DOCSLIB.ORG

Borderline Personality Disorder? Understanding the Clinical, Psychopathological, and Sociodemographic Correlates Is Critical

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Borderline Personality Disorder? Understanding the Clinical, Psychopathological, and Sociodemographic Correlates Is Critical Bipolar disorder or borderline personality disorder? Understanding the clinical, psychopathological, and sociodemographic correlates is critical Sabrina Correa da Costa, MD* Addiction Psychiatry Fellow lthough evidence suggests that bipolar disorder (BD) and bor- Department of Psychiatry derline personality disorder (BPD) are distinct entities, their Yale University School of Medicine differential diagnosis is often challenging as a result of consid- New Haven, Connecticut A erable overlap of phenotypical features. Moreover, BD and BPD fre- Marsal Sanches, MD, PhD, FAPA Associate Professor quently co-occur, which makes it even more difficult to differentiate Research Track Residency Training Director these 2 conditions. Strategies for improving diagnostic accuracy are crit- Department of Psychiatry and Behavioral Sciences ical to optimizing patients’ clinical outcomes and long-term prognosis. The University of Texas Health Science Center at Houston McGovern Medical School Misdiagnosing these 2 conditions can be particularly deleterious, and Houston, Texas failure to recognize their co-occurrence can result in additional burden Jair C. Soares, MD, PhD to typically complex and severe clinical presentations. Professor & Chairman This article describes key aspects of the differential diagnosis between Pat R. Rutherford, Jr. Chair in Psychiatry Director, Center of Excellence on Mood Disorders BD and BPD, emphasizing core features and major dissimilarities Executive Director UTHealth HCPC between these 2 conditions, and discusses the implications of misdiag- Department of Psychiatry and Behavioral Sciences nosis. The goal is to highlight the clinical and psychopathological aspects The University of Texas Health Science Center at Houston McGovern Medical School of BD and BPD to help clinicians properly distinguish these 2 disorders. Houston, Texas * At the time this article was written, Dr. da Costa was Chief Resident, Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas. Psychopathological and sociodemographic correlates Disclosures Bipolar disorder is a chronic and severe mental illness that is classified Dr. Soares receives grant or research support from Compass, based on clusters of symptoms—manic, hypomanic, and depressive.1 It Pathways, Alkermes, Allergan, Merck, and Pfizer, is a consultant to Johnson & Johnson, Myriad, and LivaNova, and is a speaker for is among the 10 leading causes of disability worldwide, with significant 2 Sanofi and Sunovion. Dr. Soares is an Editorial Consultant for CURRENT morbidity arising from acute affective episodes and subacute states. PSYCHIATRY. Drs. da Costa and Sanches report no financial relationships Data suggest the lifetime prevalence of BPD is 2.1%, and subthreshold with any companies whose products are mentioned in this article, or 3 with manufacturers of competing products. forms may affect an additional 2.4% of the US population. The onset of symptoms typically occurs during late adolescence or early adulthood, É and mood lability and cyclothymic temperament are the most common prodromal features.4 continued Current Psychiatry LUDVIK GLAZER-NAUD Vol. 18, No. 11 27 Figure Bipolar disorder and borderline personality disorder: Clinical and sociodemographic correlates Bipolar and related disorders Bipolar disorder 2.1% of the population 1:1.1 female/male ratio or BPD? 10% to 20% mortality from suicide • Episodic course • Gradual changes in mood (days to weeks) • SI/SA in the context of mood symptoms Clinical Point • NSSI less common • Psychotic symptoms only in the presence of mood As a result of the symptoms phenotypical • Family history of mood disorders resemblance between • Interpersonal relationships usually preserved BD and BPD, the differential diagnosis Highly comorbid with: Treatments is often difficult • Anxiety disorders • First-line: Mood stabilizers, SGAs, • ADHD AEDs, and other pharmacologic agents; ECT, rTMS, and other • Substance use disorders somatic treatments (up to 60% comorbid AUD) • Adjunctive: Psychosocial/ behavioral interventions ADHD: attention-deficit/hyperactivity disorder; AEDs: antiepileptic drugs; AUD: alcohol use disorder; ECT: electroconvulsive therapy; NSSI: nonsuicidal