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borderline personality guidelines

Ella Hancock-Johnson, Chris Griffiths, Marco Picchioni
BACKGROUND: Medicines are routinely prescribed to treat borderline personality disorder (BPD) despite a relative lack of high-quality evidence and in breach of some treatment guidelines. An earlier Cochrane review of pharmacotherapy in BPD underlined the lack of evidence, encouraged the replication of earlier studies, but also emphasised the pressing need for more randomised placebo-controlled trials, and for those studies to employ broadened inclusion criteria. METHOD: The authors searched bibliographic databases, reference lists of articles and trials registers...
March 28, 2017: CNS Drugs
J Hutsebaut, C J Hessels
Within the accumulating evidence for a life span perspective on borderline personality disorder (BPD), the key factor is a developmental perspective.<br/> AIM: To demonstrate that the lessons learnt from early intervention in somatic medicine and psychosis should be used to improve the diagnosis and treatment of BPD.<br/> METHOD: We describe the rationale for early detection and intervention and present a staging model which can serve as a guideline for the development and selection of interventions for BPD...
2017: Tijdschrift Voor Psychiatrie
Michael H Stone
In relation to the psychotherapy of borderline personality disorder (BPD), the contextual model embraces the subjective components that operate alongside the more readily objectifiable elements of the medical model. The latter include the guidelines of the various psychodynamic and cognitive approaches, the randomized control trials of these approaches, follow-up studies, and data from MRI and other neurophysiological tests. The contextual model focuses on less easily measurable factors that comprise the real relationship between therapist and patient, including the heterogeneity in the BPD domain...
2017: Psychodynamic Psychiatry
Beverly Reeves-Dudley
Borderline personality disorder (BPD) is a complex and at times debilitating mental disorder, treatment of which has eluded effective pharmacotherapy (Gunderson, 2007). Although once considered untreatable, psychodynamic therapy and cognitive therapy (two types of psychological therapies) have provided hope for better lives for patients with this diagnosis (Gunderson). The author performed an integrative review of the literature pertaining to the present role of evidence-based practice (EBP) using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) definition of BPD to identify symptoms of the disorder...
February 2017: Archives of Psychiatric Nursing
R Vera, E Dotor, J Feliu, E González, B Laquente, T Macarulla, E Martínez, J Maurel, M Salgado, J L Manzano
Pancreatic cancer remains an aggressive disease with a 5 year survival rate of 5%. Only 15% of patients with pancreatic cancer are eligible for radical surgery. Evidence suggests a benefit on survival with adjuvant chemotherapy (gemcitabine o fluourouracil) after R1/R0 resection. Adjuvant chemoradiotherapy is also a valid option in patients with positive margins. Borderline resectable pancreatic cancer is defined as the involvement of the mesenteric vasculature with a limited extension. These tumors are technically resectable, but with a high risk of positive margins...
December 2016: Clinical & Translational Oncology
G Munch, N Godart
INTRODUCTION: Adolescence is a unique phase of the human developmental process. In adolescents, psychotropic medications may have different efficacy and tolerance profiles compared to those at other stages of the lifespan. Mood stabilizers are a complex pharmacological category including lithium, some anticonvulsants, and some second generation antipsychotics. Focusing on this class of pharmacological agents, we aim to answer the following questions: in which indications and according to which modalities should mood stabilizers be prescribed during adolescence? METHODS: Information was sought from the websites of the French Haute Autorité de santé (HAS) and Agence nationale de sécurité du médicament et des produits de santé (ANSM), the American Food and Drug Administration (FDA) and the British National Institute for Health and Clinical Excellence (NICE)...
November 18, 2016: L'Encéphale
Geoffrey L Dickens, Catherine Frogley, Fiona Mason, Katina Anagnostakis, Marco M Picchioni
BACKGROUND: Clozapine is an atypical antipsychotic medicine which can cause significant side-effects. It is often prescribed off-license in severe cases of borderline personality disorder contrary to national treatment guidelines. Little is known about the experiences of those who take clozapine for borderline personality disorder. We explored the lived-experience of women in secure inpatient care who were prescribed clozapine for borderline personality disorder. FINDINGS: Adult females (N = 20) participated in audio-taped semi-structured interviews...
