Trainee experience in diagnosis and management of personality disorders

2018 ◽  
Vol 37 (2) ◽  
pp. 136-140
Author(s):  
R. Wallace ◽  
G. Rush
Keyword(s):  
Clinical Practice ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Diagnostic System ◽  
Psychiatry Training ◽  
Linear Fashion ◽  
Diagnosis And Management ◽  
Training Structure ◽  
Trainee Experience

The diagnosis and management of personality disorders continues to evolve and develop alongside psychiatry internationally, however, not always in a linear fashion. Trainees working in a variety of clinical areas have regular exposure to personality disorder presentations. Psychiatry training bodies continue to adapt their training structure and curriculum, however, there seems to be a lack of sufficient emphasis with regards this area. We are now embarking on a new diagnostic system for personality disorders; this may impact on our clinical practice and perspective of these patients. The role of psychiatrists in diagnosing and managing personality disorders can be unclear at times and may benefit from on-going reflection and standardization.

scholarly journals Principles of managing patients with personality disorder

2002 ◽  
Vol 8 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Sophie E. Davison
Keyword(s):  
Clinical Practice ◽  
Personality Disorder ◽  
Mental Disorder ◽  
Personality Disorders ◽  
Clinical Skills ◽  
Management Plan ◽  
Everyday Clinical Practice ◽  
Clinical Problems

The management of individuals with personality disorder is one of the most challenging and sometimes controversial areas of psychiatry. This paper describes the principles involved in identifying the clinical problems and formulating a management plan for patients with personality disorder in everyday clinical practice. It demonstrates that the principles of assessing and managing personality disorders and the clinical skills required are no different from those of treating any other chronic mental disorder.

scholarly journals Suicidality and Personality Pathology in Adolescence: A Systematic Review

2021 ◽  
Author(s):  
Marta Moselli ◽  
Maria Pia Casini ◽  
Camilla Frattini ◽  
Riccardo Williams
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Borderline Personality ◽  
Personality Pathology ◽  
Suicidal Risk ◽  
Research Papers ◽  
Mediating Role ◽  
Identity Diffusion ◽  
Predictive Role

AbstractThis work presents a review of research papers examining the role of emerging personality pathology in suicidal ideation and behaviours in adolescence. Initially, 226 studies were selected in line with PRISMA guidelines, and 33 articles were finally included in this review. The data show percentages of any personality disorder diagnosis ranging from 19.5 to 22.8% in suicide attempters, while in autopsy studies, the rate of personality disorder diagnosis varied between 29.6 and 42.1%. The overwhelming majority of the studies focus on the role of borderline personality disorder (BPD) in suicidal behaviours, also highlighting its predictive role at a longitudinal level. Furthermore, the literature review shows that personality traits supposed to underlie BPD, such as affective instability, impulsivity and identity diffusion, have specific predictive links with suicidal conduct. Other personality pathology dimensions, such as aggressiveness, sadism and perfectionism that are associated with other personality disorders, namely, antisocial and narcissistic personality disorders, have also shown a significant mediating role for suicidal risk. Overall, these results seem to parallel the role of personality pathology in predicting suicide in adulthood and point to the relevance of assessing the presence of emerging patterns of personality disorders for the clinical management of suicidal risk in adolescence.

Psychopharmacological Treatment of Personality Disorders

2015 ◽  
Author(s):  
M. Mercedes Perez-Rodriguez ◽  
Larry J. Siever
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Borderline Personality ◽  
Mood Stabilizers ◽  
Omega 3 ◽  
Psychopharmacological Treatment ◽  
Limited Effectiveness ◽  
Second Generation Antipsychotics

Despite the lack of approval by the U.S. Food & Drug Administration, drugs are used widely to treat personality disorders, particularly borderline personality disorder, based on their effects known from clinical trials in other psychiatric disorders (off-label use). The role of medications in personality disorders is limited to moderate effects on some but not all of the symptom domains. There are no medications available that improve the global severity of any personality disorder as a whole. In borderline personality disorder, evidence is strongest for second-generation antipsychotics and mood stabilizers, while dietary supplements like omega-3 fatty acids hold some promise. However, medications have limited effectiveness and are still viewed as adjunctive to other forms of treatment, particularly psychotherapy.

