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===Borderline Personality Disorder===
===Borderline Personality Disorder===
* '''1 Stage 1 - Name of stage'''
** 1.1 '''Specific Organ system involved 1'''
*** 1.1.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 100 mg PO q12h for 10-21 days '''(Contraindications/specific instructions)''' 
**** Preferred regimen (2): [[drug name]] 500 mg PO q8h for 14-21 days
**** Preferred regimen (3): [[drug name]] 500 mg q12h for 14-21 days
**** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
**** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
**** Alternative regimen (3): [[drug name]] 500 mg PO q6h for 14–21 days
*** 1.1.2 '''Pediatric'''
**** 1.1.2.1 (Specific population e.g. '''children < 8 years of age''')
***** Preferred regimen (1): [[drug name]] 50 mg/kg PO per day q8h (maximum, 500 mg per dose) 
***** Preferred regimen (2): [[drug name]] 30 mg/kg PO per day in 2 divided doses (maximum, 500 mg per dose)
***** Alternative regimen (1): [[drug name]]10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
****1.1.2.2 (Specific population e.g. '<nowiki/>'''''children < 8 years of age'''''')
***** Preferred regimen (1): [[drug name]] 4 mg/kg/day PO q12h（maximum, 100 mg per dose）
***** Alternative regimen (1): [[drug name]] 10 mg/kg PO q6h (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h (maximum, 500 mg per dose) 
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h (maximum, 500 mg per dose)
** 1.2 '''Specific Organ system involved 2'''
*** 1.2.1 '''Adult'''
**** Preferred regimen (1): [[drug name]] 500 mg PO q8h
*** 1.2.2  '''Pediatric'''
**** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h (maximum, 500 mg per dose)
* 2 '''Stage 2 - Name of stage'''
** 2.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.1.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '<nowiki/>'''''(Contraindications/specific instructions)''''''
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.2.2 '''Pediatric'''
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day)
**** Oral regimen
***** Preferred regimen (1):  [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Preferred regimen (2): [[drug name]] 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)


* 1.00 '''Therapies'''
* 1.00 '''Therapies'''
** 1.10 '''Psychotherapy'''
** 1.10 '''Psychotherapy'''
*** 1.11 Simple supportive therapy alone may enhance self-esteem and mobilize the existing strengths of individuals with BPD.<ref>Aviram, R.B.; D.J. Hellerstein, J. Gerson, et al. (May 2004). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15330220&dopt=Abstract Adapting supportive psychotherapy for individuals with Borderline personality disorder who self-injure or attempt suicide]". ''J Psychiatr Pract'' '''10''' (3): 145-55. Retrieved on 2007-09-23.</ref> Specific psychotherapies may involve sessions over several months or, as is particularly common for personality disorders, several years.
*** Simple supportive therapy alone may enhance self-esteem and mobilize the existing strengths of individuals with BPD.<ref>Aviram, R.B.; D.J. Hellerstein, J. Gerson, et al. (May 2004). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15330220&dopt=Abstract Adapting supportive psychotherapy for individuals with Borderline personality disorder who self-injure or attempt suicide]". ''J Psychiatr Pract'' '''10''' (3): 145-55. Retrieved on 2007-09-23.</ref> Specific psychotherapies may involve sessions over several months or, as is particularly common for personality disorders, several years.
*** 1.12 Psychotherapy can often be conducted either with individuals or with groups. Group therapy can aid the learning and practice of interpersonal skills and self-awareness by individuals with BPD<ref name=AMN>Gunderson, J.G. MD (2006-04-10). "[http://www.health.am/psy/more/borderline_personality_disorder_psychotherapies "Borderline Personality Disorder - Psychotherapies]". ''American Medical Network''. Retrieved on 2007-09-23.</ref> although drop-out rates may be problematic.<ref>Hummelen, B.; T. Wilberg, S. Karterud (January 2007). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17266430 Interviews of female patients with borderline personality disorder who dropped out of group psychotherapy]". ''Int J Group Psychother'' '''57''' (1): 67-91. Retrieved on 2007-09-23.</ref>
*** Psychotherapy can often be conducted either with individuals or with groups. Group therapy can aid the learning and practice of interpersonal skills and self-awareness by individuals with BPD<ref name=AMN>Gunderson, J.G. MD (2006-04-10). "[http://www.health.am/psy/more/borderline_personality_disorder_psychotherapies "Borderline Personality Disorder - Psychotherapies]". ''American Medical Network''. Retrieved on 2007-09-23.</ref> although drop-out rates may be problematic.<ref>Hummelen, B.; T. Wilberg, S. Karterud (January 2007). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17266430 Interviews of female patients with borderline personality disorder who dropped out of group psychotherapy]". ''Int J Group Psychother'' '''57''' (1): 67-91. Retrieved on 2007-09-23.</ref>
** 1.20 '''Dialectical Behavioral Therapy'''
** 1.20 '''Dialectical Behavioral Therapy'''
*** 1.21
*** Dialectical behavior therapy is derived from cognitive-behavioral techniques (and can be seen as a form of CBT) but emphasizes an exchange and negotiation between therapist and client, between the rational and the emotional, and between acceptance and change (hence dialectic). Treatment targets are agreed upon, with self-harm issues taking priority.
*** 1.22
*** The learning of new skills is a core component - including mindfulness, interpersonal effectiveness (e.g. assertiveness and social skills), coping adaptively with distress and crises; and identifying and regulating emotional reactions.
*** 1.23
*** DBT can be based on a biosocial theory of personality functioning in which BPD is seen as a biological disorder of emotional regulation in a social environment experienced as invalidating by the borderline patient.<ref name=promising>Murphy, E. T. PhD; J. Gunderson MD (January 1999). "[http://web.archive.org/web/19991014032825/http://www.mcleanhospital.org/psychupdate/psyupI-3.htm A Promising TreatmentBorderline Personality Disorder]". ''McLean Hospital Psychiatic Update''. Retrieved on 2007-09-23.</ref>
*** Dialectical behavioral therapy has been found to significantly reduce self-injury and suicidal behavior in individuals with BPD, beyond the effect of usual or expert treatment, and to be better accepted by clients.<ref>Verheul, R.; L.M. Van Den Bosch, M.W. Koeter, et al. (February 2003). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=12562741&query_hl=3&itool=pubmed_docsum Dialectical behavioural therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands]". ''British Journal of Psychiatry'' (182): 135-40. Retrieved on 2007-09-23.</ref><ref>Linehan, M.M.; K.A. Comtois, A.M. Murray, et al. (July 2006). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16818865 Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder]". ''Archives of General Psychiatry'' '''63''' (7): 757-66. Retrieved on 2007-09-23.</ref> although whether it has additional efficacy in the overall treatment of BPD appears less clear.<ref name="Cochranepsychotherapy"/> Training nurses in the use of DBT has been found to replace a therapeutic pessimism with a more optimistic understanding and outlook.<ref>Hazelton, M.; R. Rossiter, J. Milner (February - March 2006). "[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16594889 Managing the 'unmanageable': training staff in the use of dialectical behaviour therapy for borderline personality disorder]". ''Contemporary Nurse'' '''21''' (1): 120-30. Retrieved on 2007-09-23.</ref>
** 1.30 '''Schema Therapy'''
** 1.30 '''Schema Therapy'''
***
***

