Six percent of people in North America will develop borderline personality disorder (BPD) in their lifetime, and about 46% of them will have alcohol use disorder (AUD) at the same time. Alcohol use exacerbates the symptoms of both diseases, rendering treatment more challenging and increasing the risk of suicide. Integrated treatments have been lacking.
Good Psychiatric Management for Borderline Personality Disorder and Alcohol Use Disorder meets the urgent need for such an integrated approach. It provides clearly articulated descriptions of both BPD and AUD, outlining clinical patterns and how to diagnose them with confidence. Relying on general psychiatric principles with which most clinicians are already familiar, as well as up-to-date standards of care for both BPD and AUD, the handbook pays particular attention to areas of potential synergy, providing clinical logic for addressing complex, real-world cases.
Topics include the following:
Progress assessment, psychoeducation, and goal setting; Managing suicidality and nonsuicidal self-harm; Pharmacotherapy; Multimodal treatments, including mutual-help groups and family intervention; and Level-of-care considerations.
The authors stress that, in the absence of evidence-based manualized therapy for treating BPD and AUD simultaneously, clinicians already have the tools to increase treatment retention, reduce the risk of suicide and death, and provide a sensible road map in the face of interpersonal, behavioral, and emotional challenges inherent to recovery for both conditions.
"Borderline personality disorder (BPD) and alcohol use disorder (AUD) co-occur quite often. Nearly half of all patients meeting diagnostic criteria for BPD have a concurrent AUD, and more than half will have AUD sometime in their life. Yet no integrated treatments for this common set of conditions have been adequately tested or disseminated. While still among the most stigmatized disorders in psychiatry and medicine at large, BPD's prognosis has been radically transformed; despite the longstanding beliefthat it was not treatable, we now know that it is highly likely to remit over time and is responsive to numerous evidence-based psychotherapies. Alcohol use combines with the vulnerabilities of BPD bidirectionally to compound disabling symptoms, increaserisk for death by suicide, and render treatment more challenging. But, like BPD, AUD is treatable. These facts about BPD and AUD make obvious the need for combined intervention. Good Psychiatric Management for Borderline Personality Disorder and Alcohol Use Disorder provides education and a general approach to clinical management. Good psychiatric management's (GPM's) multimodal approach naturally incorporates medication, individual therapies, clinical case management, family work, and mutual help groups. BPD and AUD share core features of diminished neurocognitive and emotional processing capacity and insufficient agency, self-esteem, and coherent sense of self, and they are both associated with diminished social networks. Multimodal treatment broadens social networks (multiple clinical professionals providing care alongside loved ones) to reduce risk factors for relapse, increase support, and enhance recovery from both disorders. Treatment emphasizes the development of different coping responses and more effective prosocial behaviors that are more likely to generate the interpersonal responses needed to build health in sense of self and relationships. GPM uses motivational interviewing that focuses on drinking behaviors as well as self-destructive behaviors related to BPD. This generalist intervention is meant to be "good enough," in the spirit of pediatrician and psychoanalyst Donald Winnicott discussing normal developmental transformations. GPM encourages clinicians to gradually foster tolerable challenges for patients in their lives outside of treatment so that they can develop a sense of capability to manage those challenges on their own"--
Biežāk uzdotie jautājumi par e-grāmatām