Addiction and Borderline Personality Disorder

Topics: Borderline Personality Disorder | Comorbidity | Dialectical Behavioral Therapy | Psychotherapy

CATR: Please introduce yourself. Dr. Pierson: I am a clinical psychologist and an assistant professor at Yale University School of Medicine. I serve as the director of dialectical behavior therapy (DBT) services at Yale New Haven Psychiatric Hospital. CATR: What is a useful way for addiction treatment providers to conceptualize borderline personal

Note From the Editor-in-Chief

Topics: Agitation | Anticholinergics | Cognitive functioning | Dementia | Geriatrics | Psychotherapy

One of the most challenging aspects of hospital psychiatry is the management of acute psychotic agitation. Sometimes we have little choice but to administer sedating medications to a combative patient who is putting others at risk of injury. Which medications work most quickly, safely, and effectively? Dr. Carlat and I combed through the literature to n

Exposure Therapy Efficacious for PTSD Co-Occurring With Alcohol Use Disorder

Topics: Addiction | Addiction Treatment | Alcohol | Alcohol Use | Alcohol use disorder | Alcoholism | Co-occurring disorders | Dual diagnosis | Prolonged exposure | Psychotherapy | PTSD | Research | Research Update | Substance Use | Substance use disorders

Review of: Norman SB et al, Efficacy 2019;76(8):791–799 Patients with co-occurring posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) have worse outcomes compared to patients with either diagnosis alone. Integrated approaches, in which both diagnoses are simultaneously addressed, are viewed as best practice. Providers, however, are

The COMBINE Study: A Core Paper in the Treatment of AUD

Topics: Acamprosate | Addiction | Addiction Treatment | Alcohol | Alcohol Use | Alcohol use disorder | Alcoholism | Medication | Naltrexone | Pharmacology | Psychotherapy | Research | Research Update | Substance Use | Substance use disorders | Therapy during medication appointment | Therapy with Med Management

Review of: Anton RF et al, JAMA 2006;295(17):2003–2017 Conducted from 2001 to 2004 and published in 2006, the COMBINE study was the largest pharmacotherapy study that assessed the treatment of alcohol use disorder (AUD). Although there were significant data on the use of naltrexone and acamprosate (both had been FDA approved), widespread use had no

Real-World Alcohol Use Disorder Treatment

Topics: Alcohol use disorder | Comorbidity | Dual diagnosis | Psychopharmacology | Psychotherapy

CATR: Please tell us about yourself. Dr. Petrakis: I’m an addiction psychiatrist, professor at Yale School of Medicine, and the Chief of Mental Health for the VA Connecticut Healthcare System. I have several research focuses, one of which is the treatment of individuals with comorbid psychiatric illness and alcohol use disorder (AUD). CATR: We kno

Does CBT Enhance Pharmacotherapy for Addiction?

Topics: Adjunct treatment | Cognitive Behavioral Therapy | Psychotherapy

REVIEW OF: Ray LA et al, JAMA Network Open 2020;3(6):e208279 Does cognitive behavioral therapy (CBT) provide any extra benefit when added to medication treatment for substance use disorders? It’s not clear. Most notably, in the COMBINE study of comparative treatments for alcohol use disorder (see CATR, Nov/Dec 2019), a combined behavioral intervent

Diagnosing and Treating Stimulant Use Disorders

Topics: contingency management | Diagnosis | Harm reduction | online therapy | Pharmacotherapy | Psychotherapy | Stimulants

CATR: Welcome, Dr. dela Cruz. Tell us what you do. Dr. dela Cruz: I’m an assistant professor at UT Southwestern Medical School where I’m the adult psychiatry residency associate program director, and I teach medical students, residents, and fellows. Clinically, I’m an outpatient addiction psychiatrist where I treat a variety of patients with subs

A Timely Look at Community Reinforcement for Seniors With Unhealthy Alcohol Use

Topics: Alcohol | Alcohol use disorder | Geriatric Psychiatry | Motivational Interviewing | Psychotherapy

Review of: Andersen K et al, Addiction 2020;115(1):69–81 During the COVID-19 pandemic, when every personal contact requires risk-reward deliberations, understanding the impact of relationships on health is crucial. This timely study, conducted from 2014 through 2016, investigated whether social networks reduce drinking among older adults with alcoh

Primer: Evidence-Based Psychosocial Interventions for Substance Use Disorders

Topics: Addiction | Addiction Treatment | Cognitive Behavioral Therapy | Motivational Interviewing | Psychotherapy | Substance Use Disorder

Evidence-based psychosocial interventions form a critical component of substance use disorder (SUD) treatment. However, clinicians may be less familiar with some of the newer modalities. This primer will help you make informed referrals and discuss options with your patients. Basic interventions Drug counseling Addiction counselors are the backbone o

Mental Illness and Flourishing

Topics: Depression | Mood | Personality Disorders | Psychotherapy

TCPR: You and other psychiatrists at Johns Hopkins have a way of viewing mental illness that differs from the biopsychosocial model. Tell us about that. Dr. Chisolm: We use a model called “perspectives of psychiatry” that was developed by Paul McHugh and Phillip Slavney in the 1970s. It’s really a framework that considers the origin of patients�

