Ejecicio basado en: “Medication Management for Patients with Borderline Personality Disorder” by J Gunderson.
Autor del ejercicio Dr. Sergio Grosman – Agosto 2018
Metodología:
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Responda las preguntas en orden.
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Pase a la página siguiente en la que está desarrollada
cada respuesta (En Ingles) con su respectiva referencia bibliográfica y
link.
1. ¿Qué porcentaje de los pacientes que atendemos
los psiquiátricas en un marco ambulatorio reúne criterios para el
Dg de T. de Personalidad Limítrofe?
a.
Entre un 2 y un
8 %
b.
Entre un 7 y un 27%
c.
Entre un 25 y un 43%
d.
Entre un 35 y 62 %
e.
Todes son border incluso mis amiges
2. ¿Qué medicamentos muestran efectividad para
el tratamiento de Trastorno de Personalidad Limítrofe?
a.
Hay evidencia de que apoya que los IRS tienen moderada efectividad disminuyendo la impulsividad y son de elección
en el tratamiento primario del TPL.
b.
No se recomienda el uso de IRS porque los pacientes con TLP que los reciben aumentan riesgosamente la frecuencia de autolesiones y pensamientos suicidas.
c.
No hay evidencia que demuestre que algún
medicamento tiene efectividad en el tratamiento primario del TLP.
d.
Hay evidencia de que apoya que los
antirecurrenciales mejoran y estabilizan el estado anímico de pacientes con TLP
independientemente de si tienen T. Bipolar .
e.
Hay evidencia
que demuestra que los antipsicóticos atípicos ayudan
disminuir la ansiedad y la tendencia a la desorganización de de los pacientes con TLP.
3. ¿Qué efectividad tiene la Lamotrigina en el TLP?
a.
Leer el articulo J
4. ¿Cuál es la co-morbilidad de T. Bipolar y TLP
?
a.
El TLP
debe considerarse parte del espectro bipolar.
b.
La comorbilidad es del 62%
c.
La comorbilidad es del 15%
d.
La comorbilidad es del 45%
e.
La comorbilidad es del 32%
5. ¿Cuál es la terapéutica con más evidencias?
a.
Solo la Terapia Dialectico Comportamental tiene
evidencias favorables
b.
Terapia Dialectico
Comportamental, Terapia Basada en Mentalización y Terapia Centrada en la Transferencia.
c.
Ninguna psicoterapia reúne evidencias que
superen a los cuidados habituales.
d.
El modelo CPP supera a todos, en todas las
canchas y si no es así tráigalo a cámara.
6. ¿Cuál es la evolución natural del TLP?
a.
Todos los trastornos de personalidad son
estables a lo largo del tiempo y si el paciente deja de reunir criterios es
probable que haya sido mal diagnosticado inicialmente.
b.
De los pacientes con TLP a los 2 años el 39% no reúnen criterios para ese diagnostico y a los 10
años el 80 % no reúne los criterios
.
c.
A los 5 años solo el 25 % de los pacientes con TLP
evolucionan en forma favorable como para dejar
de reunir criterios diagnósticos.
1- ¿Qué porcentaje de los pacientes que atendemos las psiquiátricas, en un marco ambulatorio, reúne criterios para el dg de T. de Personalidad Limítrofe?
The prevalence of borderline personality disorder (BPD) in
outpatient clinics varies greatly (7%-27%) depending on the setting and
methodology.
In our study 22.6% incidence / mean age was 40.2 years,
75.4% were female, most patients were unable to work, and they averaged 3.8 lifetime
hospitalizations.
Estimating the prevalence of borderline personality disorder
in psychiatric outpatients using a two-phase procedure. Compr Psychiatry. 2008 Jul-Aug;49(4):380-6.
2- ¿Que medicamentos muestran efectividad para el tratamiento del trastorno limítrofe de personalidad?
No
medication has been shown to be an adequate primary treatment agent
No medication has been approved by the U.S. Food and Drug
Administration for borderline personality disorder. The U.K. National Institute
for Health and Care Excellence has concluded that psychoactive medications
should not be used for borderline personality disorder except for the treatment
of co-occurring disorders, and then only for the shortest possible time
Both patients with borderline personality disorder and their
clinicians can at times idealize the potential effects of medications.
