Incremental integration of nosological innovations is improving psychiatric diagnosis and treatment

Krueger, Robert F.

doi:10.1002/wps.21001

Cited by 4 publications

(3 citation statements)

References 9 publications

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“…Taking the shift from categorical to dimensional concepts into account 20 , research on psychotherapy of BPD (and of personality disorders in general) needs to take dimensional outcome measures (e.g., Level of Personality Functioning Scale 27 ), as well as personality traits, into account. Treatment research on dimensionally defined (severe) personality disorders is required 265 .…”

Section: Discussionmentioning

confidence: 99%

Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies

Leichsenring,

Fonagy,

Heim

et al. 2024

World Psychiatry

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Borderline personality disorder (BPD) was introduced in the DSM‐III in 1980. From the DSM‐III to the DSM‐5, no major changes have occurred in its defining criteria. The disorder is characterized by instability of self‐image, interpersonal relationships and affects. Further symptoms include impulsivity, intense anger, feelings of emptiness, strong abandonment fears, suicidal or self‐mutilation behavior, and transient stress‐related paranoid ideation or severe dissociative symptoms. There is evidence that BPD can be reliably diagnosed and differentiated from other mental disorders by semi‐structured interviews. The disorder is associated with considerable functional impairment, intensive treatment utilization, and high societal costs. The risk of self‐mutilation and suicide is high. In the general adult population, the lifetime prevalence of BPD has been reported to be from 0.7 to 2.7%, while its prevalence is about 12% in outpatient and 22% in inpatient psychiatric services. BPD is significantly associated with other mental disorders, including depressive disorders, substance use disorders, post‐traumatic stress disorder, attention‐deficit/hyperactivity disorder, bipolar disorder, bulimia nervosa, and other personality disorders. There is convincing evidence to suggest that the interaction between genetic factors and adverse childhood experiences plays a central role in the etiology of BPD. In spite of considerable research, the neurobiological underpinnings of the disorder remain to be clarified. Psychotherapy is the treatment of choice for BPD. Various approaches have been empirically supported in randomized controlled trials, including dialectical behavior therapy, mentalization‐based therapy, transference‐focused therapy, and schema therapy. No approach has proved to be superior to others. Compared to treatment as usual, psychotherapy has proved to be more efficacious, with effect sizes between 0.50 and 0.65 with regard to core BPD symptom severity. However, almost half of the patients do not respond sufficiently to psychotherapy, and further research in this area is warranted. It is not clear whether some patients may benefit more from one psychotherapeutic approach than from others. No evidence is available consistently showing that any psychoactive medication is efficacious for the core features of BPD. For discrete and severe comorbid anxiety or depressive symptoms or psychotic‐like features, pharmacotherapy may be useful. Early diagnosis and treatment of BPD can reduce individual suffering and societal costs. However, more high‐quality studies are required, in both adolescents and adults. This review provides a comprehensive update of the BPD diagnosis and clinical characterization, risk factors, neurobiology, cognition, and management. It also discusses the current controversies concerning the disorder, and highlights the areas in which further research is needed.

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Section: Discussionmentioning

confidence: 99%

Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies

Leichsenring,

Fonagy,

Heim

et al. 2024

World Psychiatry

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“…With new treatment approaches, the improved safety of modern antipsychotics, and the fulfillment of some of the unmet needs, the outcome of patients with schizophrenia is changing, and many can now achieve full recovery. This should be the goal of clinicians dealing with schizophrenia [ 24 ]. The so-called third-generation antipsychotics, which include cariprazine, lurasidone, and brexpiprazole, have recently been introduced as monotherapy or adjuncts for the treatment of depressive and negative symptoms in patients with schizophrenia [ 25 , 26 , 27 , 28 ].…”

Section: Introductionmentioning

confidence: 99%

The Role of Lurasidone in Managing Depressive Symptoms in People with Schizophrenia: A Review

