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Hersh RG. Treating Narcissistic Disorders in General Psychiatry: Practical Application of Transference-Focused Psychotherapy Principles. Psychodyn Psychiatry 2024; 52:150-172. [PMID: 38829230 DOI: 10.1521/pdps.2024.52.2.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Patients with primary or co-occurring narcissistic disorders are seen routinely in general psychiatry settings. Contemporary trends in training and practice have impacted psychiatrists' skills and confidence in identifying and treating these disorders, which can range from relatively benign to high-acuity presentations. The goal of this article is to introduce key principles derived from transference-focused psychotherapy (TFP) for use by clinicians in general practice in their work with patients with narcissistic disorders, even when those clinicians do not routinely provide individual psychotherapy. Practical application of TFP principles in work with patients with narcissistic disorders in general psychiatry are proposed, including in diagnostic evaluation, family engagement, prescribing, and safety assessment and risk management calculus. Many psychiatrists whose practices are focused primarily on psychopharmacology, or a "medical model," may not appreciate fully the impact of pathological narcissism in their work. Clinicians who may benefit from familiarity with TFP principles in work with patients with narcissistic disorders include the approximately one-half of U.S. psychiatrists who do not offer psychotherapy in their practice.
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Shapiro-Thompson R, Shah TV, Yi C, Jackson N, Trujillo Diaz D, Fineberg SK. Modulation of Trust in Borderline Personality Disorder by Script-Based Imaginal Exposure to Betrayal. J Pers Disord 2023; 37:508-524. [PMID: 37903023 PMCID: PMC11002460 DOI: 10.1521/pedi.2023.37.5.508] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2023]
Abstract
Interpersonal and trust-related difficulties are central features of borderline personality disorder (BPD). In this study, we applied script-driven betrayal imagery to evoke mistrustful behavior in a social reinforcement learning task. In 21 BPD and 20 healthy control (HC) participants, we compared this approach to the standard confederate paradigm used in research studies. The script-driven imagery evoked a transient increase in negative affect and also decreased trusting behavior to a similar degree in both groups. Across conditions, we also replicated previously reported between-group differences in negative affect (increased in BPD) and task behavior (more sensitive to social cues in BPD). These results support the validity of script-driven imagery as an alternative social task stimulus. This script-driven imagery approach is appealing for clinical research studies on reinforcement learning because it eliminates deception, scales easily, and evokes disorder-specific states of social difficulty.
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Affiliation(s)
| | - Tanya V Shah
- Department of Psychiatry, Yale University, New Haven, Connecticut
- Pomona College, Claremont, California
| | | | - Nasir Jackson
- Department of Psychiatry, Yale University, New Haven, Connecticut
- Meharry Medical College, Nashville, Tennessee
| | | | - Sarah K Fineberg
- Department of Psychiatry, Yale University, New Haven, Connecticut
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Fineberg SK, Choi EY, Shapiro-Thompson R, Dhaliwal K, Neustadter E, Sakheim M, Null K, Trujillo-Diaz D, Rondeau J, Pittaro GF, Peters JR, Corlett PR, Krystal JH. A pilot randomized controlled trial of ketamine in Borderline Personality Disorder. Neuropsychopharmacology 2023; 48:991-999. [PMID: 36804489 PMCID: PMC10209175 DOI: 10.1038/s41386-023-01540-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 02/19/2023]
Abstract
This study is the first randomized controlled trial to test the effects of ketamine in Borderline Personality Disorder (BPD). BPD remains undertreated in the community and no medication has FDA approval for this indication. People with BPD experience chronic mood disturbances with depressed mood, suicidal ideation, and severe social difficulties. In this double-blind, randomized controlled pilot study, we tested the effects of one infusion of ketamine (0.5 mg/kg, n = 10) or the psychoactive comparator drug midazolam (0.04 mg/kg, n = 12) in adults with BPD. Infusions were well tolerated in both groups. Dissociative symptoms during infusion were more intense with ketamine than midazolam (t(12.3) = 3.61, p = 0.01), but they resolved by 40 min after infusion in both groups. Post-infusion adverse events were at the expected low levels in both groups. For our primary outcome measure of suicidal ideation and our secondary outcome measure of depression, we found numerical reduction but not significant group or group x timepoint difference (p > 0.05). For our secondary outcome measures of anxiety and BPD symptoms, we did not observe group or group x timepoint differences. There was a group x timepoint effect for socio-occupational functioning (F(1,20.12) = 5.16, p = 0.03, at Day 14, ketamine group showed more improvement than midazolam group). An exploratory analysis revealed that improvement in socio-occupational functioning was correlated with improvement in depression in the ketamine group (r(8) = 0.65, p = 0.04) but not midazolam group (r(9) = 0.41, p = 0.216). This pilot study provides the first randomized controlled evidence of the effects of antidepressant-dosed ketamine in people with BPD. Our results provide reason for optimism that antidepressant-dosed ketamine will be well-tolerated in larger studies and may provide clinical benefit for mood symptoms and related impairments in people with BPD.