2016: Borderline Personality Disorder and Emotion Dysregulation
Astrid Baljé, Anja Greeven, Anne van Giezen, Kees Korrelboom, Arnoud Arntz, Philip Spinhoven
BACKGROUND: Social anxiety disorder (SAD) with comorbid avoidant personality disorder (APD) has a high prevalence and is associated with serious psychosocial problems and high societal costs. When patients suffer from both SAD and APD, the Dutch multidisciplinary guidelines for personality disorders advise offering prolonged cognitive behavioral therapy (CBT). Recently there is increasing evidence for the effectiveness of schema therapy (ST) for personality disorders such as borderline personality disorder and cluster C personality disorders...
October 8, 2016: Trials
Nabil Naser, Alen Dzubur, Azra Durak, Mehmed Kulic, Nura Naser
INTRODUCTION: The term masked hypertension (MH) should be used for untreated individuals who have normal office blood pressure but elevated ambulatory blood pressure. For treated patients, this condition should be termed masked uncontrolled hypertension (MUCH). RESEARCH OBJECTIVES: Masked uncontrolled hypertension (MUCH) has gone unrecognized because few studies have used 24-h ABPM to determine the prevalence of suboptimal BP control in seemingly well-treated patients, and there are few such studies in large cohorts of treated patients attending usual clinical practice...
July 27, 2016: Medical Archives
Kye L McCarthy, Kate L Lewis, Marianne E Bourke, Brin F S Grenyer
BACKGROUND: Engaging parents who have a personality disorder in interventions designed to protect children from the extremes of the disorder supports both parenting skills and healthy child development. In line with evidence-based guidelines, a 'Parenting with Personality Disorder' brief intervention was developed, focusing on child safety, effective communication and parenting strategies. METHOD: Ratings of acceptability for the brief intervention model were given by 168 mental health clinicians who attended training...
2016: Borderline Personality Disorder and Emotion Dysregulation
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
Carla Sharp
Despite a marked increase in research supporting the assessment, diagnosis and treatment of personality disorder (PD) in adolescence, clinicians continue to be reluctant to apply treatment guidelines and psychiatric nomenclature in routine clinical care. This gap arises from several beliefs: (1) psychiatric nomenclature does not allow the diagnosis of PD in adolescence; (2) certain features of PD are normative and not particularly symptomatic of personality disturbance; (3) the symptoms of PD are better explained by other psychiatric syndromes; (4) adolescents' personalities are still developing and therefore too unstable to warrant a PD diagnosis; and (5) because PD is long-lasting, treatment-resistant and unpopular to treat, it would be stigmatising to label an adolescent with borderline personality disorder (BPD)...
January 2017: Archives of Disease in Childhood
Kolapo A Idowu, Babafemi Adenuga, Oritsetsemaye Otubu, Krishnan Narasimhan, Feremusu Kamara, Finie Hunter-Richardson, Daniel Larbi, Zaki A Sherif, Adeyinka O Laiyemo
BACKGROUND: Historically, studies suggested that immigrants acquire the risk of colorectal cancer (CRC) as US-born persons within the same generation. CRC risk of immigrants is largely unknown in this era of cancer screening and widespread immigration. We investigated the association of place of birth and cancer beliefs with uptake of CRC screening. METHODS: The 2007 Health Information National Trends Survey was used and 4,299 respondents (weighted population size=81,896,392) who were 50 years and older (3,960 US-born and 339 foreign-born) were identified...
