Dialectical behavior therapy for personality disorders

Advancing Psychosocial Treatment for Body Dysmorphic Disorder: A State-of-the-Science Review

Body dysmorphic disorder (BDD) is an underrecognized, challenging illness with severe comorbidities, demanding urgent advancements in treatment strategies. This state-of-the-science review describes current research on existing BDD treatments, beginning with a detailed discussion of cognitive-behavioral therapy (CBT), the primary psychosocial intervention for BDD, and its foundational theories. We emphasize the significant progress in the field, including the efficacy of face-to-face CBT, the promising outcomes of digital interventions for broadening access to care, and emerging treatments that warrant further exploration. The review also addresses the critical gap of targeted interventions for youth, considering the diseases' typical onset during adolescence. Our review also sheds light on the significant gap in research dedicated to testing these treatments in underserved communities, stressing the importance of including these populations in research and culturally informed and adapted, if necessary, care. The review concludes with recommendations for future directions, outlining areas for ongoing treatment development and research to expand the scope and efficacy of interventions for BDD.

Ketamine Therapy in Complex Cases: A Cautionary Tale of Exacerbated Personality Traits and the Crucial Role of Comprehensive Follow-Up and Psychosocial Interventions

This case report examines the unexpected increase in suicidal ideation following ketamine infusion therapy in a 75-year-old female with a history of treatment-resistant depression. Despite ketamine's established efficacy in treating depression and acute suicidality, this patient's condition deteriorated posttreatment. The report delves into the patient's complex background, including psychosocial stressors, genetic predisposition to depression, and a history of personality traits that may have influenced her response to ketamine. This case underscores the importance of cautious administration of ketamine, especially in patients with personality disorders, and calls for deeper understanding and individualized treatment plans in mental health care. It is a reminder of the complexities involved in treating mental health conditions and the varying effects of treatments like ketamine on different individuals.

Beyond the tip of the iceberg: A narrative review to identify research gaps on comorbid psychiatric disorders in adolescents with methamphetamine use disorder or chronic methamphetamine use

BACKGROUND

Methamphetamine use disorder (MUD) frequently begins in adolescence, often accompanied by other psychiatric or mental disorders. Up to now, no comprehensive review about MUD and comorbid disorders in adolescents is available. We thus aimed to review the literature on comorbid mental disorders and MUD in adolescents in order to identify future research topics. Method: A PubMed search was conducted in July 2019. Relevant comorbidities were defined as attention-deficit disorder with/without hyperactivity, anxiety disorders, depression, eating disorders, post-traumatic stress disorder, psychosis, borderline personality disorder, conduct disorder and antisocial personality disorder, as well as other substance use disorders. For each comorbidity, we summarized prevalence rates, findings on comorbidity mechanisms, and recommended treatment options, if applicable. Results: Few articles focused on MUD in adolescents. Prevalence rates differed largely between comorbid disorders, with tobacco use disorder, conduct disorder, post-traumatic stress disorder, anxiety disorders, and attention-deficit disorders being the most prevalent comorbidities while eating disorders were rare. Examined onset patterns and comorbidity mechanisms indicated three groups of comorbidities: preexisting disorders self-medicated with methamphetamine, disorders induced by chronic methamphetamine use, and disorders arising due to risk factors shared with MUD. Reviewed comorbidities were frequently associated with worse treatment outcomes. Conclusions: The limited evidence is in stark contrast to the presumably high prevalence and relevance of comorbid mental disorders in adolescents with MUD. Suggestions for future research topics, informed by adult findings, include genetic vulnerabilities, biological changes, and consequences of different use patterns. Surprisingly few MUD treatment programs explicitly integrate comorbid mental disorder modules.

California State Hospital Violence Assessment and Treatment (Cal-VAT) guidelines

Here we provide comprehensive guidelines for the assessment and treatment of violence and aggression of various etiologies, including psychotic aggression and impulsive aggression due to schizophrenia, mood disorders, ADHD, or trauma, and predatory aggression due to psychopathy and other personality disorders. These guidelines have been developed from a collection of prescribing recommendations, clinical trial results, and years of clinical experience in treating patients who are persistently violent or aggressive in the California Department of State Hospital System. Many of the recommendations provided in these guidelines employ off-label prescribing practices; thus, sound clinical judgment based on individual patient needs and according to institution formularies must be considered when applying these guidelines in clinical practice.

The DiaS trial: dialectical behavior therapy versus collaborative assessment and management of suicidality on self-harm in patients with a recent suicide attempt and borderline personality disorder traits - study protocol for a randomized controlled trial

Background

In Denmark 8,000 to 10,000 people will attempt suicide each year. The Centre of Excellence in Suicide Prevention in the Capital Region of Denmark is treating patients with suicidal behavior, and a recent survey has shown that 30% of the patients are suffering from borderline personality disorder. The majority of patients (70% to 75%) with borderline personality disorder have a history of deliberate self-harm and 10% have a lifetime risk to die by suicide. The DiaS trial is comparing dialectical behavior therapy with collaborative assessment and management of suicidality-informed supportive psychotherapy, for the risk of repetition of deliberate self-harm in patients with a recent suicide attempt and personality traits within the spectrum of borderline personality disorder. Both treatments have previously shown effects in this group of patients on suicide ideation and self-harm compared with treatment as usual.