self-injury; PTSD: posttraumatic stress disorder; rTMS: repetitive transcranial magnetic stimulation; SGAs: second-generation antipsychotics; SA: suicide attempt; SI: suicidal ideation In contrast, personality disorders, such According to the National Survey on as BPD, are characteristically pervasive Alcohol and Related Conditions (NESARC), and maladaptive patterns of emotional approximately 15% of US adults were found responses that usually deviate from an to have at least one type of personality dis- individual’s stage of development and cul- order, and 6% met criteria for a cluster B tural background.1 These disorders tend personality disorder (antisocial, borderline, to cause significant impairment, particu- narcissistic, and histrionic).7 The lifetime larly in personal, occupational, and social prevalence of BPD is nearly 2%, with higher domains. Environmental factors, such as estimates observed in psychiatric settings.7,8 Discuss this article at early childhood trauma, seem to play an As a result of the phenotypical resem- www.facebook.com/ important role in the genesis of personality blance between BD and BPD (Figure), the MDedgePsychiatry disorders, which may be particularly rel- differential diagnosis is often difficult. Recent evant in BPD, a disorder characterized by studies suggest that co-occurrence of BD and marked impulsivity and a pattern of insta- BPD is common, with rates of comorbid BPD bility in personal relationships, self-image, as high as 29% in BD I and 24% in BD II.8,9 and affect.1,5,6 Similarly to BD, BPD is also On the other hand, nearly 20% of individu- Current Psychiatry 28 November 2019 chronic and highly disabling. als with BPD seem to have comorbid BD.8,9 MDedge.com/psychiatry Borderline personality disorder 1% to 2% of the population 2:1 female/male ratio 8% to 10% mortality from suicide • Pervasive course • Abrupt changes in mood (hours) • SI/SA in the context of psychosocial stressors • NSSI common Clinical Point • Transient psychotic symptoms, usually in the context of stressful situations Evidence suggests • Chaotic interpersonal relationships that BD and BPD • Significant history of trauma have distinct underlying Highly comorbid with: Treatments neurobiological and • Mood disorders • First-line: Psychosocial/behavioral psychopathological • PTSD interventions mechanisms • Substance use • Adjunctive: Pharmacotherapy • Eating disorders ADHD: attention-deficit/hyperactivity disorder; AEDs: antiepileptic drugs; AUD: alcohol use disorder; ECT: electroconvulsive therapy; NSSI: nonsuicidal self-injury; PTSD: posttraumatic stress disorder; rTMS: repetitive transcranial magnetic stimulation; SGAs: second-generation antipsychotics; SA: suicide attempt; SI: suicidal ideation Several studies suggest that comorbid per- Multidimensional approaches have been sonality disorders represent a negative prog- proposed to better characterize these dis- nostic factor in the course of mood disorders, orders in at-risk populations, based on and the presence of BPD in patients with BD structured interviews, self-administered seems to be associated with more severe clini- and clinician-rated clinical scales (Table 1, cal presentations, greater treatment complex- page 35), neuroimaging studies, biological ity, a higher number of depressive episodes, markers, and machine-learning models.15,16 poor inter-episode functioning, and higher Compelling evidence suggests that BD and rates of other comorbidities, such as sub- BPD have distinct underlying neurobiologi- stance use disorders (SUDs).8-11 The effect of cal and psychopathological mechanisms12,13; BD on the course of BPD is unclear and fairly however, the differential diagnosis still unexplored, although it has been suggested relies on phenotypical features, since the that better control of mood symptoms may search for biological markers has not yet lead to more stable psychosocial functioning identified specific biomarkers that can be in BPD.9 used in clinical practice. Whether BD and BPD are part of the Core features of BPD, such as mood labil- Current Psychiatry same spectrum is a matter for debate.12-14 ity, impulsivity, and risk-taking behaviors, Vol. 18, No. 11 29 continued on page 35 continued from page 29 Table 1 Clinical scales used in the differential diagnosis of bipolar disorder and borderline personality disorder MDedge.com/psychiatry Rating scale Description Mood Disorder Questionnaire 15 questions (MDQ) The first 13 questions are designed to identify lifetime manic or hypomanic symptoms; the