July 2016: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
M Bohus, C Schmahl, S C Herpertz, K Lieb, M Berger, S Roepke, A Heinz, J Gallinat, L Lyssenko
BACKGROUND: Borderline personality disorders (BPD) are severe mental diseases which place high pressure on the psychiatric healthcare system. Nowadays, well-tested, disorder-specific treatment concepts are available also for inpatient treatment in Germany. These show very good and long-term improvements in the psychopathology as well as posttreatment social participation; however, prerequisites for the implementation of these evidence-based inpatient psychotherapy programs are well-trained treatment teams and appropriate financing of resource expenditure...
July 2016: Der Nervenarzt
Julie Eyden, Catherine Winsper, Dieter Wolke, Matthew R Broome, Fiona MacCallum
There is growing interest in whether the parenting strategies and offspring outcomes of mothers with borderline personality disorder (BPD) differ from those of mothers without BPD. We searched PsychINFO, PubMed, EMBASE, Web of Science, Scopus and ASSIA databases for studies examining parenting skills and attitudes among mothers with BPD/BPD symptoms and/or offspring outcomes. PRISMA reporting guidelines were followed. Of 10,067 abstracts screened, 101 full-text articles were retrieved and 33 met pre-determined criteria for qualitative synthesis...
July 2016: Clinical Psychology Review
Connie W Tsao, Asya Lyass, Martin G Larson, Susan Cheng, Carolyn S P Lam, Jayashri R Aragam, Emelia J Benjamin, Ramachandran S Vasan
OBJECTIVES: This study sought to examine the association of a borderline left ventricular ejection fraction (LVEF) of 50% to 55% with cardiovascular morbidity and mortality in a community-based cohort. BACKGROUND: Guidelines stipulate a LVEF >55% as normal, but the optimal threshold, if any, remains uncertain. The prognosis of a "borderline" LVEF, 50% to 55%, is unknown. METHODS: This study evaluated Framingham Heart Study participants who underwent echocardiography between 1979 and 2008 (n = 10,270 person-observations, mean age 60 years, 57% women)...
June 2016: JACC. Heart Failure
João Paulo Consentino Solano, Eduardo Sawaya Botelho Bracher, Alexandre Faisal-Cury, Hazem Adel Ashmawi, Maria José Carvalho Carmona, Francisco Lotufo-Neto, Joaquim Edson Vieira
CONTEXT AND OBJECTIVE: Personal resilience is associated with several mental health outcomes. The Connor-Davidson resilience scale (CD-RISC) is a widely used self-report measurement of resilience. This study aimed to investigate the reliability and validity of a Brazilian Portuguese version of the CD-RISC. DESIGN AND SETTING: Cross-sectional validation study carried out in the outpatient clinics of a public university hospital. METHODS: The cross-cultural adaptation followed established guidelines and involved interviews with 65 adults in psychiatric and non-psychiatric outpatient clinics at a teaching hospital...
May 13, 2016: São Paulo Medical Journal, Revista Paulista de Medicina
Emma Malmström, Niklas Hörberg, Ioannis Kouros, Kristina Haglund, Mia Ramklint
BACKGROUND: Psychiatric illness is common among young adults, but there are only a few studies examining their views about the care they receive. There is a paradigm shift towards person-centred care and, therefore, a need for patients' perspectives in the development of clinical guidelines. AIM: The aim of this study was to examine the views about provided psychiatric care in a group of young adult psychiatric patients. METHOD: This study was part of a larger study...
October 2016: Nordic Journal of Psychiatry
L E Chapman, A L Darling, J E Brown
AIM: Metformin is the most widely used oral hypoglycaemic drug, but it may lower B12 status, which could have important clinical implications. We undertook a systematic review and meta-analysis of the relationship between metformin use and vitamin B12 deficiency in persons with type 2 diabetes. METHODS: Electronic database searches were undertaken (1st January 1957-1st July 2013) using the Cochrane library, Scopus, CINAHL, Grey literature databases, Pub Med Central, NICE Clinical Guidelines UK, and ongoing clinical trials...
November 2016: Diabetes & Metabolism
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