Methods/Design

The trial is designed as a single-center, two-armed, parallel-group observer-blinded randomized clinical superiority trial. We will recruit 160 participants with a recent suicide attempt and at least two traits of the borderline personality disorder from the Centre of Excellence in Suicide Prevention, Capital Region of Denmark. Randomization will be performed though a centralized and computer-generated approach that conceals the randomization sequence. The interventions that are offered are a modified version of a dialectical behavior therapy program lasting 16 weeks versus collaborative assessment and management of suicidality-informed supportive psychotherapy, where the duration treatment will vary in accordance with established methods up to 16 weeks. The primary outcome measure is the ratio of deliberate self-harming acts including suicide attempts measured at week 28. Other exploratory outcomes are included such as severity of symptoms, suicide intention and ideation, depression, hopelessness, self-esteem, impulsivity, anger, and duration of respective treatments.

Trial registration

Clinical Trial.gov: NCT01512602.

Mindfulness and psychosocial care in cancer: historical context and review of current and potential applications

Mindfulness-based interventions and mindfulness techniques have become increasingly popular in psychosocial care.  These interventions have also been increasingly used with cancer patients and survivors. However, more attention is due to issues such as how these techniques may be specifically relevant for an oncology population and whether the religious derivation of mindfulness should be considered by frontline psychosocial clinicians. This article provides a history and overview of the use of mindfulness in psychosocial cancer care.

Phantasy Therapy: Statistical Evaluation of a New Approach to Group Psychotherapy for Stationary and Ambulatory Psychotic Patients

BACKGROUND

Since 1995 we have developed a depth-psychological, experience- and expression-oriented approach to group therapy for psychotic patients--"Phantasy Therapy"--complementary to the main-stream emphasis upon behavioural, learn- and goal-oriented methods.

AIMS

A group psychotherapy for acute and remitting patients suffering from psychosis or schizophrenia is statistically evaluated under treatment-as-usual in a public psychiatric clinic.

METHODS

Phantasy Therapy is compared to an alternative treatment (art therapy = AT) and a placebo group (PG; weekly ward gatherings) via cognitive testing before and after each session.

RESULTS

(1) Improvement of cognitive deficits over the first 4 sessions: session 1 (effect size d = 0 between all 3 groups) versus session 4 (d = 0.2 and 0.4 of Phantasy Therapy over AT and PG, respectively). Averaged over the first 4 sessions, the cognitive test showed tendential improvements for Phantasy Therapy and AT compared to PG. (2) Self-rating (sum of 4 item scores) averaged over the first 4 sessions showed a small effect. Patients judged themselves more improved after Phantasy Therapy compared to AT (d = 0.2) or PG (d = 0.3); tendential d (0.1) of AT over PG. (3) Psychosocial communication skills considerably improved during Phantasy Therapy, slightly worsened during AT, and remained relatively unchanged during PG. The effect sizes of Phantasy Therapy for values averaged over the first 4 sessions was 0.6 compared to AT and 0.4 compared to PG.

CONCLUSIONS

Phantasy Therapy is better than PG and at least as good as AT. These results should be hardened by further studies.

Treatment guidelines for children and adolescents with bipolar disorder

Clinicians who treat children and adolescents with bipolar disorder desperately need current treatment guidelines. These guidelines were developed by expert consensus and a review of the extant literature about the diagnosis and treatment of pediatric bipolar disorders. The four sections of these guidelines include diagnosis, comorbidity, acute treatment, and maintenance treatment. These guidelines are not intended to serve as an absolute standard of medical or psychological care but rather to serve as clinically useful guidelines for evaluation and treatment that can be used in the care of children and adolescents with bipolar disorder. These guidelines are subject to change as our evidence base increases and practice patterns evolve.

Psychopharmacology of borderline personality disorder

Psychopharmacology is widely used in the treatment of borderline personality disorder. However, support for this form of treatment has been largely based on case reports, case series, and open-label clinical trials. This evidence-based review examines the most recent randomized controlled trials of psychopharmacology in the treatment of borderline personality disorder, with a goal of highlighting the most promising pharmacotherapy for use in current clinical practice, as well as for future large-scale research testing. The results and limitations of the randomized controlled trial data are presented along with case vignettes illustrating the complexity of the disorder and the heterogeneity of its treatment. To date, there is at least some evidence-based support for the use of antipsychotics (conventional and atypical), monoamine oxidase inhibitors, serotonin reuptake inhibitors, and omega-3 fatty acids in the treatment of borderline personality disorder.

The Prevalence of Psychiatric Disorders in Sexually Transmitted Disease Clinic Patients and Their Association With Sexually Transmitted Disease Risk

BACKGROUND AND OBJECTIVES

Psychiatric disorders could limit the success of behavioral counseling strategies. We evaluated the prevalence of psychiatric disorders among sexually transmitted disease (STD) clinic patients and their association with STD risk.

METHODS

A systematic sample of 201 patients presenting to a public STD clinic in Baltimore, Maryland, participated in the structured clinical interview for the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.

RESULTS

Overall, 45% of 201 STD clinic patients interviewed had a current axis I disorder and 29% had an axis II personality disorder. Substance use disorders predominated among axis I diagnoses; antisocial personality disorder (ASPD) predominated among axis II diagnoses, with an ASPD prevalence of 29.4% in men. ASPD was associated with a diagnosis of an STD (odds ratio, 3.67; 95% confidence interval, 1.63-8.30; P = 0.002). Substance use was not associated with an STD diagnosis.

CONCLUSIONS

STD clinic patients have complex psychopathology that could increase HIV risk and compromise prevention interventions. Specialized counseling strategies, particularly targeting personality traits of ASPD, could improve prevention outcomes.