last 2 questions measure severity and level of functional impairment Hypomania/mania Checklist 2 introductory questions on current emotional state (HCL-32) 32 questions designed to identify manic and hypomanic symptoms Screening Assessment of 3-item scale: Depression-Polarity (SAD-P) • presence of delusions • number of depressive episodes • family history of major depression or mania Bipolar Prodrome Symptom Semi-structured interview developed based on DSM-IV criteria Interview and Scale-Prospective for BD and MDD, clusters of symptoms (mania, depression, and (BPSS-P) general symptom index) Clinical Point The Personality Inventory for 220-item scale assessing 25 personality trait facets, with each trait DSM-5 facet consisting
Load more

Recommended publications
  • A Case of Steroid Induced Mania
    Case Report International Journal of Psychiatry A Case of Steroid Induced Mania 1* 1 Maryam M Alnasser , Yasser M Alanzi and Amena H * 2 Corresponding author Alhemyari Maryam M Alnasse, MBBS from University of Dammam, Saudi Arabia, E-mail: [email protected]. 1 MBBS from University of Dammam, Saudi Arabia. Submitted: 14 Dec 2016; Accepted: 26 Dec 2016; Published: 30 Dec 2016 2MBBS from King Faisal University, Saudi Arabia. Abstract Background: Steroids have been widely used and prescribed for a variety of systemic diseases. Although they prove to be highly effective, they have many physical and psychiatric adverse effects. The systemic side effects of these medications are well known and well studied, in contrast to the psychiatric adverse effects which its phenomenology needs to be the focus of more clinical studies. However, the incidence of diagnosable psychiatric disorders due to steroid therapy is reported to be 3-6%. Affective reactions such as depression, mania, and hypomania are the most common adverse effects, along with psychosis, anxiety and delirium. Aim: We describe a case of corticosteroid induced mania, its unusual clinical picture, its course and management. Case description: A 14-year-old female intermediate school student, with a recent diagnosis of Chron’s disease was brought to A&E department due to acute behavioral disturbance in form of confusion, visual hallucinations, psychomotor agitation, irritability, hyperactivity, talkativeness, lack of sleep, and physical aggression. Those symptoms have started few days following corticosteroid therapy which was Prednisolone 40mg PO OD. And she was diagnosed with steroid induced mania. Discussion: This case illustrates the need for more understanding of the phenomenology and diversity of corticosteroids induced psychiatric syndromes.
    [Show full text]
  • Supporting Individuals with Grief: Using a Psychological First Aid Framework Barney Dunn, July 2020 My Background and Acknowledgements
    Supporting individuals with grief: Using a psychological first aid framework Barney Dunn, July 2020 My background and acknowledgements • Professor of Clinical Psychology at Mood Disorders Centre, University of Exeter and co-lead AccEPT clinic (NHS ‘post IAPT gap’ service) • Main area depression but been involved in developing some grief guidance as part of COVID response with Kathy Shear (Columbia) and Anke Ehlers (Oxford) • These materials developed to support counsellors/therapists to work with grief with principals of psychological first aid. • Thanks to Kathy Shear for letting me use some of her centre’s materials and videos Overview • Part 1: Understanding grief • Part 2: Supporting individuals through acute grief • Part 3: Use of psychological first aid framework for grief (and more generally) • Part 4: Prolonged grief disorder Learning objectives • Be familiar with range of grief reactions • Be able use your common factor skills and knowledge around bereavement from workshop to respond empathically and supportively to people who are grieving in a non-pathologizing way • Be able to use the psychological first aid framework to help people look after themselves while grieving • To know who and how to signpost on to further help • You are not expected to be experts in grief or to ‘treat’ grief Optional core reading Supporting people with grief: • Shear, M. K., Muldberg, S., & Periyakoil, V. (2017). Supporting patients who are bereaved. BMJ (Clinical research ed.), 358, j2854. https://doi.org/10.1136/bmj.j2854 • See also material for clinicians and public on this website: https://complicatedgrief.columbia.edu/professionals/complicated-grief-professionals/overview/ Prolonged grief disorder: • Jordan, A.