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Affiliation(s)
- Sarah K Fineberg
- Yale School of Medicine Department of Psychiatry, New Haven, CT, USA.
| | - Esther Y Choi
- Yale School of Medicine Department of Psychiatry, New Haven, CT, USA
| | - Rosa Shapiro-Thompson
- Yale School of Medicine Department of Psychiatry, New Haven, CT, USA
- Goucher College Post-Baccalaureate Premedical Program, Baltimore, MA, USA
| | | | - Eli Neustadter
- Yale School of Medicine Department of Psychiatry, New Haven, CT, USA
| | | | - Kaylee Null
- University of California Los Angeles Department of Psychology, Los Angeles, CA, USA
| | - Daniel Trujillo-Diaz
- Alpert Medical School of Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | | | | | - Jessica R Peters
- Alpert Medical School of Brown University Department of Psychiatry and Human Behavior, Providence, RI, USA
| | - Philip R Corlett
- Yale School of Medicine Department of Psychiatry, New Haven, CT, USA
| | - John H Krystal
- Yale School of Medicine Department of Psychiatry, New Haven, CT, USA
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Wu T, Hu J, Davydow D, Huang H, Spottswood M, Huang H. Demystifying borderline personality disorder in primary care. Front Med (Lausanne) 2022; 9:1024022. [PMID: 36405597 PMCID: PMC9668888 DOI: 10.3389/fmed.2022.1024022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/12/2022] [Indexed: 11/05/2022] Open
Abstract
Borderline personality disorder (BPD) is a common mental health diagnosis observed in the primary care population and is associated with a variety of psychological and physical symptoms. BPD is a challenging disorder to recognize due to the limitations of accurate diagnosis and identification in primary care settings. It is also difficult to treat due to its complexity (e.g., interpersonal difficulties and patterns of unsafe behaviors, perceived stigma) and healthcare professionals often feel overwhelmed when treating this population. The aim of this article is to describe the impact of BPD in primary care, review current state of knowledge, and provide practical, evidence-based treatment approaches for these patients within this setting. Due to the lack of evidence-based pharmacological treatments, emphasis is placed on describing the framework for treatment, identifying psychotherapeutic opportunities, and managing responses to difficult clinical scenarios. Furthermore, we discuss BPD treatment as it relates to populations of special interest, including individuals facing societal discrimination and adolescents. Through this review, we aim to highlight gaps in current knowledge around managing BPD in primary care and provide direction for future study.
