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Harvard Review of Psychiatry

Karen L Jacob
Borderline Personality Disorder (BPD) has a reputation for being a challenging disorder to treat due to the nature of the illness. With the development of evidence-based treatments, therapists are becoming more skilled at successfully helping this cohort of patients. A common factor associated with all validated treatments for BPD is the active involvement of therapists. For example, DBT is one treatment where therapists are expected to be available to patients for coaching outside of sessions. However, understanding the benefits and pitfalls associated with therapists' accessibility in between sessions is relevant to any treatment with intersession contact...
September 2016: Harvard Review of Psychiatry
Kenneth R Silk
There has been much discussion and controversy concerning the process undertaken and the decisions made with respect to the Personality and Personality Disorders Work Group (PPDWG) proposal for DSM-5, as well as the rejection of the work group's final proposal, by the American Psychiatric Association Board of Trustees. This commentary suggests that the way the PPDWG members were selected and the perceived secrecy associated with the PPDWG's deliberations almost assured that, despite the hard work and good intentions of the group members, the proposal would raise controversy and could ultimately fail...
September 2016: Harvard Review of Psychiatry
Brandon T Unruh, John G Gunderson
While the public health burden posed by borderline personality disorder (BPD) rivals that associated with other major mental illnesses, the prevailing disposition of psychiatrists toward the disorder remains characterized by misinformation, stigma, aversive attitudes, and insufficient familiarity with effective generalist treatments that can be delivered in nonspecialized health care settings. Residency training programs are well positioned to better equip the next generation of psychiatrists to address these issues, but no consensus or guidelines currently exist for what and how residents should be taught about managing BPD...
September 2016: Harvard Review of Psychiatry
Victor Hong
Patients with borderline personality disorder (BPD) are high utilizers of psychiatric emergency services and present unique challenges in that setting. Frequently advised to visit an emergency department (ED) if safety is in question, their experiences once there often do not have beneficial effects. Issues specific to patients with BPD in the ED include volatile interactions with staff, repeat visits, concerns about safety (and liability), and disposition. Emergency department staff attitudes toward these patients are frequently negative when compared to patients with other diagnoses, and can detrimentally affect outcomes and perpetuate stigma regarding BPD...
September 2016: Harvard Review of Psychiatry
Lois W Choi-Kain, Elizabeth B Albert, John G Gunderson
LEARNING OBJECTIVE: After participating in this activity, learners should be better able to:• Evaluate evidence-based therapies for borderline personality disorder ABSTRACT: Several manualized psychotherapies for treating borderline personality disorder (BPD) have been validated in randomized, controlled trials. Most of these approaches are highly specialized, offering different formulation of BPD and different mechanisms by which recovery is made possible. Mental health clinicians are challenged by the degree of specialization and clinical resources that these approaches require in their empirically validated adherent forms...
September 2016: Harvard Review of Psychiatry
Anthony C Ruocco, Dean Carcone
Borderline personality disorder (BPD) is a severe mental disorder with a multifactorial etiology. The development and maintenance of BPD is sustained by diverse neurobiological factors that contribute to the disorder's complex clinical phenotype. These factors may be identified using a range of techniques to probe alterations in brain systems that underlie BPD. We systematically searched the scientific literature for empirical studies on the neurobiology of BPD, identifying 146 articles in three broad research areas: neuroendocrinology and biological specimens; structural neuroimaging; and functional neuroimaging...
September 2016: Harvard Review of Psychiatry
John G Gunderson, Lois W Choi-Kain
No abstract text is available yet for this article.
September 2016: Harvard Review of Psychiatry
Andrew M Chanen, Michael Berk, Katherine Thompson
Borderline personality disorder (BPD) has been demonstrated to be a reliable and valid construct in young people (adolescents and young adults). Both borderline- and mood-related psychopathology become clinically apparent from puberty through to young adulthood, frequently co-occur, can reinforce one another, and can be difficult to differentiate clinically. This Gordian knot of overlapping clinical features, common risk factors, and precursors to both BPD and mood disorders complicates clinical assessment, prevention, and treatment...
September 2016: Harvard Review of Psychiatry
Nicholas Kontos, John Querques, Oliver Freudenreich
Many patients demonstrate amplified somatic symptom experiences that are felt by providers to cause excessive distress and functional impairment, and that can be diagnostically misleading. Terms attached to these presentations include somatization, medically unexplained symptoms, and, most recently, somatic symptom disorder. The analogous amplification of psychological symptoms has not been considered. Accordingly, this column makes a case for discussion and investigation of psychological symptom amplification (PSA), a process made possible by the medical legitimization of certain types of human suffering...
July 2016: Harvard Review of Psychiatry
Paulo Lizano, Ami Popat-Jain, Jeremiah M Scharf, Noah C Berman, Alik Widge, Darin D Dougherty, Emad Eskandar
No abstract text is available yet for this article.
