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.

Prediction of Diagnostic Evolution of Borderline Personality Disorder in Andalusia (Spain)

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
A. Fontalba-Navas ◽  
J.M. Pena-Andreu ◽  
A. Rodriguez-Rosado ◽  
M.I. Rodriguez-Idigoras ◽  
J.L. Martinez-Gonzalez
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Linear Regression ◽  
Personality Disorders ◽  
Statistical Significance ◽  
Borderline Personality ◽  
List Type ◽  
Main Research ◽  
Psychiatric Admissions ◽  
Number Of Patients

Introduction:Along last years psychiatric literature has shown an increased interest about Borderline Personality Disorder (BPD) diagnosis. Nevertheless, few studies in large samples has been developed in our country. This study is a part of a main research: Personality Disorders in Andalusian Community. Diagnostic evolution and its link with use of health services.Objectives:•To study BPD diagnosis in Andalusian inpatients throughout the last 10 years.•To establish a predictive model analyzing the BPD diagnostic evolution.Method:The information has been obtained from the Basic Information Minimum Set: A record of admissions (with clinical and demographic variables) registered in the Andalusian population. We made an observational naturalistic study about the number of inpatients with BPD diagnosis, and an analytical study (Linear Regression) to determine the trend marked in the last years about evolution in the diagnosis of inpatients with Personality Disorders (PD).Results:The number of total psychiatric admissions was 99444 (64968 inpatients): 10755 records had a Personality Disorder (PD) diagnosis.The number of patients with BPD diagnosis has increased from 75 in 1995 to 340 in 2004 (11,8% to 26,13% over percentage of PD). the linear regression had a thread of 0,95, with a determination coefficient of 91,6% (standard error 0,34), with statistical significance (p = 0,00), establishing a prediction linear model about the increase of inpatients with BPD diagnosis.Conclusions:1.The number of inpatients with BPD diagnosis in Andalusia is increasing over last years.2.The model predicts a growing of BPD diagnosis along next years.

Emotion-Oriented Coping Style Predicts Self-Harm in Response to Acute Psychiatric Hospitalization

Crisis ◽  
2020 ◽  
pp. 1-7
Author(s):  
Jacqueline M. Frei ◽  
Vladimir Sazhin ◽  
Melissa Fick ◽  
Keong Yap
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychiatric Hospitalization ◽  
Coping Styles ◽  
Psychiatric Inpatients ◽  
Borderline Personality ◽  
Self Report ◽  
Therapeutic Interventions ◽  
Coping Behaviors ◽  
Self Harm

Abstract. Psychiatric hospitalization can cause significant distress for patients. Research has shown that to cope with the stress, patients sometimes resort to self-harm. Given the paucity of research on self-harm among psychiatric inpatients, a better understanding of transdiagnostic processes as predictors of self-harm during psychiatric hospitalization is needed. The current study examined whether coping styles predicted self-harm after controlling for commonly associated factors, such as age, gender, and borderline personality disorder. Participants were 72 patients (mean age = 39.32 years, SD = 12.29, 64% male) admitted for inpatient treatment at a public psychiatric hospital in Sydney, Australia. Participants completed self-report measures of coping styles and ward-specific coping behaviors, including self-harm, in relation to coping with the stress of acute hospitalization. Results showed that younger age, diagnosis of borderline personality disorder, and higher emotion-oriented coping were associated with self-harm. After controlling for age and borderline personality disorder, higher levels of emotion-oriented coping were found to be a significant predictor of self-harm. Findings were partially consistent with hypotheses; emotion-oriented but not avoidance-oriented coping significantly predicted self-harm. This finding may help to identify and provide psychiatric inpatients who are at risk of self-harm with appropriate therapeutic interventions.

Rumination in Borderline Personality Disorder: Meta-Analysis

2018 ◽  
Author(s):  
Mara J. Richman ◽  
Zsolt Unoka ◽  
Robert Dudas ◽  
Zsolt Demetrovics
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Emotion Dysregulation ◽  
Meta Analysis ◽  
Borderline Personality ◽  
Therapeutic Interventions ◽  
Sample Type ◽  
Moderator Variables ◽  
Analytic Review ◽  
Self Harm

Borderline personality disorder (BPD) is characterized by deficits in emotion regulation and affective liability. Of this domain, ruminative behaviors have been considered a core feature of emotion dysregulation difficulties. Despite this, inconsistencies have existed in the literature regarding which rumination type is most prominent in those with BPD symptoms. Moreover, no meta-analytic review has been performed to date on rumination in BPD. Taking this into consideration, a meta-analysis was performed to assess how BPD symptoms correlate with rumination, while also considering clinical moderator variables (i.e., BPD symptom domain, co-morbidities, GAF score) and demographic moderator variables (i.e., age, gender, sample type, and education level). Analysis of correlation across rumination domains for the entire sample revealed a medium overall correlation between BPD symptoms and rumination. When assessing types of rumination, the largest correlation was among pain rumination followed by anger, depressive, and anxious rumination. Among BPD symptom domain, affective instability had the strongest correlation with increased rumination, followed by unstable relationships, identity disturbance, and self-harm/ impulsivity, respectively. Demographic variables showed no significance. Clinical implications are considered and further therapeutic interventions are discussed in the context of rumination.

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.

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

Aggressive behavior and self-harm in Borderline Personality Disorder: The role of impulsivity and emotion dysregulation in a sample of outpatients

2017 ◽  
Vol 249 ◽  
pp. 321-326 ◽  
Author(s):  
Laura Terzi ◽  
Francesca Martino ◽  
Domenico Berardi ◽  
Biancamaria Bortolotti ◽  
Anna Sasdelli ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Aggressive Behavior ◽  
Emotion Dysregulation ◽  
Borderline Personality ◽  
Self Harm
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