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Somewhere between 11% and 22% of adolescents seeking mental health care in outpatient clinics-and between 33% and 49% of those in inpatient units-meet the diagnostic criteria for borderline personality disorder (BPD). Despite its high prevalence, however, and the high social and economic costs that it entails, BPD remains underdiagnosed, and sufficient training regarding its fundamentals and clinical management is largely unavailable for mental health professionals treating adolescents. It is precisely these essential guidelines that clinicians will find in the Handbook of Good Psychiatric Management for Adolescents With Borderline Personality Disorder. Adapted from Dr. John Gunderson's good psychiatric management (GPM), a resource-efficient generalist treatment for adults with BPD, this manual uses GPM for adolescents (GPM-A) to demystify BPD in young people, describing common problems that arise during each phase or aspect of treatment, from patient rejection of diagnosis and conflicts among clinicians providing care to nonadherence to medications and concerns about stigma. Case vignettes that feature key decision points propose alternative interventions and demonstrate how to apply the book's concepts in a variety of settings. Additionally, speech bubbles throughout the handbook offer suggestions for how to phrase explanations and interventions to communicate effectively with adolescent patients at an appropriate level. Although the pragmatic GPM-A principles outlined in this book are based on real-world experience and bolstered by scientific evidence, they are not intended to be an end point for treatment. They are, rather, a road map to provide "good enough" care even in the absence of specialized treatments, and clinicians are encouraged to adjust the lessons as needed for their practice. The education provided in the handbook is meant to be shared with patients, their families, schools, clinical teams, and trainees as a resource for motivation in persevering with the difficult but worthwhile investments in treatment.
In "Borderline Personality and Mood Disorders: Comorbidity and Controversy," a panel of distinguished experts reviews the last two decades of progress in scientific inquiry about the relationship between mood and personality disorders and the influence of this empirical data on our ways of conceptualizing and treating them. This comprehensive title opens with an introduction defining general trends both influencing the expansion of the mood disorder spectrum and undermining clinical recognition and focus on personality disorders. The overlaps and differences between MDD and BPD in phenomenology and biological markers are then reviewed, followed by a review of the overlaps and distinctions between more atypical mood disorder variants. Further chapters review the current state of thinking on the distinctions between bipolar disorder and BPD, with attention to problems of misdiagnosis and use of clinical vignettes to illustrate important distinguishing features. Two models explaining the relationship between mood, temperament, and personality are offered, followed by a review of the literature on risk factors and early signs of BPD and mood disorders in childhood through young adulthood as well as a review of the longitudinal studies on BPD and mood disorders. The last segment of the book includes three chapters on treatment. The book closes with a conclusion with a synthesis of the current status of thinking on the relationship between mood and borderline personality disorder. An invaluable contribution to the literature, "Borderline Personality and Mood Disorders: Comorbidity and Controversy" insightfully addresses the mood and personality disorders realms of psychiatry and outlines that it has moved away from contentious debate and toward the possibility of synthesis, providing increasing clarity on the relationship between mood and personality to inform improvements in clinical management of the convergence of these psychiatric domains in common practice.
The impetus for writing Good Psychiatric Management and Dialectical Behavior Therapy: A Clinician's Guide to Integration and Stepped Care was the realization that the availability of specialized care for borderline personality disorder (BPD) is far outstripped by the number of patients who need treatment. This manual, edited by experts on BPD, provides a framework for implementing a stepped care model in settings where access to specialized treatments is limited. The authors contend that the principles of good psychiatric management (GPM) represent a basic foundation that all clinicians can learn and that combined with dialectical behavior therapy (DBT), one of the most effective newer treatment modalities, progress can indeed be realized. The book prioritizes pragmatism by suggesting what works in terms of reasonable evidence, practical allocation of public health resources, and real-world clinical experience implementing evidence-based treatments for BPD. The book is structured to enhance understanding and the acquisition of basic skills: • An introductory chapter delivers a brief overview of both GPM and DBT, explaining in broad strokes how BPD is conceptualized in each model. Later chapters address the common principles found in both GPM and DBT—principles that any generalist clinician can incorporate into their practice, including clinician stance, treatment organization, and a strategy for managing crises. • The stepped care model for BPD, is introduced and explored, with emphasis on clinical stage and available resources. In addition, the book presents a menu of possible ways clinicians and programs can use GPM, DBT, and other specialist psychotherapy for BPD. • Two tool kits are supplied, one each for GPM and DBT. These tool kits summarize the top skills and techniques in both treatment modalities for clinicians who are interested in using them in their practices. • A full set of case illustrations is included, each depicting the application of DBT and GPM in common clinical scenarios. These vignettes demonstrate how DBT and GPM can be integrated into primary care settings, emergency rooms, and general mental health settings where specialized psychotherapies for BPD are either not available or not well suited. Aimed at general psychiatrists, therapists, social workers, mental health nurses, psychiatry residents, family physicians, psychologists, and other mental health clinicians who practice in communities where evidence-based treatments for BPD are difficult to access, Good Psychiatric Management and Dialectical Behavior Therapy enhances the clinician's ability to provide not only treatment but also hope.