Working With Severe Personality Disorders

Topics: Borderline Personality Disorder | BPD | Patient relationship | Personality Disorders | Psychoanalysis | Psychodynamic therapy | Psychotherapy

TCPR: People with severe personality disorders are notoriously difficult to treat. Can they benefit from psychotherapy? Dr. Buie: Nearly all seriously ill patients can benefit from some form of psychotherapy. Supportive psychotherapy, group skills training, and behavioral treatments can be helpful in almost any illness, including psychotic disorders. P

Turning Nightmares Into Dreams

Topics: Behavior therapy | Behavioral therapy | Brief psychotherapy | Nightmares | Psychotherapy | PTSD | Sleep Disorders | Therapy during medication appointment | Therapy with Med Management

TCPR: What is nightmare disorder? Dr. Krakow: This is a sleep disorder in DSM-5 characterized by repeated, distressing nightmares. Some patients awaken from the dreams and others do not, but either way they usually remember the dreams, sometimes vividly. These nightmares often involve themes of threat, fear, and other distressing emotions. An important

Psychotherapy and Medication in Recurrent Depression

Topics: Brief psychotherapy | Deprescribing | Depression | Depressive Disorder | Prevention | Psychotherapy | Therapy during medication appointment | Therapy with Med Management | Treatment-Resistant Depression

TCPR: When depression is recurrent, we usually continue the antidepressant indefinitely. Has that practice come under challenge? Dr. Fava: Yes. Antidepressant drugs are certainly important during the depressive episode, but what we are starting to question is whether they are as effective in preventing relapse. A meta-analysis from 12 years ago found t

Side Effects of Psychotherapy

Topics: Behavior therapy | Behavioral therapy | Behavioral treatment | Brief psychotherapy | Cognitive Behavioral Therapy | Exercise | Psychotherapy | Therapy during medication appointment | Therapy with Med Management

TCPR: What are side effects to psychotherapy?Dr. Linden: Side effects are adverse reactions to a therapy that is correctly applied. TCPR: Why do you say “correctly” applied?Dr. Linden: When I talk about side effects, I’m not talking about boundary violations or mistakes by the therapist. I’m talking about unwanted events that are caused by the

Brief Therapy During the Medication Visit

Topics: Behavior therapy | Behavioral therapy | Behavioral treatment | Brief psychotherapy | Cognitive Behavioral Therapy | Exercise | Psychotherapy | Therapy during medication appointment | Therapy with Med Management

TCPR: How does a brief therapy session differ from the 50-minute hour?Dr. Sudak: What’s different is the scope of what you can tackle in those 25–30 minutes. There’s a greater need to organize the session and make decisions about what you can take on. For example, trauma is a subject that you’d probably defer to a longer session. TCPR: How do y

Insight in Therapy: Still Relevant After All These Years

Topics: Psychotherapy | Research Update

Review of: Jennissen S et al, Am J Psychiatry 2018;175(10):961–969 STUDY TYPE: Systematic review and meta-analysis What makes psychotherapy work? Contenders abound, including the therapeutic alliance, behavior change, and cognitive restructuring. This meta-analysis looked at the role that insight plays in psychotherapy outcomes. The authors defined

Take a Breather: A Mindful Tactic for Borderline Dysphoria

Topics: Agitation | Behavior therapy | Borderline Personality Disorder | BPD | Crisis intervention | Mindfulness | Psychotherapy | Self-injury | Therapy during medication appointment | Therapy with Med Management

Managing the intense, explosive dysphoria experienced by patients with borderline personality disorder (BPD) is one of the tougher challenges we face. These complex states, with elements of anxiety, rage, depression, and shame, are hard for patients to tolerate, let alone examine. Worse, they can generate dangerous solutions: suicide, self-harm, and o

A Pragmatic Approach to Borderline Personality Disorder

Topics: Borderline Personality Disorder | BPD | Brief psychotherapy | Psychotherapy | Therapy during medication appointment | Therapy with Med Management

TCPR: Tell us about this new approach to borderline personality disorder (BPD): good psychiatric management. Dr. Choi-Kain: We have many effective therapies for BPD. There’s dialectical behavior therapy (DBT), transference-focused therapy, and mentalization-based therapy. Good psychiatric management borrows from the other approaches, but differs in t

A New Way to Talk to Patients about Medication

Topics: Collaborative care | Medication adherence | Patient relationship | Psychiatric interviewing | Psychotherapy | Therapy with Med Management

TCPR: We all want to communicate better with patients, particularly around medications. You’ve lead workshops on this for several decades. Tell us about the model you developed out of that work. Dr. Shea: The Medication Interest Model (MIM) is a set of over 100 interview techniques that create shared decision making regarding all disease states from

Becoming Successful Despite ADHD

Topics: ADHD | Psychotherapy | Registered Articles

CCPR: Dr. Katz, how did you get interested in this topic? Dr. Katz: There’s a body of research exploring the lives of those who overcame a range of adverse childhood experiences, including learning-related challenges. I’ve always been interested in this work. Parents at our center are often surprised to learn that successful adults in every prof