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Affiliation(s)
- Tina Wu
- Warren Alpert Medical School, Brown University, Providence, RI, United States
- Butler Hospital, Providence, RI, United States
- *Correspondence: Tina Wu,
| | - Jennifer Hu
- Duke University Hospital, Durham, NC, United States
- Jennifer Hu,
| | | | - Heather Huang
- University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
| | - Margaret Spottswood
- Community Health Centers of Burlington, Burlington, VT, United States
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT, United States
| | - Hsiang Huang
- Cambridge Health Alliance, Cambridge, MA, United States
- Harvard Medical School, Boston, MA, United States
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Chanen AM, Sharp C, Nicol K, Kaess M. Early Intervention for Personality Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:402-408. [PMID: 37200874 PMCID: PMC10187393 DOI: 10.1176/appi.focus.20220062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Both the DSM-5 Section III Alternative Model for Personality Disorders and the ICD-11 have introduced a genuinely developmental approach to personality disorder. Among young people with personality disorder, compelling evidence demonstrates a high burden of disease, substantial morbidity, and premature mortality, as well as response to treatment. Yet, early diagnosis and treatment for the disorder have struggled to emerge from its identity as a controversial diagnosis to a mainstream focus for mental health services. Key reasons for this include stigma and discrimination, lack of knowledge about and failure to identify personality disorder among young people, along with the belief that personality disorder must always be addressed through lengthy and specialized individual psychotherapy programs. In fact, evidence suggests that early intervention for personality disorder should be a focus for all mental health clinicians who see young people and is feasible by using widely available clinical skills.
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Affiliation(s)
- Andrew M Chanen
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Carla Sharp
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Katie Nicol
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
| | - Michael Kaess
- Orygen, and Centre for Youth Mental Health, University of Melbourne, Melbourne (Chanen, Nicol); Department of Psychology, University of Houston, Houston (Sharp); University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland, and Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany (Kaess)
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Soler J, Casellas‐Pujol E, Fernández‐Felipe I, Martín‐Blanco A, Almenta D, Pascual JC. "Skills for pills": The dialectical-behavioural therapy skills training reduces polypharmacy in borderline personality disorder. Acta Psychiatr Scand 2022; 145:332-342. [PMID: 35088405 PMCID: PMC9305183 DOI: 10.1111/acps.13403] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 01/19/2022] [Accepted: 01/23/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Polypharmacy and overprescription of off-label medications are common in patients with borderline personality disorder (BPD). The aim of the present naturalistic study was to explore whether the skills training module of dialectical-behavioural therapy (DBT) can reduce polypharmacy in these patients in routine clinical practice. METHODS Retrospective, observational study of 377 patients with a primary diagnosis of BPD consecutively admitted to the BPD outpatient unit from 2010 through 2020. All patients were invited to participate in the DBT skills training module (DBT-ST). DBT-ST participants (n = 182) were compared with a control group who did not participate in DBT-ST (n = 195). Pre-post intervention changes in medication load and use of antidepressants, benzodiazepines, mood stabilizers, and antipsychotics were evaluated. RESULTS At baseline, most patients (84.4%) were taking at least one medication and 46.9% were on polypharmacy. Compared to controls, patients in the DBT-ST group presented a significant reduction in the number of medications (2.67-1.95 vs. 2.16-2.19; p < 0.001), medication load (4.25-3.05 vs. 3.45-3.48; p < 0.001), use of benzodiazepines (54.4%-27.5% vs. 40%-40.5%; p < 0.001), mood stabilizers (43.4%-33% vs. 36.4%-39.5%; p < 0.001), and antipsychotics (36.3%-29.1% vs. 34.4%-36.9%; p < 0.001). CONCLUSIONS These findings suggest that patients with BPD can benefit from the DBT-ST module, which may reduce the medication load, particularly of sedatives. The results suggest that DBT-ST may be useful to treat overmedication in patients with BPD and could help to promote "deprescription" in clinical practice.