In Borderline Personality and Mood Disorders: Comorbidity and Controversy, a panel of distinguished experts reviews the last two decades of progress in scientific inquiry about the relationship between mood and personality disorders and the influence of this empirical data on our ways of conceptualizing and treating them. This comprehensive title opens with an introduction defining general trends both influencing the expansion of the mood disorder spectrum and undermining clinical recognition and focus on personality disorders. The overlaps and differences between MDD and BPD in phenomenology and biological markers are then reviewed, followed by a review of the overlaps and distinctions between more atypical mood disorder variants. Further chapters review the current state of thinking on the distinctions between bipolar disorder and BPD, with attention to problems of misdiagnosis and use of clinical vignettes to illustrate important distinguishing features. Two models explaining the relationship between mood, temperament, and personality are offered, followed by a review of the literature on risk factors and early signs of BPD and mood disorders in childhood through young adulthood as well as a review of the longitudinal studies on BPD and mood disorders. The last segment of the book includes three chapters on treatment. The book closes with a conclusion with a synthesis of the current status of thinking on the relationship between mood and borderline personality disorder. An invaluable contribution to the literature, Borderline Personality and Mood Disorders: Comorbidity and Controversy insightfully addresses the mood and personality disorders realms of psychiatry and outlines that it has moved away from contentious debate and toward the possibility of synthesis, providing increasing clarity on the relationship between mood and personality to inform improvements in clinical management of the convergence of these psychiatric domains in common practice.
Practitioners encounter patients with borderline personality disorder (BPD) with surprising frequency; indeed, 1 in 10 emergency room visits and 1 in 20 primary care appointments are estimated to involve people with BPD. Applications of Good Psychiatric Management for Borderline Personality Disorder: A Practical Guide was written not for the psychiatrist engaged in lengthy and complex psychotherapy with these patients but for the generalist who needs the basic skills to deliver good care to this sizeable patient population in need of help. This guide condenses the vast expanse of the latest scientific research and describes the use of good psychiatric management (GPM) with different patient populations, in conjunction with different modalities, for different professions, and in different treatment settings. Constructed carefully by two leading psychiatrists in the field of BPD, the book is designed for maximum utility with stand-alone chapters offering clear guidelines for managing BPD. Topics and features include the following: * Case vignettes, which are designed to make the book practical and eminently useful, provide "decision points" where alternative interventions are proposed and discussed, demonstrating how to apply the concepts outlined in the chapter. Although the authors review the relative merits of these interventions, the presentation promotes active learning and the ability to adapt to unpredictable clinical realities. * Challenges to implementing GPM that are specific to a particular treatment setting-consultations, inpatient and outpatient settings, emergency departments, and colleges-are directly addressed so the guidelines are immediately relevant to the target audience of each chapter.* Clinicians from a variety of fields, including social workers, primary care providers, psychopharmacologists, and training supervisors, care for patients with BPD, and the book makes concrete suggestions about how to apply GPM in a range of practice types.* Implementation of GPM in a brief format and how it can be applied to other personality disorders is also addressed. It explains how GPM can be integrated with other evidence-based treatments for BPD, such as dialectical behavior therapy, mentalization-based treatment, and transference-focused psychotherapy. Written in a down-to-earth style, this case management text will appeal to the resident on call, the specialist, and the generalist. Above all, Applications of Good Psychiatric Management for Borderline Personality Disorder: A Practical Guide addresses the challenges specific to different treatment contexts to help busy clinicians provide informed, effective care for their patients with BPD.
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