    [Show full text]
  • The Neural Basis of the Sense of Fatigue
    Iowa State University Capstones, Theses and Graduate Theses and Dissertations Dissertations 2020 The neural basis of the sense of fatigue Mark Edward Hartman Iowa State University Follow this and additional works at: https://lib.dr.iastate.edu/etd Recommended Citation Hartman, Mark Edward, "The neural basis of the sense of fatigue" (2020). Graduate Theses and Dissertations. 18136. https://lib.dr.iastate.edu/etd/18136 This Dissertation is brought to you for free and open access by the Iowa State University Capstones, Theses and Dissertations at Iowa State University Digital Repository. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of Iowa State University Digital Repository. For more information, please contact [email protected]. The neural basis of the sense of fatigue by Mark Edward Hartman A dissertation submitted to the graduate faculty in partial fulfillment of the requirements for the degree of DOCTOR OF PHILOSOPHY Major: Kinesiology Program of Study Committee: Panteleimon Ekkekakis, Major Professor Peter Clark James Lang Jacob Meyer Rick Sharp The student author, whose presentation of the scholarship herein was approved by the program of study committee, is solely responsible for the content of this dissertation. The Graduate College will ensure this dissertation is globally accessible and will not permit alterations after a degree is conferred. Iowa State University Ames, Iowa 2020 Copyright © Mark Edward Hartman, 2020. All rights reserved. ii DEDICATION This dissertation is dedicated to my mother. Thank you for all your incredible support, encouragement, and patience, especially considering that it has taken me 14 years to finish my post-secondary education.
    [Show full text]
  • Shame Handout for Dell Childrens
    Fall 08 Dell Children's Medical Center January 2015 Shame, Relevant Neurobiology, and Treatment Implications Arlene Montgomery Ph.D., LCSW Shame Guilt Early-forming (before age two) Must have concept of another (2 yrs+) Implicit memory (amygdala) Explicit memory (upper right & left hemi) Arousal involves entire body: Arousal is an upper cortex, primarily left, • excitement state of worry • painful arousal (SNS) • counter-regulate (PNS) • positive outcome = repair • negative outcome = no repair; lingering in PNS state Non-narrative (not conscious) Narrative (conscious experience) • a state of being: "I am something..." • "I did something" e.g., bad, worthless, flawed as a whole • an act person Runs away from further external Seeks to maintain attachments interactions, but cannot run away from the internal representations of the scorn of the other - an internal experience Shame states may engage the freeze Guilt experiences may engage the more (dissociated, passive) state or flight activated fight states ( not actually fighting, state(hiding, other avoidant behaviors) or but actively making thing right, correcting submit state(agreeing, becoming invisible, mistakes, engaging the milieu in some way complying) to manage the painful arousal to address the “bad act, moving toward…) Repaired shame is a normative socialization experience (Schore, 2003 a,b) Relational trauma may result from unrepaired shame experiences "corroded connections", (B. Brown, 2010); "affecting global sense of self" (Lewis, 1971) Issues and Diagnoses PTSD: shame is predictor
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders : Clinical Descriptions and Diagnostic Guidelines
