Part V - TreatmentAssessment and Emergency Management of Suicidality in Personality Disorders
Section snippets
Cluster B
Although significant epidemiological evidence exists to link personality disorders with suicidal behavior, most of this research concentrates on the Cluster B personality disorders. More limited research exists on Clusters A and C, and the evidence is reviewed according to respective clusters rather than individual personality disorders. We begin by reviewing the rates of personality disorders in subjects who have died by suicide or made suicide attempts. Then we present the rates of suicide
Characteristics of suicidal behavior in patients who have borderline personality disorder: empirical evidence
In working with patients who have BPD, clinicians have the unwieldy challenge of differentiating patients at high risk for suicide versus patients not at high risk. In this section, we use data from a randomized controlled clinical trial of 180 participants who had BPD and recurrent suicidal behavior and present the features of suicidal behavior that typify a sample of patients who have BPD. We also partially replicate an earlier investigation by Soloff and colleagues [29] to define predictors
Method
Eligible participants met the following inclusion criteria: BPD diagnosis by International Personality Disorder Examination (IPDE) [30], at least two parasuicides within the past 5 years, at least one parasuicide in last 3 months, more than 17 years of age, and not meeting the exclusion criteria; psychotic disorder, bipolar I disorder, current active substance dependence, organic brain syndrome or mental retardation, and chronic or serious physical health problem.
Based on the rating of medical
Results
The 180 participants were typical of most study samples of outpatients who have BPD. They were mainly women (86% female), average age 30 years (SD = 9.7), unmarried (only 15% married or in a relationship), with at least high school education (only 12% had less than grade 12), and most were unemployed (66% were currently unemployed). Based on our definition of high versus low lethality, 89 (49.4%) participants were considered to have a lifetime history of high lethality attempts, and 91 (50.6%)
Discussion
The current findings partially replicate the findings of Soloff and colleagues [29]. In the current sample, variables related to more extensive treatment histories (more exposure to medications and hospitalization), more evidence of psychosocial dysfunction, and evidence for greater suicide intent are convergent with Soloff and colleagues' findings. Soloff and colleagues [29] found more extensive treatment histories; lower SES and greater intent to die remained in the final model, explaining
Management of suicidality in the emergency department
In the first two sections of this article, we established the strong epidemiologic link between suicide, suicidal behavior, and BPD and the need for clinicians to differentiate between patients at high and low risk of suicide. Based on this evidence and our clinical experience, we turn our attention to the clinical management of suicidality in patients who have BPD who present to the emergency department. The American Psychiatric Association practice guidelines for the assessment and treatment
Summary
Several studies have illustrated a link between personality disorders, suicidal behavior, and suicide. The research is most robust in the field of BPD. BPD is a common and challenging diagnosis characterized by chronic suicidality, and we have attempted to differentiate between patients at risk for high versus low lethality suicide attempts. Although assessing and managing suicidality in patients who have BPD can be frustrating for even the most experienced clinicians, it is possible to
Acknowledgments
The authors wish to thank Shelley McMain for her invaluable feedback on the article.
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Emergency psychiatric management of borderline personality disorder: Towards an articulation of modalities for personalised integrative care
2020, EncephaleCitation Excerpt :Psychiatric emergency and crisis intervention units are the best places to detect persons with borderline personality disorder and, after a reliable diagnosis, to engage them in appropriate outpatient psychotherapeutic treatment [68,69]. However, there is a wide gap between this possibility and reality, and the trajectories of these people remain largely chaotic and iatrogenic, with significant negative consequences in terms of health, social functioning [35,38,68], and a high lethal risk [15–18,22,23,25,28]. Why is this the case when effective diagnostic tools and treatments exist?
Predictors of emergency department visits for suicidal ideation and suicide attempt
2020, Psychiatry ResearchCitation Excerpt :The finding that most patients did not use health services for MH reasons prior to ED visits may explain the modest contribution of enabling factors in this study. Concerning needs factors, diagnoses of personality disorders and adjustment disorders were previously reported as strong predictors of ED visits for suicidal ideation and suicide attempt (Bertolote et al., 2004; Kawashima et al., 2014; Zaheer et al., 2008). Patients with personality disorders have great difficulty coping with stressful or demanding interpersonal situations (Blasco-Fontecilla et al., 2010), which may precipitate frequent ED visits for suicidal ideation or suicide attempt.
Problem-gambling severity, suicidality and DSM-IV Axis II personality disorders
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2017, Critical Care ClinicsCitation Excerpt :In 2010, 33.4% of patients who completed suicide had alcohol in their systems.2 The comorbid presence of an alcohol use disorder increases risk almost 10 times compared with the general population.10,11 People who inject drugs are approximately 14 times more likely to commit suicide.10
Self-harm risk assessment and its medical and legal implications
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