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Psychopharmacology Oct 2023Clozapine is a unique medication with a potential role in the treatment of severe borderline personality disorder (BPD). (Review)
Review
RATIONALE
Clozapine is a unique medication with a potential role in the treatment of severe borderline personality disorder (BPD).
OBJECTIVES
The review examines the effectiveness of clozapine as a medication for management for severe BPD with high risk of suicide, violence or imprisonment, and aims to help guide clinical practice in managing severe BPD.
METHODS
A database search of the terms "Clozapine" AND "BPD"; "Antipsychotics" AND "BPD"; "Clozapine" AND "Borderline Personality Disorder"; and "Antipsychotics" AND "Borderline Personality Disorder" were performed in CINAHL, Cochrane Library, Embase, Medline, PsychINFO, PubMed, and Web of Science. Full-text articles of clinical clozapine use for BPD were included for review.
RESULTS
A total of 24 articles consisting of 1 randomised control trial, 10 non-controlled trials, and 13 case reports were identified. Most of the studies reported benefits from clozapine when used for severe BPD. Many of the studies focused on clozapine use in BPD patients at high risk of suicide. Results from these non-controlled and case reports support the use of clozapine in patients with severe BPD at high risk of suicide.
CONCLUSION
There may be a role for clozapine in treating severe treatment refractory BPD, especially for those patients at high risk of suicide and frequent hospitalisations.
Topics: Humans; Clozapine; Antipsychotic Agents; Suicide; Borderline Personality Disorder; Randomized Controlled Trials as Topic
PubMed: 37572113
DOI: 10.1007/s00213-023-06431-6 -
Current Psychiatry Reports Oct 2020Identity is one of the key domains that is disturbed in people manifesting personality disorder (PD). Within the field of personality psychology, there is a robust... (Review)
Review
PURPOSE OF REVIEW
Identity is one of the key domains that is disturbed in people manifesting personality disorder (PD). Within the field of personality psychology, there is a robust approach to studying identity focused on narrative identity which has been largely overlooked in studying PD. In this paper, a systematic review was conducted of studies published in the past decade that focused on how individuals manifesting personality pathology craft their narrative identity.
RECENT FINDINGS
This review revealed disturbances related to several motivational/affective themes (e.g., negative valence/valence shifts and thwarted themes of agency and communion), autobiographical reasoning (negative self-inferences), and structural elements (e.g., low coherence and fewer life script events) within the narrative identity of people who manifest PD. Narrative identity is disturbed in people experiencing personality pathology and may have crucial implications for enhancing our conceptual understanding of PD and for PD interventions. This review also points to several research limitations and gaps that we encourage the field to pursue in the future.
Topics: Humans; Motivation; Narration; Personality; Personality Disorders; Self Concept
PubMed: 33034756
DOI: 10.1007/s11920-020-01187-8 -
The Psychiatric Quarterly Dec 2020No treatment has been approved and recognized as effective in borderline personality disorder (BPD). Impulsivity is a key dimension because it is a predictor of... (Review)
Review
No treatment has been approved and recognized as effective in borderline personality disorder (BPD). Impulsivity is a key dimension because it is a predictor of remission but also suicide. The purpose of this review is to establish an inventory on the management of impulsivity in BPD and determine the effective treatments. A systematic review on the PubMed and Ovid databases was conducted up to September 2019 to December 2019 using the PRISMA guidelines. The inclusion criteria were: studies with patients with borderline personality disorder, were published between 1989 and 2019, used English-language and evaluated impulsivity before and after treatment. 41 articles selected were included for pharmacological treatment. 24 articles were found for psychotherapeutic management and one randomized study of transcranial magnetic stimulation. Based on this review, we must focus on psychotherapy in BPD, particularly the schema therapy, dialectical behavioral therapy, psychoeducation, system training of emotional predictability and problem solving and psychotherapy using mentalisation. The use of neuroleptics and mood stabilizers appears to be more effective than antidepressants. Another approach, such as transcranial magnetic stimulation, may prove useful in the near future if this technique is studied further.
Topics: Behavior Therapy; Borderline Personality Disorder; Humans; Impulsive Behavior; Psychotherapy; Suicide; Suicide Prevention
PubMed: 32989635
DOI: 10.1007/s11126-020-09845-z -
Psychiatry Research Nov 2022Pediatric depression is a common psychiatric disorder that is associated with significant morbidity and mortality. Ketamine is a non-competitive N-methyl-D-aspartate... (Review)
Review
Pediatric depression is a common psychiatric disorder that is associated with significant morbidity and mortality. Ketamine is a non-competitive N-methyl-D-aspartate (NMDA) receptor antagonist with demonstrated antidepressant effects in the adult population, however, the efficacy and safety of ketamine for the treatment of pediatric depression remains poorly understood. Electronic databases were searched from inception to June 2022 to identify relevant articles. Six articles involving 46 participants with a mean age of 15.7 years were included in this systematic review. Out of six articles, three were case reports, one was a randomized clinical trial (RCT) and two were open-label trials. All studies used 0.5 mg/kg intravenous ketamine except for one, which used 2-7 micrograms/kg. Ketamine was significantly associated with reduced depressive symptoms without severe adverse events. Taken together, the results of these studies demonstrated the potential role of ketamine for treating pediatric depression. Several important limitations were identified, most notably the small sample sizes of the component studies, and that all studies administered intravenous ketamine. Further studies with larger sample sizes and different administration modalities are needed to better determine the efficacy and safety of ketamine in pediatric depression.