scholarly journals Boredom in Borderline Personality Disorder: A Lost Criterion Reconsidered

2020 ◽  
Vol 53 (5-6) ◽  
pp. 239-253
Author(s):  
Sara R. Masland ◽  
Tanya V. Shah ◽  
Lois W. Choi-Kain
Keyword(s):  
Clinical Practice ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Diagnostic Criteria ◽  
Empirical Research ◽  
Borderline Personality ◽  
Cascade Model ◽  
Identity Disturbance ◽  
Behavioral Dysregulation

Difficulty with boredom was eliminated from the formal diagnostic criteria for borderline personality disorder (BPD) in 1994 based on significantly limited, unpublished data. However, it is apparent in clinical practice that boredom remains relevant to BPD. This review synthesizes empirical research, with consideration of theoretical accounts, to critically examine the relevance of boredom to BPD. We first briefly review issues in defining and measuring boredom and offer an expanded conceptualization for BPD, which includes the notion of boredom reactivity, before turning to boredom’s differentiation from and overlap with feelings of emptiness, with which it was paired prior to its removal from the DSM. We then discuss perspectives on boredom’s significance in BPD, briefly touching on its relevance in other personality disorders. We propose a Boredom Cascade Model that articulates how boredom and boredom reactivity interact with identity disturbance and chronic emptiness to create escalating patterns of behavioral dysregulation and make recommendations for research and treatment.

Something Doesn’t Seem Right

2021 ◽  
pp. 35-42
Author(s):  
Daniel M. Doleys ◽  
Nicholas D. Doleys
Keyword(s):  
Chronic Pain ◽  
Clinical Practice ◽  
Borderline Personality Disorder ◽  
Pain Management ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Borderline Personality ◽  
Residential Placement ◽  
Controlled Substances ◽  
Female Patients

This case depicts a situation wherein the facts do not seem to fit. In a hurried and busy clinical practice, one is glad to encounter what seems to be a pleasant patient. Patients with personality disorders, especially those with a borderline personality disorder (BPD), can be very deceptive. Their overall manner is often very congenial, until their expectations or requests are not met. Their presentation may be very different to the staff versus the clinician. Self-destructive (mutilation) behavior can be seen in the more severe cases. Female patients can be very disarming. Their objective, in the chronic pain setting, relates more to issues of control and manipulation than to receiving effective pain management. Treatment can be intensive and involve residential placement. Use of controlled substances can be very dangerous. Patient with BPD are best referred to a specialist.

scholarly journals Canadian Thoracic Society 2012 Guideline Update: Diagnosis and Management of Asthma in Preschoolers, Children and Adults

2012 ◽  
Vol 19 (2) ◽  
pp. 127-164 ◽  
Author(s):  
M Diane Lougheed ◽  
Catherine Lemiere ◽  
Francine M Ducharme ◽  
Chris Licskai ◽  
Sharon D Dell ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Asthma Control ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Action Plan ◽  
Guideline Implementation ◽  
Adjunct Therapy ◽  
Diagnosis And Management ◽  
Controller Medication

