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הבעיה: האם מקומה של הפרעת האישיות הגבולית הוא בציר 1 או בציר 2? המלצותינו לוועדת ה V DSM ...

קבוצה מס' 2. הבעיה: האם מקומה של הפרעת האישיות הגבולית הוא בציר 1 או בציר 2? המלצותינו לוועדת ה V DSM . מנחים: ד"ר מיקי בלוך – איכילוב ד"ר גיל זלצמן – גה ה . מתמחים: ירוסלבסקי איזבלה שרון איילת דדון צמרת ליסקר אלכסנדר עוואד קתנאני לירון שני. Is the question relevant?.

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הבעיה: האם מקומה של הפרעת האישיות הגבולית הוא בציר 1 או בציר 2? המלצותינו לוועדת ה V DSM ...

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  1. קבוצה מס' 2 הבעיה: האם מקומה של הפרעת האישיות הגבולית הוא בציר 1 או בציר 2? המלצותינו לוועדת ה VDSM... מנחים: ד"ר מיקי בלוך – איכילוב ד"ר גיל זלצמן – גהה מתמחים: ירוסלבסקי איזבלה שרון איילת דדון צמרת ליסקר אלכסנדר עוואדקתנאני לירון שני

  2. Is the question relevant? • Effects the treatment approach of the therapist • Economical consequences • Legal and forensic consequences • Research directions

  3. Axis II characteristics as opposed to Axis I • Enduring pattern of inner experience and behavior. • …deviates markedly from the expectations of the individual’s culture. • pervasive… inflexible… stable over time. • …onset in adolescence or early adulthood. • …leads to distress or impairment. • Etiology is highly influenced by environmental factors. • Ego-syntonic.

  4. The Evolution of BPD Before the 70’s – Borderline personality organization 70’s-80’s – Borderline syndrome 80’s-90’s – from syndrome to personality disorder. 90’s-2000 – from unwanted personality disorder to disorder specific treatability. 2000-2009 – borderline personality disorder: “ a good prognosis brain disease” (BPD ontogeny of diagnosis, Gunderson, AJP 2009)

  5. Robins & Guze axis I diagnosis criteria: 1. a careful delineation of symptoms 2. information about the course 3. evidence of familial clustering 4. predictable treatment response 5. biological markers

  6. Evidence for shifting BPD to Axis I Charney et al. Bio Psychiatry 2008

  7. The course and Prognosis • Prevalence – 2% • Suicidality – 10%, attempt – 75% • longitudinal studies – 88% of sample BPD pts- remission over 10 years. (Zanarini)

  8. Heritability and familiality • 1st degree x10 risk. • affective instability and impulsivity - more frequent in BPD relatives. • MDD more frequent in relatives. • Twin studies. • 76% !

  9. Predictability of treatment response • Strong evidence for the effectively of medications (mood stabilizers, SGA’s etc’) in BPD, as opposed to other personality disorders (Klaus L. BJP 2010). • Specific treatments for specific symptoms of BPD

  10. Biological markers • No specific for BPD, yet neither for any other psychiatric diagnosis. • Decrease in serotonergic responsiveness in BPD. • Neuroimaging: decreased volume of ACG, lower activity in ACG and OFC. • Same circuits as in MDD and Bipolar. • involvement of the hypothalamic-pituitary-adrenal axis.

  11. Borderless borderline…

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