Revision as of 15:16, 31 July 2018

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Borderline Personality Disorder

  • 1.00 Therapies
    • 1.10 Psychotherapy
      • Simple supportive therapy alone may enhance self-esteem and mobilize the existing strengths of individuals with BPD.[1] Specific psychotherapies may involve sessions over several months or, as is particularly common for personality disorders, several years.
      • Psychotherapy can often be conducted either with individuals or with groups. Group therapy can aid the learning and practice of interpersonal skills and self-awareness by individuals with BPD[2] although drop-out rates may be problematic.[3]
    • 1.20 Dialectical Behavioral Therapy
      • Dialectical behavior therapy is derived from cognitive-behavioral techniques (and can be seen as a form of CBT) but emphasizes an exchange and negotiation between therapist and client, between the rational and the emotional, and between acceptance and change (hence dialectic). Treatment targets are agreed upon, with self-harm issues taking priority.
      • The learning of new skills is a core component - including mindfulness, interpersonal effectiveness (e.g. assertiveness and social skills), coping adaptively with distress and crises; and identifying and regulating emotional reactions.
      • DBT can be based on a biosocial theory of personality functioning in which BPD is seen as a biological disorder of emotional regulation in a social environment experienced as invalidating by the borderline patient.[4]
      • Dialectical behavioral therapy has been found to significantly reduce self-injury and suicidal behavior in individuals with BPD, beyond the effect of usual or expert treatment, and to be better accepted by clients.[5][6] although whether it has additional efficacy in the overall treatment of BPD appears less clear.[7] Training nurses in the use of DBT has been found to replace a therapeutic pessimism with a more optimistic understanding and outlook.[8]
    • 1.30 Schema Therapy
    • 1.40 Cognitive Behavioral Therapy
    • 1.50 Marital or Family Therapy
    • 1.60 Psychoanalysis
    • 1.70 Transference Focused Psychotherapy
    • 1.80 Cognitive Analytic Therapy
  • 2.0 Medication
    • 2.1 Antidepressants
    • 2.2 Antipsychotics
  • 3.0 Mental Health Services and Recovery
    • 3.1 Combining Pharmacotherapy and Psychotherapy
    • 3.2 Difficulties in Therapy
    • 3.3 Other Strategies
  1. ↑ Aviram, R.B.; D.J. Hellerstein, J. Gerson, et al. (May 2004). "Adapting supportive psychotherapy for individuals with Borderline personality disorder who self-injure or attempt suicide". J Psychiatr Pract 10 (3): 145-55. Retrieved on 2007-09-23.
  2. ↑ Gunderson, J.G. MD (2006-04-10). ""Borderline Personality Disorder - Psychotherapies". American Medical Network. Retrieved on 2007-09-23.
  3. ↑ Hummelen, B.; T. Wilberg, S. Karterud (January 2007). "Interviews of female patients with borderline personality disorder who dropped out of group psychotherapy". Int J Group Psychother 57 (1): 67-91. Retrieved on 2007-09-23.
  4. ↑ Murphy, E. T. PhD; J. Gunderson MD (January 1999). "A Promising TreatmentBorderline Personality Disorder". McLean Hospital Psychiatic Update. Retrieved on 2007-09-23.
  5. ↑ Verheul, R.; L.M. Van Den Bosch, M.W. Koeter, et al. (February 2003). "Dialectical behavioural therapy for women with borderline personality disorder: 12-month, randomised clinical trial in The Netherlands". British Journal of Psychiatry (182): 135-40. Retrieved on 2007-09-23.
  6. ↑ Linehan, M.M.; K.A. Comtois, A.M. Murray, et al. (July 2006). "Two-year randomized controlled trial and follow-up of dialectical behavior therapy vs therapy by experts for suicidal behaviors and borderline personality disorder". Archives of General Psychiatry 63 (7): 757-66. Retrieved on 2007-09-23.
  7. ↑
  8. ↑ Hazelton, M.; R. Rossiter, J. Milner (February - March 2006). "Managing the 'unmanageable': training staff in the use of dialectical behaviour therapy for borderline personality disorder". Contemporary Nurse 21 (1): 120-30. Retrieved on 2007-09-23.
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