BACKGROUND: In 2010, the Canadian Thoracic Society (CTS) published a Consensus Summary for the diagnosis and management of asthma in children six years of age and older, and adults, including an updated Asthma Management Continuum. The CTS Asthma Clinical Assembly subsequently began a formal clinical practice guideline update process, focusing, in this first iteration, on topics of controversy and/or gaps in the previous guidelines.METHODS: Four clinical questions were identified as a focus for the updated guideline: the role of noninvasive measurements of airway inflammation for the adjustment of anti-inflammatory therapy; the initiation of adjunct therapy to inhaled corticosteroids (ICS) for uncontrolled asthma; the role of a single inhaler of an ICS/long-acting beta2-agonist combination as a reliever, and as a reliever and a controller; and the escalation of controller medication for acute loss of asthma control as part of a self-management action plan. The expert panel followed an adaptation process to identify and appraise existing guidelines on the specified topics. In addition, literature searches were performed to identify relevant systematic reviews and randomized controlled trials. The panel formally assessed and graded the evidence, and made 34 recommendations.RESULTS: The updated guideline recommendations outline a role for inclusion of assessment of sputum eosinophils, in addition to standard measures of asthma control, to guide adjustment of controller therapy in adults with moderate to severe asthma. Appraisal of the evidence regarding which adjunct controller therapy to add to ICS and at what ICS dose to begin adjunct therapy in children and adults with poor asthma control supported the 2010 CTS Consensus Summary recommendations. New recommendations for the adjustment of controller medication within written action plans are provided. Finally, priority areas for future research were identified.CONCLUSIONS: The present clinical practice guideline is the first update of the CTS Asthma Guidelines following the Canadian Respiratory Guidelines Committee’s new guideline development process. Tools and strategies to support guideline implementation will be developed and the CTS will continue to regularly provide updates reflecting new evidence.

scholarly journals Problems of Psychopathy Concept in the Modern Domestic and Foreign Psychology

2016 ◽  
Vol 8 (1) ◽  
pp. 114-127 ◽  
Author(s):  
J.A. Atadjikova ◽  
S.N. Enikolopov
Keyword(s):  
Clinical Practice ◽  
Social Behavior ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Psychopathic Personality ◽  
Legal Practice ◽  
Psychological Mechanisms ◽  
The Subject ◽  
Definition Of ◽  
Terminological Confusion

The article raises the problem of the heterogeneity of the group of persons with antisocial behavior and the need for dividing it into subgroups. This problem can be solved by adopting psychology of the subject and his identity specifically as mediating process. Psychopathy as a personal anomaly acts as a link enables a clear assessment of anti-social behavior mechanisms in a particular group of individuals. We describe the understanding of psychopathy concept also known as antisocial (dissocial, psychopathic) personality disorder by domestic and foreign authors. The article discusses the main debating points of psychopathy role in clinical practice, definition of the diagnostic criteria, terminological confusion caused by the concept of antisocial (dissocial) personality disorders, as well as the search for the reasons and psychological mechanisms of psychopathy emergence and developing. Analysis of psychopathy relations with such constructs as aggression, violence and anti-social behavior, allows examining applied problems and the prospects of using the psychopathy construct in medical and legal practice.

Established and Novel Pharmacological Approaches to the Treatment of Personality Disorders

2018 ◽  
Author(s):  
S. Charles Schulz ◽  
Robert O. Friedel
Keyword(s):  
Personality Disorder ◽  
Personality Disorders ◽  
Current Knowledge ◽  
Mechanisms Of Action ◽  
Drug Form ◽  
The Past ◽  
New Findings ◽  
Psychotropic Agents

In the past few decades, the widely held belief of personality disorder patients being unresponsive to medication has been challenged. This chapter first reviews the current knowledge on medication for patients with personality disorders and then considers a number of novel pharmacological approaches that may yield additional beneficial results in the treatment of these disorders. It utilizes the neuroscience-based nomenclature for psychotropic agents, in which the presumptive modes and mechanisms of action of each drug form the basis of the nomenclature. A special emphasis of the chapter is laid on the role of clozapine in the treatment of personality disorders as well as new findings in the areas of pharmacogenetics and epigenetics.

scholarly journals Management of personality disorders in acute in-patient settings. Part 1: Borderline personality disorders

2004 ◽  
Vol 10 (2) ◽  
pp. 93-99 ◽  
Author(s):  
Leonard Fagin
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Patient Care ◽  
Personality Disorders ◽  
Borderline Personality ◽  
Care Plan ◽  
Borderline Personality Disorders

General principles of management of patients with personality disorders admitted in crises to the in-patient unit are discussed. The role of the acute ward in the overall plan of care, the clinical thresholds to consider in deciding whether admission is appropriate and the main elements of the in-patient care plan are outlined. The management of patients with borderline personality disorder, who constitute the majority of such admissions, is discussed in detail.

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