Frequently receive prescriptions for mood stabilizers, whose
use is then sustained over time . In the absence of benefits from these
medications, patients with borderline personality disorder receiving them—or
any other ineffective medication—may suffer unnecessary side effects, postpone
getting more effective treatments, and, even as their despair grows, cling to
the seductive message that their future might depend on medication effects. The
need for caution is underscored by recognizing lamotrigine’s potential for
severe complications, such as Stevens-Johnson syndrome and hemophagocytic
lymphohistiocytosis.
3- ¿Que efectividad tiene la Lamotrigina en el TLP?
Mike Crawford, M.D. et al – 2018
Objective:
The authors examined whether lamotrigine is a clinically
effective and cost-effective treatment for people with borderline personality
disorder.
Method:
This was a multicenter, double-blind, placebo-controlled
randomized trial. Between July 2013 and November 2016, the authors recruited
276 people age 18 or over who met diagnostic criteria for borderline
personality disorder. Individuals with coexisting bipolar affective disorder or
psychosis, those already taking a mood stabilizer, and women at risk of
pregnancy were excluded. A web-based randomization service was used to allocate
participants randomly in a 1:1 ratio to receive either an inert placebo or up
to 400 mg/day of lamotrigine. The primary outcome measure was score on the
Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52
weeks. Secondary outcome measures included depressive symptoms, deliberate
self-harm, social functioning, health-related quality of life, resource use and
costs, side effects of treatment, and adverse events.
Results:
A total of 195 (70.6%) participants were followed up at 52
weeks, at which point 49 (36%) of those in the lamotrigine group and 58 (42%)
of those in the placebo group were taking study medication. The mean ZAN-BPD
score was 11.3 (SD=6.6) among those in the lamotrigine group and 11.5 (SD=7.7)
among those in the placebo group (adjusted difference in means=0.1, 95%
CI=−1.8, 2.0). There was no evidence of any differences in secondary outcomes.
Costs of direct care were similar in the two groups.
Conclusions:
The results suggest that treating people with borderline
personality disorder with lamotrigine is not a clinically effective or
cost-effective use of resources.
Borderline personality disorder is distinct from bipolar
disorder, and that placebo may be an effective treatment when delivered in the
context of good clinical management.
4- ¿Cuál es la co-morbilidad de T. Bipolar y TLP?
It is now known that the actual co-occurrence of borderline
personality disorder and bipolar I or II disorder is only about 15%, that the
coaggregation of bipolar and borderline personality disorders in families is
only modest, and that the two disorders have little effect on each other’s
course and only rarely evolve into each other-
Gunderson JG, Stout RL, Shea MT, et
al.: Interactions of borderline personality disorder and mood disorders
over 10 years. J Clin
Psychiatry 2014; 75:829– https://www.ncbi.nlm.nih.gov/pubmed/25007118
5-¿Cuál es la evolución natural del TLP?
A total of 290 inpatients meeting criteria for both the
Revised Diagnostic Interview for Borderlines and DSM-III-R
Eighty-eight percent of the patients with borderline
personality disorder studied achieved remission. In terms of time to remission,
39.3% of the 242 patients who experienced a remission of their disorder first
remitted by their 2-year follow-up, an additional 22.3% first remitted by their
4-year follow-up, an additional 21.9% by their 6-year follow-up, an additional
12.8% by their 8-year follow-up, and another 3.7% by their 10-year follow-up.
Sixteen variables were found to be significant bivariate predictors of earlier
time to remission. Seven of these remained significant in multivariate
analyses: younger age, absence of childhood sexual abuse, no family history of
substance use disorder, good vocational record, and absence of an anxious
cluster personality disorder, low neuroticism, and high agreeableness.
Zanarini et Al.
Prediction of the 10-year course of borderline personality disorder. Am
J Psy. 2006 May;163(5):827-32. https://www.ncbi.nlm.nih.gov/pubmed/16648323
6-¿Cuál es la terapéutica con más evidencias?
The literature on treating borderline personality disorder
emphasized evidence-based psychotherapies such as dialectical behavior therapy,
mentalization-based therapy, and transference-focused psychotherapy, which are intensive in both their training and clinical resource
time requirements.
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