patients receiving three or more regular medications.Clinical implicationsCrisis and home treatment services can be beneficial to most people with BPD in crisis. The high rate of polypharmacy seen in this study is of concern.

All-Cause Mortality of Hospital-Treated Borderline Personality Disorder: A Nationwide Cohort Study

2020 ◽  
Vol 34 (6) ◽  
pp. 723-735 ◽  
Author(s):  
Jesper N⊘rgaard Kjær ◽  
Robert Biskin ◽  
Claus Vestergaard ◽  
Povl Munk-J⊘rgensen
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mortality Rate ◽  
Borderline Personality ◽  
High Rate ◽  
Standardized Mortality Ratio ◽  
Central Research ◽  
Emergency Rooms ◽  
Icd 10 ◽  
Mortality Ratio

Patients with borderline personality disorder (BPD) are known to present frequently in emergency rooms, and they have a high rate of suicide. The mortality rate of patients with BPD is still unclear. The Danish Psychiatric Central Research Register and The Danish Register for Causes of Death were used to identify patients with a first-ever diagnosis of BPD (ICD-10: F60.31) from 1995 through 2011 together with time and cause of death. A total of 10,545 patients with a BPD diagnosis were followed for a mean time of 7.98 years. A total of 547 deaths were registered. The standardized mortality ratio of patients with BPD compared to the general population was 8.3 (95% CI [7.6, 9.1]). More than three inpatient admissions per year or a comorbid diagnosis of substance use disorder correlated with a higher mortality rate. The increased mortality rate in patients with BPD treated in secondary care emphasizes that it is a severe mental disorder.

Part 2: Borderline Personality Disorder and Its Clinical Management

2017 ◽  
Author(s):  
Robert Biskin ◽  
Joel Paris
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Behavior Therapy ◽  
Dialectical Behavior Therapy ◽  
Service Use ◽  
Age Groups ◽  
Borderline Personality ◽  
Stepped Care ◽  
Care Models ◽  
Self Harm

The treatment of patients with borderline personality disorder (BPD) has changed significantly over the past 25 years. The previous therapeutic pessimism about BPD treatment outcomes has become more optimistic with the development of a variety of specialized psychotherapies that have been shown to reduce self-harm, suicidality, and health service use as well as improve overall psychopathology. Dialectical behavior therapy was the first evidence-supported treatment, but it has been joined by mentalization-based psychotherapy and a variety of other treatments. Several common factors, including structured treatment approach, are likely important in the effectiveness of these treatments compared with unstructured comparators. Pharmacotherapy serves a more limited role in the treatment of BPD due to many methodological issues in the research and a lack of replication of studies. Judicious and rational use of pharmacotherapy is discussed, as well as suggestions for improving accessibility to specialized psychotherapies through the development of stepped care models. Improving access to care for patients with BPD, throughout all age groups, remains an important next step. This review contains 2 figures, 1 table, and 47 references. Key words: borderline personality disorder, dialectical behavior therapy, mentalization-based treatment, personality disorder, pharmacotherapy, psychotherapy, self-harm

Is Borderline Personality Disorder a Neuroendocrine Disease?

2017 ◽  
Vol 41 (S1) ◽  
pp. S631-S632
Author(s):  
C. Ferreira ◽  
S. Alves ◽  
C. Oliveira ◽  
M.J. Avelino
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Hpa Axis ◽  
Affect Regulation ◽  
Scientific Evidence ◽  
Borderline Personality ◽  
Neuroendocrine System ◽  
Anterior Cingulate ◽  
Serotonergic System ◽  
Cortisol Release

IntroductionBorderline personality disorder (BPD) is a disabling heterogeneous psychiatric disorder characterized by poor affect regulation and impulse control, with a high reactivity and vulnerability to stress. It has been hypothesized that these patients may have a dysregulation of the neuroendocrine system.AimsThe goal of this work is to systematically review the scientific knowledge regarding the role of the neuroendocrine system in the physiopathology of BPD.MethodsThe literature was reviewed by online searching using PubMed®. The authors selected scientific papers with the words “borderline personality disorder” and “neuroendocrine”/“endocrine” in the title and/or abstract, published in English.Results and discussionThere is scientific evidence for an enhanced cortisol release and HPA axis hyperactivity in BPD. The dexamethasone suppression test has been used in BPD, finding high rates of non-suppressors in that sample. There also seems to be a reduced volume of the amygdala and anterior cingulate cortex, suggesting an involvement of those regions in the emotional disturbances in BPD. Symptoms of impulsivity, aggression and suicidal behavior seem to be strongly mediated by the serotonergic system. The available research suggests a serotoninergic dysfunction in BPD, with lower levels of serotonin in those patients.ConclusionsThere seems to be several neuroendocrine changes related to BPD, namely a hyperactivity of the HPA axis with stimulated cortisol release together with disturbances of the serotonergic system. Also some brain structural alterations in BPD are scientifically depicted. Further studies are needed to clarify the neurobiology of BPD improving both psychotherapeutic and psychopharmacological treatment in these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Real-World Effectiveness of Clozapine for Borderline Personality Disorder: Results From a 2-Year Mirror-Image Study