    ICD-10 ThelCD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines | World Health Organization I Geneva I 1992 Reprinted 1993, 1994, 1995, 1998, 2000, 2002, 2004 WHO Library Cataloguing in Publication Data The ICD-10 classification of mental and behavioural disorders : clinical descriptions and diagnostic guidelines. 1.Mental disorders — classification 2.Mental disorders — diagnosis ISBN 92 4 154422 8 (NLM Classification: WM 15) © World Health Organization 1992 All rights reserved. Publications of the World Health Organization can be obtained from Marketing and Dissemination, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel: +41 22 791 2476; fax: +41 22 791 4857; email: [email protected]). Requests for permission to reproduce or translate WHO publications — whether for sale or for noncommercial distribution — should be addressed to Publications, at the above address (fax: +41 22 791 4806; email: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
    [Show full text]
  • Repetitive Transcranial Magnetic Stimulation [Rtms] for Panic Disorder
    Repetitive transcranial magnetic stimulation (rTMS) for panic disorder in adults (Review) Li H, Wang J, Li C, Xiao Z This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2014, Issue 9 http://www.thecochranelibrary.com Repetitive transcranial magnetic stimulation (rTMS) for panic disorder in adults (Review) Copyright © 2014 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 SUMMARY OF FINDINGS FOR THE MAIN COMPARISON . ..... 4 BACKGROUND .................................... 6 OBJECTIVES ..................................... 7 METHODS...................................... 7 Figure1. ..................................... 9 RESULTS....................................... 12 Figure2. ..................................... 13 Figure3. ..................................... 15 Figure4. ..................................... 16 DISCUSSION ..................................... 18 AUTHORS’CONCLUSIONS . 20 ACKNOWLEDGEMENTS . 21 REFERENCES..................................... 21 CHARACTERISTICSOFSTUDIES . .. 25 DATAANDANALYSES. 31 Analysis 1.3. Comparison 1 rTMS + pharmacotherapy versus sham rTMS + pharmacotherapy, Outcome 3 Acceptability: 1.dropoutsforanyreason. .33 Analysis 1.4. Comparison 1 rTMS + pharmacotherapy versus sham rTMS + pharmacotherapy, Outcome 4 Acceptability: 2.dropoutsforadverseeffects. .... 34 Analysis
    [Show full text]
  • Grief Support Groups: Preference for Online Vs
    Fort Hays State University FHSU Scholars Repository Master's Theses Graduate School Summer 2011 Grief Support Groups: Preference For Online Vs. Face To Face Kris S. Fox Fort Hays State University Follow this and additional works at: https://scholars.fhsu.edu/theses Part of the Psychology Commons Recommended Citation Fox, Kris S., "Grief Support Groups: Preference For Online Vs. Face To Face" (2011). Master's Theses. 144. https://scholars.fhsu.edu/theses/144 This Thesis is brought to you for free and open access by the Graduate School at FHSU Scholars Repository. It has been accepted for inclusion in Master's Theses by an authorized administrator of FHSU Scholars Repository. GRIEF SUPPORT GROUPS: PREFERENCE FOR ONLINE VS. FACE-TO-FACE being A Thesis Presented to the Graduate Faculty of the Fort Hays State University in Partial Fulfillment of the Requirements for the Degree of Master of Science by Kris S. Fox B.S., Fort Hays State University Date_____________________ Approved________________________________ Major Professor Approved________________________________ Chair, Graduate Council ABSTRACT Grief is a reaction to loss and will be experienced to some degree by everyone in his or her life. For most, this is a brief process lasting a few weeks or months, after which they regain their focus and return to their normal lives. For a percentage of the population, however, it is more difficult to return to normal life functions. The grieving process can further diminish low social support and social support networks. However, generally providing the opportunity to talk about their feelings is sufficient to help most work through their grief without therapy (Burke, Eakes, and Hainsworth, 1999; Neimeyer, 2008).