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Affiliation(s)
- Joaquim Soler
- Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain,Universitat Autònoma de Barcelona (UAB)BarcelonaSpain,Institut d’Investigació Biomèdica‐ Sant Pau (IIB‐SANT PAU)Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMBarcelonaSpain
| | - Elisabet Casellas‐Pujol
- Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain,Universitat Autònoma de Barcelona (UAB)BarcelonaSpain,Institut d’Investigació Biomèdica‐ Sant Pau (IIB‐SANT PAU)Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMBarcelonaSpain
| | - Isabel Fernández‐Felipe
- LabpsitecLaboratorio de Psicología y Tecnología. Dpto. Psicología BásicaClínica y PsicobiologíaUniversitat Jaume ICastellóSpain
| | - Ana Martín‐Blanco
- Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain,Universitat Autònoma de Barcelona (UAB)BarcelonaSpain,Institut d’Investigació Biomèdica‐ Sant Pau (IIB‐SANT PAU)Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMBarcelonaSpain
| | - David Almenta
- Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain,Universitat Autònoma de Barcelona (UAB)BarcelonaSpain,Institut d’Investigació Biomèdica‐ Sant Pau (IIB‐SANT PAU)Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMBarcelonaSpain
| | - Juan C. Pascual
- Department of PsychiatryHospital de la Santa Creu i Sant PauBarcelonaSpain,Universitat Autònoma de Barcelona (UAB)BarcelonaSpain,Institut d’Investigació Biomèdica‐ Sant Pau (IIB‐SANT PAU)Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAMBarcelonaSpain
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Shapiro-Thompson R, Fineberg SK. The State of Overmedication in Borderline Personality Disorder: Interpersonal and Structural Factors. CURRENT TREATMENT OPTIONS IN PSYCHIATRY 2022; 9:1-13. [PMID: 36185615 PMCID: PMC9524237 DOI: 10.1007/s40501-021-00255-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose of review a)This review paper describes the state of prescribing practice in Borderline Personality Disorder (BPD), wherein medications are prescribed far more than either evidence or practice guideline would recommend. First, we describe the frequencies of medication use and polypharmacy in people with BPD. Recent findings b)In subsequent sections, we elaborate two main categories of factors that lead to overmedication of people with BPD: the interpersonally mediated and the structural. We consider interpersonally mediated factors to arise from communications of patients in distress and the well-meaning efforts of their prescribers to provide relief for certain overwhelming affective states. We are particularly focused on patterns of countertransference in prescribing that are directly linked to specific aspects of BPD pathology. We consider structural factors to arise from the complexities of medical and medicolegal systems and the contemporary patterns of financing medical care; we postulate that these complexities often compel prescribers to start medications, with associated disincentives for decreasing or discontinuing those medications over time. Summary c)More research is needed to understand how to best use medications in BPD, for example in targeted combination with psychotherapeutic and psychosocial interventions. However, current practice often departs markedly from the evidence. We recommend the dissemination of accessible, generalist BPD-treatment models in outpatient and inpatient practice; increased early detection of BPD; and increased diagnostic disclosure. We also recommend for individual providers and systems to implement prospective treatment plans that draw from BPD-specific psychosocial models. This approach can employ tiers of interventions to minimize reactive prescribing by anticipating high affect and offering BPD patients steadily empathic evidence-supported care.
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Pascual JC, Martín-Blanco A, Soler J. Twenty-Year Trends in the Psychopharmacological Treatment of Outpatients with Borderline Personality Disorder: A Cross-Sectional Naturalistic Study in Spain. CNS Drugs 2021; 35:1023-1032. [PMID: 34370282 DOI: 10.1007/s40263-021-00852-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Although no psychotropic drugs have been officially approved for the treatment of borderline personality disorder (BPD), medications are routinely prescribed for these patients. The primary aim of this study was to evaluate changes in the pharmacological management of patients with BPD treated in an outpatient specific unit in Spain over the past 20 years, while a secondary aim was to identify the factors associated with the prescription. METHODS Observational and cross-sectional study of all patients with a primary diagnosis of BPD (n = 620) consecutively admitted to a BPD outpatient program in Barcelona, Spain, from 2001 through 2020. We examined trends in the prescription of antidepressants, benzodiazepines, mood stabilizers, and antipsychotics. For the analysis, prescription data were grouped into four 5-year periods (2001-2005, 2006-2010, 2011-2015, and 2016-2020). Logistic regression models were performed to identify sociodemographic and clinical variables associated with pharmacological prescription and polypharmacy. RESULTS The percentage of patients receiving pharmacotherapy decreased over time. Antidepressant prescription rates remained high and stable over time (74% of patients), while benzodiazepine use decreased significantly during the study period (from 77 to 36%) and second-generation antipsychotic (SGA) use increased from 15 to 32%. Psychiatric comorbidity was the main factor associated with pharmacological treatment (odds ratio 2.5, 95% confidence interval 1.5-4.2) and polypharmacy, although a high percentage of patients without comorbidity were also taking medications. CONCLUSIONS Over the past 20 years, the pharmacological treatment of BPD outpatients has undergone important changes, most notably the decrease in benzodiazepines and increase in SGAs. The findings of this study demonstrate that pharmacotherapy is much more prevalent in patients with BPD than recommended in most clinical guidelines.
