Evidence-Based Treatments for Borderline Personality Disorder: Implementation, Integration, and Stepped Care
This article will evaluate four major evidence-based treatments for BPD—dialectical behavioral therapy, mentalization-based treatment, transference-focused psychotherapy, and General Psychiatric Management—and possible modes of implementation in adherent and integrative forms. Models of implementing these diverse treatment approaches will be evaluated, and the potential advantages of combining evidence-based treatments will be discussed, along with some cautionary notes. A proposal for providing stepwise care through assessment of clinical severity will be presented as a means of achieving system-wide changes and great...
Source: Harvard Review of Psychiatry - September 1, 2016 Category: Psychiatry Tags: Perspectives Source Type: research
Integrating Early Intervention for Borderline Personality Disorder and Mood Disorders
This article aims to integrate early intervention for BPD and mood disorders in the clinical context of developmental and phenomenological change and evolution. “Clinical staging,” similar to disease staging in general medicine, is presented as a pragmatic, heuristic, and trans-diagnostic framework to guide prevention and intervention. It acknowledges that the early stages of these disorders cannot be disentangled sufficiently to allow for disorder-specific preventive measures and early interventions. Clinical staging defines an individual’s location along the continuum of the evolving temporal course of a disorder. ...
Source: Harvard Review of Psychiatry - September 1, 2016 Category: Psychiatry Tags: Reviews Source Type: research
A Neurobiological Model of Borderline Personality Disorder: Systematic and Integrative Review
Abstract: Borderline personality disorder (BPD) is a severe mental disorder with a multifactorial etiology. The development and maintenance of BPD is sustained by diverse neurobiological factors that contribute to the disorder’s complex clinical phenotype. These factors may be identified using a range of techniques to probe alterations in brain systems that underlie BPD. We systematically searched the scientific literature for empirical studies on the neurobiology of BPD, identifying 146 articles in three broad research areas: neuroendocrinology and biological specimens; structural neuroimaging; and functional neuroimagi...
Source: Harvard Review of Psychiatry - September 1, 2016 Category: Psychiatry Tags: Reviews Source Type: research
Introduction
No abstract available (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - September 1, 2016 Category: Psychiatry Tags: Special Issue: Emerging Topics in the Treatment of Borderline Personality Disorder Source Type: research
Psychological Symptom Amplification: Are Psychological Symptoms Subject to “Somatization”-Like Processes?
Abstract: Many patients demonstrate amplified somatic symptom experiences that are felt by providers to cause excessive distress and functional impairment, and that can be diagnostically misleading. Terms attached to these presentations include somatization, medically unexplained symptoms, and, most recently, somatic symptom disorder. The analogous amplification of psychological symptoms has not been considered. Accordingly, this column makes a case for discussion and investigation of psychological symptom amplification (PSA), a process made possible by the medical legitimization of certain types of human suffering. As var...
Source: Harvard Review of Psychiatry - July 1, 2016 Category: Psychiatry Tags: Psychopathology Source Type: research
Challenges in Managing Treatment-Refractory Obsessive-Compulsive Disorder and Tourette's Syndrome
No abstract available (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - July 1, 2016 Category: Psychiatry Tags: Clinical Challenge Source Type: research
Posttraumatic Stress Disorder, Overweight, and Obesity: A Systematic Review and Meta-analysis
Abstract: Previous reports have suggested a high prevalence of overweight and obesity among individuals with posttraumatic stress disorder (PTSD). Few studies, however, systematically analyze the relationship between PTSD and body mass index (BMI). We conducted a systematic review and meta-analysis aimed at estimating the association between PTSD and BMI. Fifty-four articles were reviewed, 30 of which (with 191,948 individuals with PTSD and 418,690 trauma-exposed individuals or healthy controls) were eligible for inclusion in the meta-analysis. The pooled standard mean difference, based on a random-effects model, was 0.41 ...
Source: Harvard Review of Psychiatry - July 1, 2016 Category: Psychiatry Tags: Review Source Type: research
Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder
This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status....
Source: Harvard Review of Psychiatry - July 1, 2016 Category: Psychiatry Tags: Perspectives Source Type: research
The Psychopharmacology Algorithm Project at the Harvard South Shore Program: An Algorithm for Generalized Anxiety Disorder
Abstract: This revision of previous algorithms for the pharmacotherapy of generalized anxiety disorder was developed by the Psychopharmacology Algorithm Project at the Harvard South Shore Program. Algorithms from 1999 and 2010 and associated references were reevaluated. Newer studies and reviews published from 2008–14 were obtained from PubMed and analyzed with a focus on their potential to justify changes in the recommendations. Exceptions to the main algorithm for special patient populations, such as women of childbearing potential, pregnant women, the elderly, and those with common medical and psychiatric comorbiditie...
Source: Harvard Review of Psychiatry - July 1, 2016 Category: Psychiatry Tags: Review Source Type: research
Practical and Legal Challenges to Electroconvulsive Therapy in Malignant Catatonia
We present a clinical vignette of malignant catatonia that required court-ordered ECT, followed by a discussion of practical and legal obstacles to expediting emergent ECT when patients cannot provide consent. We review particularly exacting mandates for involuntary ECT from three states: California, Texas, and New York. As compared to standard practice for other clinical interventions when a patient lacks decision-making capacity, ECT is highly regulated; in some cases, these regulations can interfere with life-saving treatment. (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - May 1, 2016 Category: Psychiatry Tags: Forensics Source Type: research
Psychosis Secondary to Anti-N-methyl-D-Aspartate Receptor Encephalitis
No abstract available (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - May 1, 2016 Category: Psychiatry Tags: Clinical Challenge Source Type: research
Insight in Psychiatry and Neurology: State of the Art, and Hypotheses
This article provides a comprehensive review of insight in different psychiatric and neurological disorders, with a special focus on brain areas and neurotransmitters that serve as the substrate for this complex phenomenon. (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - May 1, 2016 Category: Psychiatry Tags: Reviews Source Type: research
A Systematic Review of Suicidality in People with Intellectual Disabilities
Conclusions: In what we believe to be first systematic review of suicidality in people with intellectual disabilities, it was apparent that well-designed, standardized research studies on the topic are scarce. There is consequently limited evidence to guide prevention and intervention strategies for suicidality in this population. (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - May 1, 2016 Category: Psychiatry Tags: Reviews Source Type: research
Cognitive Vulnerability to Major Depression: View from the Intrinsic Network and Cross-network Interactions
Abstract: Although it is generally accepted that cognitive factors contribute to the pathogenesis of major depressive disorder (MDD), there are missing links between behavioral and biological models of depression. Nevertheless, research employing neuroimaging technologies has elucidated some of the neurobiological mechanisms related to cognitive-vulnerability factors, especially from a whole-brain, dynamic perspective. In this review, we integrate well-established cognitive-vulnerability factors for MDD and corresponding neural mechanisms in intrinsic networks using a dual-process framework. We propose that the dynamic alt...
Source: Harvard Review of Psychiatry - May 1, 2016 Category: Psychiatry Tags: Reviews Source Type: research
Postpartum Depression Screening: A Review for Psychiatrists
Conclusions: The American Congress of Obstetricians and Gynecologists, American Academy of Pediatrics, and most authors firmly recommend screening for PPD. The Edinburgh Postnatal Depression Scale can be administered in various clinical settings. Screening should occur at multiple time-points throughout the first postpartum year. The psychiatrist's role in early detection and prevention of PPD requires further exploration. (Source: Harvard Review of Psychiatry)
Source: Harvard Review of Psychiatry - May 1, 2016 Category: Psychiatry Tags: Reviews Source Type: research