    [Show full text]
  • Medical Treatment Guidelines (MTG)
    Post-Traumatic Stress Disorder and Acute Stress Disorder Effective: November 1, 2021 Adapted by NYS Workers’ Compensation Board (“WCB”) from MDGuidelines® with permission of Reed Group, Ltd. (“ReedGroup”), which is not responsible for WCB’s modifications. MDGuidelines® are Copyright 2019 Reed Group, Ltd. All Rights Reserved. No part of this publication may be reproduced, displayed, disseminated, modified, or incorporated in any form without prior written permission from ReedGroup and WCB. Notwithstanding the foregoing, this publication may be viewed and printed solely for internal use as a reference, including to assist in compliance with WCL Sec. 13-0 and 12 NYCRR Part 44[0], provided that (i) users shall not sell or distribute, display, or otherwise provide such copies to others or otherwise commercially exploit the material. Commercial licenses, which provide access to the online text-searchable version of MDGuidelines®, are available from ReedGroup at www.mdguidelines.com. Contributors The NYS Workers’ Compensation Board would like to thank the members of the New York Workers’ Compensation Board Medical Advisory Committee (MAC). The MAC served as the Board’s advisory body to adapt the American College of Occupational and Environmental Medicine (ACOEM) Practice Guidelines to a New York version of the Medical Treatment Guidelines (MTG). In this capacity, the MAC provided valuable input and made recommendations to help guide the final version of these Guidelines. With full consensus reached on many topics, and a careful review of any dissenting opinions on others, the Board established the final product. New York State Workers’ Compensation Board Medical Advisory Committee Christopher A. Burke, MD , FAPM Attending Physician, Long Island Jewish Medical Center, Northwell Health Assistant Clinical Professor, Hofstra Medical School Joseph Canovas, Esq.
    [Show full text]
  • The Grief of Late Pregnancy Loss a Four Year Follow-Up
    The grief of late pregnancy loss A four year follow-up Joke Hunfeld The grief of late pregnancy loss A four year follow-up Rouwreacties bij laat zwangerschapsverlies. Een vervolgstudie over vier jaar. Proefschrift Tel' verkrijging van de graad van doctor aan de Erasmus Universiteit Rotterdam op gezag van de rector magnificus Pro£dr P.W.C. Akkermans M.A. en volgens besluit van het college voor promoties. De open bare verdediging zal plaatsvinden op woensdag 13 september 1995 om 15.45 uur door Johanna Aurelia Maria Hunfeld geboren te Utrecht. Promotiecommissie: Promotoren: Pro£ jhr dr J.w, Wladimiroff Pro£ dr E Verhage Overige leden: Pro£ dr H.P. van Geijn Pro£ dr D. Tibboel Pro£ dr Ee. Verhulst Het onderzoek dat in dit proefschrift is beschreven kon worden uitgevoerd dankzij subsidies van Ontwikkelings Geneeskunde, het Universiteitsfonds van de Erasmus Universiteit en het Nationaal Fonds voor de Geestelijke Volksgezondhcid. CIP-gegevens KDninklijke Bibliotheek, Den Haag Hunfeld, J.A.M. The grief onate pregnancy loss / Johanna Aurelia Maria Hunfeld - Delft Eburon P & L Proefschrift Erasmus Universiteit Rotterdam - met samenvatting in het Nederlands ISBN 90-5651-011-8 Nugi Trefw;: perinatal grief Distributie: Eburon P&L, Postbus 2867, 2601 CW Delft Drukwerk: Ponsen & Looijen BY, Wageningen Lay-out verzorging: A. Praamstra All rights reserved Omslagtekening © P. Picasso, 1995 do Becldrecht Amsterdam © Joke Hunfeld, 1995 Rouwreacties bij laat zwangerschapsverlics Eell vcrvolgstudie over vier jaar Contents 1 Theoretical and empirical background
    [Show full text]
  • Neurobiology of Repeated Transcranial Magnetic Stimulation in the Treatment of Anxiety: a Critical Review Stefano Pallantia,B,C and Silvia Bernardia,B
    Review 163 Neurobiology of repeated transcranial magnetic stimulation in the treatment of anxiety: a critical review Stefano Pallantia,b,c and Silvia Bernardia,b Transcranial magnetic stimulation (TMS) has been applied the posttraumatic stress disorder symptom core can be to a growing number of psychiatric disorders as hypothesized. TMS remains an investigational intervention a neurophysiological probe, a primary brain-mapping tool, that has not yet gained approval for the clinical treatment of and a candidate treatment. Although most investigations any anxiety disorder. Clinical sham-controlled trials are have focused on the treatment of major depression, scarce. Many of these trials have supported the idea that increasing attention has been paid to anxiety disorders. TMS has a significant effect, but in some studies, the effect The aim of this study is to summarize published findings is small and short lived. The neurobiological correlates about the application of TMS as a putative treatment for suggest possible efficacy for the treatment of social anxiety disorders. TMS neurophysiological and mapping anxiety that still has to be investigated. Int Clin findings, both clinical and preclinical, have been included Psychopharmacol 24:163–173 c 2009 Wolters Kluwer when relevant. We searched Medline, PsycInfo, and the Health | Lippincott Williams & Wilkins. Cochrane Library from 1980 to January 2009 for the terms ‘generalized anxiety disorder’, ‘social anxiety disorder’, International Clinical Psychopharmacology 2009, 24:163–173 ‘social phobia’, ‘panic’, ‘anxiety’, or ‘posttraumatic stress Keywords: anxiety, cortical excitability, panic, posttraumatic stress disorder, disorder’ in combination with ‘TMS’, ‘cortex excitability’, repeated transcranial magnetic stimulation, social anxiety, transcranial ‘rTMS’, ‘motor threshold’, ‘motor evoked potential’, ‘cortical magnetic stimulation silent period’, ‘intracortical inhibition’, ‘neuroimaging’, or ‘intracortical facilitation’.
