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  • Gunderson JG: Borderline Personality Disorder: Ontogeny of a diagnosis. Am J Psychiatry 2009; 166: 530-539.
  • Soloff PH. And Chiappetta L.: Prospective Predictors of Suicidal Behavior in Borderline Personality Disorder at 6-Year Follow-Up .Am J Psychiatry 2012;169:484-490.
  • Zanarini M. C. , Frances R. Frankenburg D, Reich B. , Fitzmaurice G. : Attainment and Stability of Sustained Symptomatic Remission and Recovery Among Patients With Borderline Personality Disorder and Axis II Comparison Subjects: A 16-Year Prospective Follow-Up Study. Am J Psychiatry 2012;169:476-483 .

Transcript

  • 1. ‫‪BORDE RLINE‬‬‫‪PE RS ONA LITY: DIS ORDE R‬‬ ‫‪?What‘s new‬‬ ‫د/ نشأت عبد ربه ملك‬ ‫استشاري الطب النفسي بمستشفى الصحة النفسية‬ ‫بالعبـــــــــــاسية‬
  • 2. Let‘s remember:DSM-IV-TR diagnostic criteria for borderline personality disorder A pervasive pattern of instability of interpersonal relationships, self-image, and affects:(1) frantic efforts to avoid real or imagined abandonment.(2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation(3)markedly and persistently unstable self-image or sense of self
  • 3. :Diagnostic criteria(4) impulsivity (e.g., spending, sex, substance abuse, reckless driving, binge eating).(5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior(6) affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety)(7) chronic feelings of emptiness(8) inappropriate, intense anger or difficulty controlling anger(9) transient, stress-related paranoid ideation or severe dissociative symptoms
  • 4. Treatment of borderline pers onality dis order Psychodynamic individual psychotherapy. Supportive individual psychotherapy. Cognitive-behavioral or schema-focused psychotherapy Dialectical behavior therapy. Interpersonal psychotherapy. Family psychoeducation. Antidepressant medications SSRIs (for affective dysregulation & impulsivity) Atypical antipsychotic medications (psychotic- like features) Anticonvulsant medications (APA Textbook of Psychiatry, 5th ed., 2008)
  • 5. B orderline Pers onality Dis order: Ontogeny of a Diagnos is Before 1970unders on, 2009) colloquialism ( G : psychoanalytic for untreatable neurotics. 1970–1980: From Personality Organization to Syndrome: “An Adjective in Search of a Noun” 1980–1990:From Syndrome to Personality Disorder: “Wisdom Is Never Calling a Patient Borderline” 1990–2000: From Unwanted Personality Disorder to Disorder-Specific Treatability: “Would the Patient Be Borderline If She Remitted From a Medication?” 2000–2009: Borderline Personality Disorder: “A Good-Prognosis Brain Disease”?
  • 6. Conclusions Bo. Per. D is a valid diagnosis with significant heritability and with specific and effective psychotherapeutic treatments. Increased awareness involving much more education and research is still needed. Psychiatric institutions, professional organizations, public policies, and reimbursement agencies need to prioritize this need.
  • 7. Prospective Predictors of Suicidal Behavior in Borderline Personality Disorder at 6-Year F-U (Soloff & Chiappetta, 2012).Most patients achieve remission of suicidalbehavior over time, as many as 10% die by suicide, raising the question of whether there is a high-risk suicidal subtype??
  • 8. Prospective Predictors of Suicidal Behavior in Borderline Personality Disorder at 6-Year F-U (Soloff & Chiappetta, 2012).Results:Among 90 participants, 25 (27.8%) made at least one suicide attempt in the interval, and most attempts occurred in the first 2 years. The risk of suicide attempt was increased by:3. low socioeconomic status,4. poor psychosocial adjustment,5. family history of suicide,6. previous psychiatric hospitalization.
  • 9. Prospective Predictors of Suicidal Behavior in Borderline Personality Disorder at 6-Year F/U (Soloff & Chiappetta, 2012).Conclusions: Risk factors predictive of suicide attempt change over time. Acute stressors such as major depressive disorder were predictive only in the short term (12 months). Poor psychosocial functioning had persistent and long-term effects on suicide risk. Half of borderline patients have poor psychosocial outcomes despite symptomatic improvement. A social and vocational rehabilitation model of treatment is needed to decrease suicide risk and optimize long-term outcomes.
  • 10. Attainment and Stability of Sustained Symptomatic Remission and Recovery Among Patients With Borderline Personality Disorder and Axis II Comparison Subjects: A 16-Year Prospective Follow-Up Study ( Zanarini et al, 2012 )OBJECTIVE:To determine time to attainment of symptom remission and to recovery lasting 2, 4, 6, or 8 years among patients with borderline personality disorder and comparison subjects with other personality disorders and to determine the stability of these outcomes.
  • 11. Attainment and Stability of Sustained Symptomatic Remission and Recovery Among Patients With Borderline Personality Disorder and Axis II Comparison Subjects METHOD: A total of 290 inpatients with borderline personality disorder and 72 comparison subjects with other axis II disorders were assessed during their index admission using a series of semi-structured interviews, which were administered again at eight successive 2- year follow-up sessions.
  • 12. Conclusion: Borderline patients were significantly slower to achieve remission or recovery (which involved good social and vocational functioning as well as symptomatic remission) than axis II comparison subjects. Sustained symptomatic remission is substantially more common than sustained recovery from borderline personality disorder and that sustained remissions and recoveries are substantially more difficult for individuals with borderline personality disorder to attain and maintain than for individuals with other forms of personality disorder.