Fiorillo,

Sampogna,

Albert

et al. 2024

Brain Sciences

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Background: Schizophrenia is a severe mental disorder characterized by positive, negative, affective, and cognitive symptoms. Affective symptoms in patients with schizophrenia have traditionally been overlooked or even neglected because they are not considered as fundamental as positive and negative symptoms in the choice of medication. Methods: This paper aims to systematically evaluate the efficacy and safety of lurasidone in the treatment of depressive symptoms of schizophrenia. Results: Lurasidone appears to be particularly effective on the depressive symptomatology of schizophrenia while also alleviating the positive and negative symptoms associated with the illness. Conclusions: The efficacy of lurasidone in treating patients with first-episode psychosis who present with predominant depressive symptoms suggests that this medication may be a valuable treatment option not only for established cases of schizophrenia but also for individuals in the early stages of the illness. The good tolerability of lurasidone is an important factor that may positively influence treatment decisions.

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“…Bipolar disorder is one of the most burdensome severe mental disorders, characterized by high levels of personal and social disability [1]. Patients often need an integrated [2][3][4] and personalized [5,6] pharmacological and nonpharmacological approach [7,8]. In particular, when an acute depressive, manic or mixed episode occurs, a pharmacological treatment is usually needed; however, the majority of bipolar patients need long-term treatments, to prolong the free interval, to prevent recurrences, to lessen subthreshold symptoms, to improve relational, social, and occupational functioning [6,9].…”

Section: Introductionmentioning

confidence: 99%

Facts and myths about the use of lithium for bipolar disorder in routine clinical practice: an expert consensus paper

Fiorillo,

Sampogna,

Albert

et al. 2023

Ann Gen Psychiatry

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Background Bipolar disorder is one of the most burdensome severe mental disorders, characterized by high levels of personal and social disability. Patients often need an integrated pharmacological and non-pharmacological approach. Lithium is one of the most effective treatments available not only in psychiatry, but in the whole medicine, and its clinical efficacy is superior to that of other mood stabilizers. However, a declining trend on lithium prescriptions has been observed worldwide in the last 20 years, supporting the notion that lithium is a ‘forgotten drug’ and highlighting that the majority of patients with bipolar disorder are missing out the best available pharmacological option. Based on such premises, a narrative review has been carried out on the most common “misconceptions” and “stereotypes” associated with lithium treatment; we also provide a list of “good reasons” for using lithium in ordinary clinical practice to overcome those false myths. Main text A narrative search of the available literature has been performed entering the following keywords: “bipolar disorder”, “lithium”, “myth”, “mythology”, “pharmacological treatment”, and “misunderstanding”. The most common false myths have been critically revised and the following statements have been proposed: (1) Lithium should represent the first choice for the treatment of patients with bipolar disorder; (2) lithium treatment is effective in different patients’ groups suffering from bipolar disorder; (3) Drug–drug interaction risk can be easily managed during lithium treatment; (4) The optimal management of lithium treatment includes periodical laboratory tests; (5) Slow-release lithium formulation has advantages compared to immediate release formulation; (6) Lithium treatment has antisuicidal properties; (7) Lithium can be carefully managed during pregnancy. Conclusions In recent years, a discrepancy between evidence-based recommendations and clinical practice in using lithium treatment for patients with bipolar disorder has been highlighted. It is time to disseminate clear and unbiased information on the clinical efficacy, effectiveness, tolerability and easiness to use of lithium treatment in patients with bipolar disorder. It is necessary to reinvigorate the clinical and academic discussion about the efficacy of lithium, to counteract the decreasing prescription trend of one of the most effective drugs available in the whole medicine.

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Incremental integration of nosological innovations is improving psychiatric diagnosis and treatment

Cited by 4 publications

References 9 publications

Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies

Borderline personality disorder: a comprehensive review of diagnosis and clinical presentation, etiology, treatment, and current controversies

The Role of Lurasidone in Managing Depressive Symptoms in People with Schizophrenia: A Review

Facts and myths about the use of lithium for bipolar disorder in routine clinical practice: an expert consensus paper

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