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Blay M, Benmakhlouf I, Duarte M, Perroud N, Greiner C, Charbon P, Choi-Kain L, Speranza M. Case reports: Using Good Psychiatric Management (GPM) conceptualizations in the dimensional assessment and treatment of personality disorders. Front Psychiatry 2023; 14:1186524. [PMID: 37564248 PMCID: PMC10410145 DOI: 10.3389/fpsyt.2023.1186524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Good Psychiatric Management (GPM) is a generalist clinical management approach for borderline personality disorder that incorporates common ingredients of good standard care for any psychiatric diagnosis with what works from prevailing specialist psychotherapies. Similar to all validated therapies for BPD, it relies on a specified formulation of the disorder' symptoms as arising from interpersonal hypersensitivity, to dynamically describe typical patterns of daily self- and interpersonal issues that drive the instability that defines the general personality dysfunction characteristic of the disorder. Recent adaptations of GPM have been proposed for narcissistic personality disorder and obsessive-compulsive personality disorder, with development of similar dynamic models for both (intrapsychic coherence model and model of overcontrol). New dimensional models of personality disorder diagnosis have been developed to address limitations of categorical approach, but the incorporation of these models into usage in the delivery of clinical services (where categorical approach remains the most used) is limited. This paper describes an adaptation of GPM to two cases of personality disorder that illustrate the usefulness of GPM models for dynamic representation of complex daily fluctuations in internal psychic coherence and interpersonal functioning. Specialist psychotherapies will never meet the demands of public health needs to treat personality dysfunction, and incorporation of new dimensional models of diagnosis are needed for treatments that can provide a minimal standard of care for providers and patients.
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Affiliation(s)
- Martin Blay
- ADDIPSY, Outpatient Addictology and Psychiatry Center, Santé Basque Développement Group, Lyon, France
- Lyon Est Faculty of Medicine, Claude Bernard University Lyon 1, Lyon, France
| | - Ines Benmakhlouf
- ADDIPSY, Outpatient Addictology and Psychiatry Center, Santé Basque Développement Group, Lyon, France
| | - Miguel Duarte
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Nader Perroud
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
- Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Christian Greiner
- Consultative Psychiatry and Crisis Intervention Department, University Hospitals of Geneva, Geneva, Switzerland
| | - Patrick Charbon
- Department of Mental Health and Psychiatry, Service of Psychiatric Specialties, University Hospitals of Geneva, Geneva, Switzerland
| | - Lois Choi-Kain
- McLean Hospital, Gunderson Personality Disorders Institute, Belmont, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Mario Speranza
- Versailles Hospital Center, University Department of Child and Adolescent Psychiatry, Le Chesnay, France
- Centre de recherche en Epidémiologie et Santé des Populations Team “DevPsy”, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), INSERM, Université Paris-Saclay, Villejuif, France
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Simpson HB, Foa EB, Wheaton MG, Gallagher T, Gershkovich M, Schmidt AB, Huppert JD, Campeas RB, Imms PA, Cahill SP, DiChiara C, Tsao SD, Puliafico AC, Chazin D, Asnaani A, Moore K, Tyler J, Steinman SA, Sanchez-LaCay A, Capaldi S, Snorrason I, Turk-Karan E, Vermes D, Kalanthroff E, Pinto A, Hahn CG, Xu B, Van Meter PE, Katechis M, Scodes J, Wang Y. Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder. Behav Res Ther 2021; 143:103890. [PMID: 34089924 DOI: 10.1016/j.brat.2021.103890] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/31/2021] [Accepted: 05/18/2021] [Indexed: 12/27/2022]
Abstract
Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. We studied whether extending the course increased overall remission rates and which patient factors predicted remission. Participants were 137 adults with clinically significant OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score ≥18) despite an adequate SRI trial (≥12 weeks). Continuing their SRI, patients received 17 sessions of twice-weekly EX/RP (standard course). Patients who did not remit (Y-BOCS ≤12) received up to 8 additional sessions (extended course). Of 137 entrants, 123 completed treatment: 49 (35.8%) remitted with the standard course and another 46 (33.6%) with the extended course. Poorer patient homework adherence, more Obsessive-Compulsive Personality Disorder (OCPD) traits, and the Brain-Derived Neurotrophic Factor (BDNF) Val66MET genotype were associated with lower odds of standard course remission. Only homework adherence differentiated non-remitters from extended course remitters. Extending the EX/RP course from 17 to 25 sessions enabled many (69.3%) OCD patients on SRIs to achieve remission. Although behavioral (patient homework adherence), psychological (OCPD traits), and biological (BDNF genotype) factors influenced odds of EX/RP remission, homework adherence was the most potent patient factor overall.
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Affiliation(s)
- Helen B Simpson
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA.
| | - Edna B Foa
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Michael G Wheaton
- New York State Psychiatric Institute, New York, NY, 10032, USA; Barnard College, Columbia University, New York, NY, 10027, USA
| | - Thea Gallagher
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Marina Gershkovich
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Andrew B Schmidt
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | | | - Raphael B Campeas
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Patricia A Imms
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shawn P Cahill
- University of Wisconsin-Milwaukee, Milwaukee, WI, 53201, USA
| | - Christina DiChiara
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Center for Anxiety and Behavior Therapy, Bryn Mawr, PA, 19010, USA
| | - Steven D Tsao
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Center for Anxiety and Behavior Therapy, Bryn Mawr, PA, 19010, USA
| | - Anthony C Puliafico
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Daniel Chazin
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Anu Asnaani
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Department of Psychology, University of Utah, Salt Lake City, UT, 84112, USA
| | - Kelly Moore
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA; Rutgers University/Biomedical Health Sciences New Brunswick, NJ, 08854, USA
| | - Jeremy Tyler
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Shari A Steinman
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; Department of Psychology, WVU, Morgantown, WV, 26506, USA
| | - Arturo Sanchez-LaCay
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Sandy Capaldi
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ivar Snorrason
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; McLean Hospital/Harvard Medical School, Belmont, MA, 02478, USA
| | - Elizabeth Turk-Karan
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Donna Vermes
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | | | - Anthony Pinto
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA; Department of Psychiatry, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, The Zucker Hillside Hospital, Glen Oaks, NY, 11004, USA
| | - Chang-Gyu Hahn
- Center for the Treatment and Study of Anxiety, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Bin Xu
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA
| | - Page E Van Meter
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Martha Katechis
- Department of Psychiatry, Columbia University, New York, NY, 10032, USA; New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Jennifer Scodes
- New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Yuanjia Wang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
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