Personality Disorders

A discussion of the development of the brain and whether neurobiology of the brain can play a role in predicting risk for future bipolar disorders and substance use disorders SUDs.

The following 3 cases illustrate the diagnostic challenges related to differentiating brain injury and posttraumatic stress disorder (PTSD) in patients presenting to the emergency department (ED) in the acute period following a traumatic injury. Such patients pose a dilemma for ED clinicians because of the interplay between head injury and PTSD in the clinical presentation of cognitive impairments in the aftermath of trauma.

The presentation of patients to the emergency department following trauma is often complicated by the behavioral reaction to the accident that brought them there. In some cases, the mental reaction to psychological trauma is the primary presenting phenomenon. ED physicians and staff often use medication to treat the acute effects of psychological trauma. However, there is little empiric evidence to support this practice.

It is common for mental health professionals to label a patient as difficult, however, it remains unclear as to what the classification actually means or what it entails.

A discussion of the epidemiology, assessment, diagnostic dilemmas, and treatment of avoidant personality disorder.

The prevalence and debilitating nature of some of the personality disorders has impeded the study of psychopharmacology in these conditions. However, important advances have been made in the last several years.

Suicidality in patients with borderline personality disorder is chronic. It is important to distinguish these patients from those with classic mood disorders, who are suicidal only when acutely depressed.

This article focuses on data concerning the efficacy of mood stabilizers in the treatment of BPD.

The evidence showing a relationship between mental disorders in childhood and adulthood has increased in the last several decades.

An examination of recent research on psychosocial treatments for personality disorders, including randomized controlled trials and empirically supported therapies as well as dialectical behavior therapy.

Mentalization-based treatment (MBT) and transference-focused psychotherapy (TFP) are relatively complex and specialized treatments for the treatment of borderline personality disorder.

You are surprised when a patient of yours, a physician recovering from a substance abuse problem, tests positive for morphine. Do you believe his explanation of a false-positive result?

Dr Muller describes a case of a patient with a paranoid psychosis who clearly needs help, yet refuses treatment.

Emotional maltreatment is of two major types: emotional abuse and emotional neglect. While emotional abuse is easier to identify, emotional neglect is subtler, possibly more damaging, and poses even more challenging barriers to definition and study.

Somatoform disorders (disorders that are not fully explained by a medical condition or mental disorder) may require psychiatrists to consult with physicians.

What does the new set of U.S. Public Health Service guidelines for treating tobacco dependence say? Should everyone, regardless of mental health status, receive treatment?

The recent evolution of neuropsychiatry/behavioral neurology as a subspecialty represents a paradigmatic shift regarding the responsibility of psychiatrists in diagnosing and managing behavioral disorders with concomitant and demonstrable brain pathology such as dementia or head injury. This authors define the clinical usefulness of electroencephalography in evaluating neuropsychiatric disorders.

About 25% of patients seen in epilepsy clinics and monitoring units who do not respond to antiepileptic drugs (AEDs) have received a misdiagnosis.1-3 The eventual diagnosis for most of these patients will be psychogenic nonepileptic seizure (PNES)1,4-a somatoform conversion disorder. It is treatable, but diagnosis, delivery of the diagnosis, and management present significant challenges. A major barrier to care has been the stigma associated with the label "psychogenic."

cognitive enhancement, cosmetic neurology

With its focus on both behavior modification and mindfulness training, dialectical behavior therapy has proven quite effective in treating patients with borderline personality disorder. This article provides a primer on a modified version of this outpatient treatment for borderline patients with substance use disorders, a comorbid condition that may affect as many as two-thirds of patients with BPD.

The most common club drugs or party drugs are MDMA, ketamine and GHB. How dangerous is continued use of these substances? Can they cause real damage to the brain?

Treatment compliance is a crucial determinant of the outcome of any disease. Poor treatment compliance can worsen the prognosis and significantly increase health care costs. Effective methods to improve treatment compliance for individuals with comorbid mental illness and SUDs will translate in better outcome for the patients and significant health care cost savings.

Huntington disease, neurogenetics, George Sumner Huntington, Systematic Evaluation of Treatments for Huntington's Disease, Alzheimer disease, Parkinson disease, amyotrophic lateral sclerosis

Anesthesia-assisted rapid opioid detoxification has been touted as a painless way to kick an addiction. In a randomized trial comparing it to two other rapid detox methods, it was found to be similar on several methods, but resulted in greater risks for life-threatening adverse events. Opioid dependency is a chronic, remitting disorder and the greatest need is not a fast painless method of getting detoxed, but a reliable method of maintaining abstinence.

Forensic examinations involving children and adolescents are particularly difficult, due to the vulnerability of this patient population. What ethical guidelines should be followed and what sorts of pitfalls should clinicians attempt to avoid?