2018 ◽  
Vol 32 (6) ◽  
pp. 823-837 ◽  
Author(s):  
Christopher Rohde ◽  
Christoffer Polcwiartek ◽  
Christoph U. Correll ◽  
Jimmi Nielsen
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Mirror Image ◽  
Image Study ◽  
Psychiatric Admissions ◽  
Number Of Patients ◽  
Second Generation Antipsychotics ◽  
Self Harm ◽  
Bed Days

While some second-generation antipsychotics have shown efficacy on patients with borderline personality disorder (BPD), limited data exist regarding the effect of clozapine. Thus, we aimed to investigate the effects of clozapine on naturalistic outcomes in BPD patients with a 2-year mirror-image model. Among 25,916 patients with BPD, 1,107 redeemed ≥ 1 clozapine prescription. Of these, 18,188 were “specific” BPD patients, and 102 redeemed ≥ 1 clozapine prescription. During a mean observation period of 598.51 days, in all BPD patients, clozapine was associated with a significant reduction in psychiatric admissions from 2.52 (95‥ CI [2.31, 2.78]) to 2.00 (95‥ CI [1.77, 2.23]) admissions (p < .001) and a significant reduction in psychiatric bed-days from 190.08 (95‥ CI [176.84, 203.33]) to 65.95 (95‥ CI [58.27, 73.66]) bed-days (p < .001). Similar findings were found for “specific” BPD patients. The number of patients with intentional self-harm or overdose decreased significantly from 189 to 114 individuals (p < .001) after clozapine initiation. Randomized trials evaluating the risk- benefit ratio of clozapine in patients with severe BPD are warranted.

scholarly journals Negative attitudes towards borderline personality disorder patients in Spanish mental health and primary care services: mHealth, a possible solution? /Actituds negatives envers pacients amb trastorn límit de la personalitat als serveis de salut mental i d’assistència primària espanyols: mHealth, una possible solució?

2017 ◽  
Vol 35 (2) ◽  
pp. 23-37
Author(s):  
Eudald Castell
Keyword(s):  
Mental Health ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mental Health Professionals ◽  
Borderline Personality ◽  
Years Of Experience ◽  
Negative Attitudes ◽  
The Past ◽  
Work Area ◽  
Number Of Patients

Summary. The purpose of this project was to study negative attitudes exhibited by mental health professionals toward patients with Borderline Personality Disorder (BPD) as a function of their work area (general health vs. mental health), profession, the quantity of patients with BPD they have treated over the past year, their number of years of experience in mental health, and their gender. The study used a sample of 310 professionals. We also explored how the professionals’ interest in using an innovative technological application (Medtep DBT) interacted with some of these variables, as well as the potential of the application to help change negative attitudes. Significant differences in attitude were found based on work area, profession, quantity of patients with BPD treated over the past and gender. Furthermore, profession, number of patients and years of experience in mental health determined significant differences in the professionals’ degree of interest in using Medtep DBT. Moreover, those with higher negative attitudes showed less interest in the application and a lesser willingness to try it. These results highlight the need to keep investigating how to improve the attitudes of healthcare professionals, especially nursing staff and family doctors, since they appear to be more susceptible to the development of negative attitudes. As a conclusion, we infer that the lack of empathy towards patients with BPD, the difficulties in their treatment and the years of experience in mental health all act as barriers to the implementation of the application. Resum. L’objectiu d’aquest estudi ha estat investigar les actituds negatives de professionals de la salut mental envers pacients amb Trastorn Límit de la Personalitat (TLP) en funció de la seva àrea de treball, la seva professió, pacients amb TLP tractats al darrer any, anys d’experiència en salut mental i sexe en una mostra de 310 professionals. A més a més s’han explorat, en base a part d’aquestes mateixes variables, el seu interès a usar una aplicació tecnològica innovadora (Medtep DBT) per al tractament d’aquests pacients així com la possibilitat que aquesta servís per a reduir les possibles actituds negatives. S’han trobat diferències significatives en les actituds en funció de l’àrea de treball, la professió, el nombre de pacients amb TLP tractats el darrer any i el sexe. La professió, el nombre de pacients i els anys d’experiència en salut mental també han determinat diferències significatives quant a l’interès a usar Medtep DBT. Aquells professionals amb majors actituds negatives han mostrat un menor interès i una menor disposició a utilitzar l’aplicació. Aquests resultats demostren la necessitat de seguir investigant com millorar les actituds d’aquests professionals, especialment dels d’infermeria i dels metges de capçalera, en ser els més vulnerables a desenvolupar-les. Com a conclusió es poden assenyalar la falta d’empatia envers pacients amb TLP, les dificultats en el seu tractament i els anys d’experiència en salut mental com a barreres en la implementació de l’aplicació. 