Topics: Adult; Humans; Child; Adolescent; Depression; Ketamine; Databases, Factual; Mental Disorders; Sample Size; Randomized Controlled Trials as Topic
PubMed: 37732856
DOI: 10.1016/j.psychres.2022.114911 -
Child Abuse & Neglect Jun 2023Parental pathology may affect parenting capacity and is deemed a risk factor for child maltreatment. Especially parental personality disorder (PD) can significantly... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Parental pathology may affect parenting capacity and is deemed a risk factor for child maltreatment. Especially parental personality disorder (PD) can significantly burden the relationship and interaction between parents and their children.
OBJECTIVE
This meta-analytic review aims to summarize and quantify the influence of parental PD on the occurrence / the risk of child maltreatment.
PARTICIPANTS AND SETTING
Studies had to meet the following inclusion criteria: They had to analyze a sample of parents with a diagnosed PD and the occurrence / risk of maltreating their children. To be included in the narrative synthesis and/or meta-analysis, they had to be case-control, cross-sectional, or longitudinal studies. Literature research was conducted in the databases Web of Science, Psychinfo, and Google Scholar up to January 2023.
METHODS
First, studies were analyzed on a narrative level, and eligible studies for the meta-analysis were identified. Studies were grouped according to the diagnosed PDs. Five different groups were included: borderline PD, antisocial PD, narcissistic PD, nondifferentiated PDs, and Cluster B PDs. Three different random-effects meta-analyses were computed (borderline PD, antisocial PD, Cluster B PDs). Meta-analyses were controlled for publication bias and different covariates (e.g., study quality, sample size).
RESULTS
After screening 41 full texts, 17 studies were included in the narrative synthesis, out of which 14 samples from 11 studies were included in the meta-analysis. Analysis of borderline PD showed an association with the occurrence / risk of child maltreatment (OR = 8.08; 95 % CI [2.51, 25.93]). However, after taking into account possible publication bias, this association was no longer significant. We found a significant and stable association between antisocial PD and the occurrence of / risk of child maltreatment (OR = 4.92; 95 % CI [3.26, 7.43]). Analysis of Cluster B PDs (antisocial, borderline, histrionic, narcissistic) revealed a significant overall association (OR = 4.23; 95 % CI [2.75, 6.5]), indicating that the presence of Cluster B PDs in parents significantly increases the occurrence of / the risk of child maltreatment.
CONCLUSIONS
Analyses indicated a significant association between of Cluster B PDs, and specifically between antisocial and borderline PD, with the occurrence of / the risk of child maltreatment. However, methodological limitations have to be taken into account, because results for borderline PD were no longer significant after controlling for possible publication bias. Moreover, the number of studies included was rather small, and results showed a substantial amount of heterogeneity.
OTHER
This work was not supported by any funding.
Topics: Humans; Child; Cross-Sectional Studies; Personality Disorders; Borderline Personality Disorder; Antisocial Personality Disorder; Child Abuse; Parents
PubMed: 37060689
DOI: 10.1016/j.chiabu.2023.106148 -
BJPsych Open May 2022Mental health crisis presentations are common in those who have a diagnosis of borderline personality disorder (BPD), and psychosocial interventions should be provided.... (Review)
Review
BACKGROUND
Mental health crisis presentations are common in those who have a diagnosis of borderline personality disorder (BPD), and psychosocial interventions should be provided. However, there is limited evidence outlining what a crisis-focused psychosocial intervention for this population should include.
AIMS
To conduct a systematic review and narrative synthesis of crisis-focused psychosocial interventions for people diagnosed with BPD.
METHOD
Three databases (MEDLINE, Embase, PsycInfo) were searched for eligible studies. Studies were included if they were quantitative studies comparing a crisis-focused intervention with any control group and they included adults (18+ years of age) who were diagnosed with BPD (or with equivalent experiences). A narrative synthesis was undertaken to analyse results.
RESULTS
A total of 3711 papers were initially identified, 95 full texts were screened and 5 studies were included in the review. Two of five studies reported on the same trial, so four individual trials were included. Overall moderate risk of bias across studies was identified. The review tentatively demonstrated that crisis-focused psychosocial interventions are feasible and acceptable to people with BPD and that they have potential impacts on outcomes such as self-harm and number of days spent in hospital. There is limited consensus on what outcome measures should be used to assess the impact of interventions.
CONCLUSIONS
There is presently insufficient data to recommend any specific psychosocial crisis intervention for people with BPD. Given the relationship between BPD and the high frequency of crises experienced by this group, further large-scale trials examining crisis-focused psychosocial interventions are required.
STATEMENT ON LANGUAGE
We acknowledge that the term personality disorder can be controversial and stigmatising. As the term borderline personality disorder has been retained in DSM-5 and is used in the research evidence base we have decided to use this term throughout this review. However, we recognise that this term may not be acceptable to all.
