124 Reframing the Approach to the Diagnosis and Treatment of Borderline Personality Disorder in Adolescents
Notice bibliographique
Résumé
Background: Using the same DSM-5 criteria as in adults, BPD in adolescents is defined as a 1-year pattern of immature personality development with disturbances in at least 5 of the 9 domains listed in the DSM-5. BPD can now be reliably diagnosed as young as 13 using one of several standardized clinician, or self-rated diagnostic instruments. Unfortunately published US and Canadian positions regarding pharmacological treatment have been, With regard to evidence-based studies, pharmacological treatment is not recommended and, if ultimately required, should be limited to second-generation antipsychotics. Fortunately, the last decade s extensive advancements in brain-mapping have provided more clarity about the various brain dysfunctions underlying the symptoms/traits presenting in BPD, providing new opportunities to address these primarily Fronto-Limbic dysfunctions neuropharmacologically and potentially, significantly ameliorate. Thus, in turn, likely enhancing the effectiveness of the newer available therapies. Objectives: The current study explores the feasibility of more effectively managing BPD symptoms/traits with a unique medication protocol consisting of two medications; an anticonvulsant (oxcarbazepine) and a dopaminergic (amantadine HCl), without use of an antipsychotic medication. Methods: Subjects were 147 females, ages 13-16, with the diagnosis of BPD treated with the described medication protocol in a residential facility. Positive outcome was described as achievement and maintenance of greater than 50% improvement from baseline admission state of functioning for 1 year. They were discharged when stable and having achieved greater than 50% improvement from baseline. Outpatient prescribers were requested to be compliant with the treatment protocol. However, some were non-compliant, substituting antipsychotic medication instead. Care givers were surveyed at 6 months and 1 year to determine whether their child was maintaining greater than 50% improvement. Results: The percent maintaining greater than 50% improvement was calculated for those whose caregivers reported continuation of the medications as prescribed, versus those whose prescribers changed the medications to the Community Standard. Of those compliant with the medication protocol, 61 of 86 (71%) maintained >50% improvement. Of those moved to the Community Standard approach, 19 of 61 (31%) maintained >50% improvement. Using Chi Square analysis, there was a significant relationship between maintenance of improvement and medication protocol compliance. Chi Square, Fisher’s exact test = p<0.001. Conclusion: The results indicate that, for adolescents 1 year post-discharge from residential treatment for BPD, continuation of the above described medication protocol provides significantly higher rates of maintenance of achieved symptom improvement. Further controlled studies are needed. Funding: None.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».