Borderline Personality Disorder and Mental Healthcare Service Use Among Adolescents

2013 ◽  
Vol 27 (2) ◽  
pp. 252-259 ◽  
Author(s):  
L. Cailhol ◽  
M. Jeannot ◽  
R. Rodgers ◽  
J. D. Guelfi ◽  
F. Perez-Diaz ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Healthcare Service ◽  
Service Use ◽  
Mental Healthcare ◽  
Borderline Personality ◽  
Healthcare Service Use

Substance Use in Youth With Borderline Personality Disorder

2018 ◽  
Vol 32 (5) ◽  
pp. 603-617
Author(s):  
Franco Scalzo ◽  
Carol A. Hulbert ◽  
Jennifer K. Betts ◽  
Sue M. Cotton ◽  
Andrew M. Chanen
Keyword(s):  
Substance Use ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
General Population ◽  
Help Seeking ◽  
Population Sample ◽  
Borderline Personality ◽  
High Rate ◽  
The Past ◽  
And Gender

Co-occurring substance misuse and borderline personality disorder (BPD) in adults is associated with more severe dysfunction and poorer prognosis than BPD alone. However, it is unknown to what extent substance use in youth with BPD is normative for this age group or pathological. This study compared substance use in 117 help-seeking youth (aged 15–25 years) with their first presentation for treatment of BPD, with an epidemiological general population sample and with healthy, age- and gender-matched controls. Established instruments were used to diagnose BPD and assess substance use. Alcohol dependence, daily tobacco use, and use of illicit substances in the past month were between four and nine times more prevalent in the BPD group than in the general population. Similarly, the prevalence of substance use was disproportionately higher in youth with BPD than in matched controls. The findings indicate a non-normative, alarmingly high rate of substance use among youth with BPD.

scholarly journals Psychotherapy of borderline personality disorder: what is more effective?

2017 ◽  
Vol 25 (4) ◽  
pp. 180-187 ◽  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Scientific Evidence ◽  
Clinical Excellence ◽  
Borderline Personality ◽  
Publication Date ◽  
Comparative Efficacy ◽  
The Third ◽  
Modern Level ◽  
Level Of Knowledge

The selected materials we offer indicate the modern level of knowledge about the effectiveness of different treatment approaches to borderline personality disorder (BPD). The current digest contains three recently published review papers by American, Australian and British researchers. The first paper provides a thorough review of the progress of adult BPD treatments and describes methods and their comparative efficacy drawing on conclusive scientific evidence. The second review targets economic efficacy of different therapies of BPD. The third paper compares the guidelines on BPD given by National Institute for Health and Clinical Excellence with research data. The materials are presented by publication date. (Translated by Elena Mozhaeva).

Borderline personality disorder and mental healthcare service use among adolescents

2011 ◽  
Vol 26 (S2) ◽  
pp. 1012-1012
Author(s):  
L. Cailhol ◽  
M. Jeannot ◽  
R. Rodgers ◽  
J.-D. Guelfi ◽  
F. Perez-Diaz ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Healthcare Service ◽  
Service Use ◽  
Mental Healthcare ◽  
Borderline Personality ◽  
Psychodynamic Therapy ◽  
Research Network ◽  
Treatment Utilization ◽  
Healthcare Service Use

Borderline personality disorder (BPD) is believed to be frequent among adolescents. While several prospective studies have assessed the use of mental health services among adults who suffer from BPD, few studies have provided adolescent data. This paper presents findings from the first assessment point of the European Research Network on Borderline Personality Disorder (EURNET BPD) study. In this study, we described treatment utilization of 85 adolescents with BPD (M = 16.5 years old). In line with adult findings, patients with BPD reported greater mental healthcare service use (outpatient: 98%; inpatient: 79%) compared to controls. Phenothiazine, a sedative neuroleptic, was the most frequently prescribed treatment. 47% of patients received psychotherapy; one-third of these patients received psychodynamic therapy. For all psychopathological variables, patients who received psychotherapy did not differ from those who did not receive psychotherapy; however, psychotherapy was more frequent among females. These data suggest that psychotherapy may be difficult to access for adolescents suffering from BPD, especially males.

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