    [Show full text]
  • Understanding Death, Grief, and Mourning – a Resource Manual
    UNDERSTANDING DEATH, GRIEF & MOURNING A Resource Manual Cornerstone of Hope Resource Manual | Page 1 UNDERSTANDING Death, Grief & Mourning Bereavement Resource Book CENTERS FOR GRIEVING CHILDREN, TEENS AND ADULTS 5905 Brecksville Road, Independence, Ohio 44131 • 216.524.4673 1550 Old Henderson Road, Suite E262, Columbus, Ohio 43220 • 614.824.4285 CORNERSTONEOFHOPE.ORG Table of Contents Letter from the Founders 4 Forward 5 Definitions 5 The Cornerstone Approach to Bereavement Care 6 Talking to Children 8 Suggestions for Informing Children about the Death of a Loved One 11 Preparing Children for Funerals 12 Children and Bereavement Charts 14 Manifestations of Grief in Youth 19 Common Fears and Questions of Grieving Children 20 Helping Children Cope with Grief Emotions 21 Helping Grieving Children | Suggestions for Parents 22 How Can I Tell if My Child Needs Counseling? 24 Children & Teen Resources 25 Books for Children and Teens Dealing with Illness, Grief, and Loss 25 Coping as a Family 28 Adult Grief | What You Can Expect 29 Adult Resources/Social Media Resources 30 Recommended Reading for Adult Grievers 30 “Suicide is Different” 31 “The Suicide Survivor’s Affirmation” 32 Beyond Surviving | Suggestions for Survivors of Suicide 33 Murder Loss 35 Support Group Resources 36 What Types of Help are Available? 36 Grief in the Workplace 37 Helping Employees Deal with Trauma 38 Creative Therapy Resources 39 Ideas for a Memory Box 39 Time Remembered 39 Spiritual Resources 40 Grief and the Scriptures 40 “Mountain Trip” 42 “The Power of Pain” 43 Services Offered by Cornerstone of Hope 44 Notes 46 From the Founders This book is dedicated to those who have lost a loved one, and to those who want to effectively service the bereaved in their professional or personal community.
    [Show full text]
  • The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research
    The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research World Health Organization Geneva The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this organization, which was created in 1948, the health professions of some 180 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. By means of direct technical cooperation with its Member States, and by stimulating such cooperation among them, WHO promotes the development of comprehensive health services, the prevention and control of diseases, the improvement of environmental conditions, the development of human resources for health, the coordination and development of biomedical and health services research, and the planning and implementation of health programmes. These broad fields of endeavour encompass a wide variety of activities, such as developing systems of primary health care that reach the whole population of Member countries; promoting the health of mothers and children; combating malnutrition; controlling malaria and other communicable diseases including tuberculosis and leprosy; coordinating the global strategy for the prevention and control of AIDS; having achieved the eradication of smallpox, promoting mass immunization against a number of other
    [Show full text]