July 2016: Harvard Review of Psychiatry
Sharain Suliman, Lise Anthonissen, Jonathan Carr, Stefan du Plessis, Robin Emsley, Sian M J Hemmings, Christine Lochner, Nathaniel McGregor, Leigh van den Heuvel, Soraya Seedat
Previous reports have suggested a high prevalence of overweight and obesity among individuals with posttraumatic stress disorder (PTSD). Few studies, however, systematically analyze the relationship between PTSD and body mass index (BMI). We conducted a systematic review and meta-analysis aimed at estimating the association between PTSD and BMI. Fifty-four articles were reviewed, 30 of which (with 191,948 individuals with PTSD and 418,690 trauma-exposed individuals or healthy controls) were eligible for inclusion in the meta-analysis...
July 2016: Harvard Review of Psychiatry
Bethany L Brand, Vedat Sar, Pam Stavropoulos, Christa Krüger, Marilyn Korzekwa, Alfonso Martínez-Taboas, Warwick Middleton
Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients...
July 2016: Harvard Review of Psychiatry
Harmony Raylen Abejuela, David N Osser
This revision of previous algorithms for the pharmacotherapy of generalized anxiety disorder was developed by the Psychopharmacology Algorithm Project at the Harvard South Shore Program. Algorithms from 1999 and 2010 and associated references were reevaluated. Newer studies and reviews published from 2008-14 were obtained from PubMed and analyzed with a focus on their potential to justify changes in the recommendations. Exceptions to the main algorithm for special patient populations, such as women of childbearing potential, pregnant women, the elderly, and those with common medical and psychiatric comorbidities, were considered...
July 2016: Harvard Review of Psychiatry
Neeta Shenai, Crystal D White, Pierre N Azzam, Priya Gopalan, LalithKumar K Solai
In cases of malignant catatonia, prompt administration of electroconvulsive therapy (ECT) can decrease mortality, whereas delays to initiating ECT have resulted in adverse outcomes, including death. We present a clinical vignette of malignant catatonia that required court-ordered ECT, followed by a discussion of practical and legal obstacles to expediting emergent ECT when patients cannot provide consent. We review particularly exacting mandates for involuntary ECT from three states: California, Texas, and New York...
May 2016: Harvard Review of Psychiatry
Geoffrey Raynor, Caroline Bader, Maya Srikanth, David Kroll, Thomas Gutheil, Aaron Berkowitz
No abstract text is available yet for this article.
May 2016: Harvard Review of Psychiatry
Philip Dodd, Ailbhe Doherty, Suzanne Guerin
BACKGROUND: Suicidality in people with intellectual disability has not been extensively researched. AIM: To identify the nature of the research that has actually been conducted on this topic. METHOD: A search of research databases was conducted according to predefined criteria. Key information was extracted and rated for methodological merit. RESULTS: Twenty-four studies met the inclusion criteria for this systematic review...
May 2016: Harvard Review of Psychiatry
Xiang Wang, Dost Öngür, Randy P Auerbach, Shuqiao Yao
Although it is generally accepted that cognitive factors contribute to the pathogenesis of major depressive disorder (MDD), there are missing links between behavioral and biological models of depression. Nevertheless, research employing neuroimaging technologies has elucidated some of the neurobiological mechanisms related to cognitive-vulnerability factors, especially from a whole-brain, dynamic perspective. In this review, we integrate well-established cognitive-vulnerability factors for MDD and corresponding neural mechanisms in intrinsic networks using a dual-process framework...
May 2016: Harvard Review of Psychiatry
Erin K Smith, Priya Gopalan, Jody B Glance, Pierre N Azzam
LEARNING OBJECTIVES: After participating in this activity, learners should be better able to:• Evaluate the rationale for screening women for postpartum depression• Assess tools for screening for postpartum depression OBJECTIVE: To perform a qualitative literature review on screening for postpartum depression (PPD), as applicable to the general psychiatrist. Results are classified by instrument, timing, and clinical setting of the screen. DATA SOURCES: A literature search was conducted using the PubMed database for English-language articles published since January 1987...
May 2016: Harvard Review of Psychiatry
Paola Landi, Donatella Marazziti, Grazia Rutigliano, Liliana Dell'Osso
In spite of the increasing number of studies on insight in psychiatry and also in neurology and psychology, its nature is still elusive. It encompasses at least three fundamental characteristics: the awareness of suffering from an illness, an understanding of the cause and source of this suffering, and an acknowledgment of the need for treatment. As such, insight is fundamental for patients' management, prognosis, and treatment. Not surprisingly, the majority of available data, which have been gathered on schizophrenia, show a relationship between low insight and poorer outcomes...
May 2016: Harvard Review of Psychiatry
Hannah E Brown, Joshua L Roffman
In this column we examine the recent literature regarding adjunctive antipsychotic treatment of schizophrenia. We provide a brief introduction outlining the urgent need for new therapeutics, particularly for the treatment of negative and cognitive symptoms of schizophrenia. We then address (by mechanism of action) the most extensively studied adjunctive antipsychotic treatments. We conclude that adjunctive treatments targeting glutamatergic modulation, as well as supplementation with certain vitamins, have the strongest evidence for use in the treatment of schizophrenia...
March 2016: Harvard Review of Psychiatry
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