PubMed: 35579039
DOI: 10.1192/bjo.2022.54 -
Schizophrenia Research Aug 2020Schizotypy is a multi-dimensional personality construct that putatively indicates an individual's liability to psychosis. Schizophrenia is associated with significant... (Meta-Analysis)
Meta-Analysis Review
Schizotypy is a multi-dimensional personality construct that putatively indicates an individual's liability to psychosis. Schizophrenia is associated with significant deficits in theory of mind (ToM). However, previous studies investigating the relationship between schizotypy and ToM provided inconsistent findings. Following the systematic review of all relevant schizotypy studies between January 1, 1980 and June 30, 2019, a meta-analysis of the relationship between ToM and schizotypy was conducted. Current meta-analysis included 24 studies consisting of 4162 healthy individuals. Overall, there was a significant but a small negative relationship between ToM and schizotypy (d = -0.23, CI = -0.14-0.33). Schizotypy scores were negatively associated with both reasoning (d = -0.24, CI = -0.11-0.38) and decoding (d = -0.21, CI = -0.09-0.32) aspects of ToM. The relationship between ToM and schizotypy was more significant in the studies using extreme-group design (d = -0.31, CI = -0.17-0.45) than non-extreme-group design (d = -0.17, CI = -0.04-0.29). ToM abnormalities were significantly related to both positive and negative schizotypy. Current findings support the continuum between schizotpy and schizophrenia. ToM abnormalities might be vulnerability markers for psychosis.
Topics: Humans; Psychotic Disorders; Schizophrenia; Schizotypal Personality Disorder; Theory of Mind
PubMed: 32461089
DOI: 10.1016/j.schres.2020.04.024 -
Dementia and Geriatric Cognitive... 2022Homicide by older offenders is rare and devastating. It likely occurs due to a complex interaction of personal, social, and environmental factors. Dementia is a...
BACKGROUND
Homicide by older offenders is rare and devastating. It likely occurs due to a complex interaction of personal, social, and environmental factors. Dementia is a progressive neurological condition which may amplify behavioural disturbances such as aggression. This systematic review aims to evaluate the factors associated with homicide committed by people with dementia in order to inform clinical practice.
SUMMARY
MEDLINE, PsychINFO, Embase, and PubMed databases were searched in accordance with PRISMA guidelines for empirical studies examining the characteristics and circumstances of people with dementia who committed homicides. Data on factors associated with the homicide were extracted and the quality of each study rated using standardized criteria. A total of 499 papers were screened and thirteen studies met the inclusion criteria. Study design included case reports (seven studies), case series (four studies), and two retrospective cohort studies, indicative of low levels of evidence. Sample sizes were 1-70. Study findings were predominantly descriptive. Quality ratings ranged from 50 to 100%. Factors associated with disinhibition such as dysexecutive syndrome, alcohol use, and delirium may predispose to severe impulsive aggression. Psychosis and personality pathology appeared to influence targeted assaults resulting in homicide by people with dementia. Victim vulnerability was also a key element.
KEY MESSAGES
The current evidence examining risk factors for homicide committed by people with dementia is limited. However, there are common characteristics reported in these descriptive studies including psychiatric factors and cognitive states causing disinhibition. Recommendations for clinical practice include early assessment of older people with dementia and changed behaviours to allow management of comorbidities and reversible risk factors, alongside education, and advice to carers (who may be targets of aggression). Specialized geriatric forensic psychiatry services and care settings should be developed.
Topics: Aged; Dementia; Homicide; Humans; Psychotic Disorders; Retrospective Studies; Risk Factors
PubMed: 35306488
DOI: 10.1159/000521878 -
Child Psychiatry and Human Development Apr 2023This work presents a review of research papers examining the role of emerging personality pathology in suicidal ideation and behaviours in adolescence. Initially, 226...
This 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.
Topics: Humans; Adolescent; Suicidal Ideation; Suicide; Suicide, Attempted; Personality Disorders; Personality; Borderline Personality Disorder
PubMed: 34524583
DOI: 10.1007/s10578-021-01239-x -
International Journal of Environmental... Aug 2021In addition to social and environmental factors, individual personality traits have intricately linked with maladaptive behaviour. Thus, the purpose of this article was... (Review)
Review
In addition to social and environmental factors, individual personality traits have intricately linked with maladaptive behaviour. Thus, the purpose of this article was to review the link between individual personality traits and criminality. A systematic review was conducted to obtain information regarding the link between individual personality traits with criminal behaviour in the Sage, Web of Science, APA PsycNet, Wiley Online Library, and PubMed databases. The results indicate that individual personality traits that contribute towards criminality are (i) psychopathy; (ii) low self-control; and (iii) difficult temperament. As an overall impact, the review is expected to provide in-depth understanding of the link between individual personality traits and criminality; hence, greater consideration will be given to the dimension of personality as a notable risk factor of criminal behaviour.
Topics: Antisocial Personality Disorder; Criminal Behavior; Humans; Personality; Personality Disorders; Personality Inventory
PubMed: 34444412
DOI: 10.3390/ijerph18168663