Évaluation des troubles de la personnalité

Traitements des troubles de la personnalité

• Évaluation et intervention (PSY-8036): A course focusing on assessment and treatment of personality disorders.
• Louis Diguer, PhD: The instructor.
• Automne 2024: The academic term the course will be taught.
• Université Laval: The institution offering the course.

Références

• Gunderson, J.G. & Hoffman, P.D. (2005): A guide for professionals and families on understanding and treating borderline personality disorders.
• Gunderson, J.G. & Links, P.S. (2014): Handbook of Good Psychiatric Management for Borderline Personality Disorder, published by the APA.
• Gabbard G.O. (2014): Gabbard's treatments of psychiatric disorders (DSM-5 edition), published by the APA.
• Caligor, E., Kernberg, O.F., Clarkin, J., & Yeomans, F. (2018): Psychodynamic Therapy for Personality Pathology: Treating Self and Interpersonal Functioning, APA.
• Linehan, M.M. (2014): DBT Skills Training Manual, Second Edition, published by Guilford.
• Bateman, A. & Fonagy, P. (2016): Psychotherapy for borderline personality disorder; mentalization-based treatment, published by Oxford University Press.
• Young J., Klosko, J.S., & Weishaar, M. (2006): Schema Therapy: A Practitioner's Guide, published by Guilford.
• Leichsenring et al. (2024): A comprehensive review on borderline personality disorder, diagnosis, clinical presentation, etiology, treatment, and current controversies published in World Psychiatry (2024).
• Cristea et al. (2017): Systematic review and meta-analysis of psychotherapy for personality disorder.
• Cochrane Storebø et al. 2020: Review on borderline personality disorder; 75 studies, 4507 participants (mostly women, aged 14.8 - 45.6.) using 16 types of treatments (TAU and waitlisted).

Niveaux de traitement

• A table displaying treatment levels (hospital, inpatient, outpatient) for borderline personality disorder based on different criteria (distress, behaviors, interpersonal concerns).

Méta-analyse Crotty (2023)

• A meta-analysis of 25 RCT studies, 2545 participants with BPD.
• Compares 8 validated treatments (vs TAU) and 9 treatments v.s. TAU (with efficiency similar).
• No significant differences between the 8 treatments.

APA Guidelines for BPD (2023)

• Treatments are usually more effective than waitlist control.
• Treatment efficiency varies based on symptoms and studies.
• Limited data on minorities and men.
• Treatment should consider patient preferences and resources.

Pharmacotherapy

• Medication effects for personality disorders, less clear than psychotherapy, with some limited uses in specific symptoms, like mood swings, impulsivity or psychotic symptoms.
• Lists of drugs and their impact (e.g., SSRIs, tricyclics, mood stabilizers, antipsychotics).

Évaluation Dx et plan d'intervention

• Evaluation on diverse aspects.
• Important factors include distress, need for support, motivation, and relevant history.
• Includes interventions relevant to the situation, crisis, and mental health status.

Modalités d'intervention

• Crisis intervention, basic needs organization, mentalization, preparation for therapy, supportive therapy, and specialized treatments are all part of the intervention methods.
• Evaluation & assessment is critical, factors like aggressiveness, social isolation, and distorted perception are all part of the criteria.

Intervention de crise

• Dangerous situations involving the patient's or treatment's safety.
• Mental instability, severe disruptions of thought patterns (delusions and illusions).
• Dangerous/suicidal/homicidal behavior and potential actions that need immediate intervention.
• Other considerations that involve life-threatening physical situations (e.g., intoxication).

Soutien psychologique

• Support tailored to personal situations, regressions, blockers.
• Changes and external factors need to be considered.
• Defense mechanisms, regressions, risks of abandonment and interventions must be carefully modulated.

Psychothérapies : caractéristiques

• The necessity of well-defined protocols due to the complexity and comorbidity of personality disorders.
• Importance of strong therapeutic relationships in understanding patient perspectives and behaviors.
• The importance of techniques that are specifically adjusted based on treatment goals, patients, and their dynamics.

Difficultés de la psychothérapie avec des patients limites

• Describes specific difficulties when interacting with personality disorder patients.
• Includes regression reactions, suicidal or homicidal tendencies, significant challenges in communication and self-expression, and issues with engagement and active involvement in treatment.

Définition de la TFP

• Describes psychodynamic therapy focused on relationship patterns and object relations.
• Emphasizes the importance of the therapeutic frame and transference.

L'approche thérapeutique de la TFP

• Aims at personality change, addressing relational patterns, and improving overall functioning.
• Emphasizes the importance of understanding the patient's subjective experience and mental processes.

Les changements espérés

• Describes desired outcomes, focusing on fostering a stable personality, stronger relations, better management of emotions, ability to handle stress, greater participation in social activities, and improvement in overall mental well-being.

Caractéristiques de la TFP

• Key aspects of the treatment, including its specific focus on the here and now, active interventions, and the relationship dynamics within the therapeutic process.

L'efficacité de la TFP

• Evidence from studies indicating the positive impact of TFP.
• Includes reduction in symptoms such as suicidal behaviors, aggression, impulsivity, anxiety, depression, and improvements in psychological functioning.

Thérapie cognitive comportementale

• A type of therapy based on Beck's work, focusing on changing thought patterns to positively impact behavior and emotional regulation.
• A combination of treatments/technics/principles of therapy to achieve the best outcome.
• Explores the patterns of thoughts, emotions, and behaviors to better understand and modify the cognitive/behavioral patterns for patients with personality disorders.

Thérapie des schémas

• An approach which integrates various CBT and psychodynamic principles to help patients identify and change maladaptive thought patterns and emotional regulation difficulties.
• Focus on identifying and modifying maladaptive schemas and coping mechanisms.

Étapes du traitement thérapie des schémas

• Includes preparatory stages for the therapy in a controlled setting, focusing on crisis management and stability establishment.
• Emphasizes the identification of schemas, behavioral analysis and cognitive/behavioral strategies to improve coping mechanisms.

Ce quiz porte sur l'évaluation et l'intervention dans le traitement des troubles de la personnalité. Basé sur le cours PSY-8036 enseigné par Louis Diguer à l'Université Laval, il explore diverses approches et techniques pour aider les professionnels à traiter ces troubles. Testez vos connaissances sur les références essentielles liées à ce domaine.