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Affiliation(s)
- Juan C Pascual
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Ana Martín-Blanco
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain. .,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain. .,Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Joaquim Soler
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,Institut d'Investigació Biomèdica-Sant Pau (IIB-SANT PAU), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
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Hopping R, Ivanova D, Howe AJ. A pill for every ill? THERAPEUTIC COMMUNITIES 2020. [DOI: 10.1108/tc-09-2019-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
National guidelines in the UK for emotionally unstable personality disorder and antisocial personality disorder (PD) do not recommend treatment with medication, suggesting instead psychotherapy. There is little evidence that medication has benefit from the literature. Despite this, many patients with PDs are prescribed medications. This study aims to quantify medication prescriptions within the therapeutic community for those with PD and assess if treatment led to changes in prescription.
Design/methodology/approach
An audit tool was designed in Microsoft Excel; 30 most recent patients discharged from the authors’ service since November 2018 were identified. Their discharge summaries were scrutinised for changes in medication comparing the beginning of treatment to the end. These were then analysed in terms of changes in class of medication and dose as well as total number of medications prescribed.
Findings
In total, 31 patients’ notes were scrutinised. Then, 25 patients were prescribed psychiatric medication at the start of their treatment, 24 had medications changed falling to 17 at the end of treatment. Antidepressants were the most commonly prescribed medications. By class, antidepressant prescriptions fell by 35 per cent, antipsychotics by 43 per cent, anxiolytics by 40 per cent. The prescription of mood stabilisers and Z drugs remained the same.
Originality/value
The assessment of medication changes during psychotherapeutic treatment within a therapeutic community is unique in the literature. Understanding and hypothesising the dynamics involved within this process has also received little attention in research. This study highlights the potential from which further research into this neglected but pertinent area could be conducted.
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Suss T, Oldani M. Little Helpers No More: A Framework for Collaborative Deprescribing of Benzodiazepines in Older Adults. J Psychosoc Nurs Ment Health Serv 2020; 58:23-28. [DOI: 10.3928/02793695-20191218-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 09/23/2019] [Indexed: 11/20/2022]
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Donald F, Arunogiri S, Lubman DI. Substance use and borderline personality disorder: fostering hope in the face of complexity. Australas Psychiatry 2019; 27:569-572. [PMID: 31512481 DOI: 10.1177/1039856219875061] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Impulsivity and emotional dysregulation are common characteristics of patients presenting with co-occurring borderline personality disorder (BPD) and substance use disorder (SUD). This article aims to provide an overview of the clinical approaches psychiatrists should consider when treating patients with these conditions. CONCLUSIONS Co-occurring BPD and SUD can be effectively treated within a staged, transdiagnostic approach with an emphasis on the therapeutic alliance.
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Affiliation(s)
- Fiona Donald
- Spectrum Personality Disorder Service, Eastern Health, Richmond, VIC, and; Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Shalini Arunogiri
- Turning Point, Eastern Health, Richmond, VIC, and; Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
| | - Dan I Lubman
- Turning Point, Eastern Health, Richmond, VIC, and; Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, VIC, Australia
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