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Management Strategies To Minimize Suicide Risk in Borderline Patients


Patients with borderline personality disorder (BPD) can present with multiple crises and minor incidents of self-harm or threats, but determining when the actions are true cause for concern can be a challenge. Assessing the patient’s current state of being, recent stressors, alcohol misuse, and support system can inform the health care provider about immediate risk. Similarly, below are suggested strategies that psychiatrists in various roles can employ to help reduce the risk of suicide. This Tipsheet is for quick reference only and not a replacement for the psychiatrist's experience and training, which are at the heart of what determines the severity of a psychiatric patient's condition. For further information, see Managing Suicide Risk in Borderline Personality Disorder Distinguishing Real Risk From Attention Seeking, from which this Tipsheet is adapted.

TIPSHEET: Management Strategies To Minimize Suicide Risk in BPD
Consultant to the Emergency Department
• Look for triggers of suicidal ideation or behavior, especially abuse, separation, or loss; are these time-limited or on-going? Ask yourself what has changed between the time of the overdose and the present to lower the risk of suicide? Consider hospitalization if there have been no changes.

• When eliciting the history, look to see whether the patient is placing blame for current difficulties onto self or onto others: the first is strongly suggestive of the guilty perpetrator state and higher suicide risk; the second is suggestive of the angry victim state and lower suicide risk.

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Negative Emotions Are Key to Well-Being

 

Feeling sad, mad, critical or otherwise awful? Surprise: negative emotions are essential for mental health

A client sits before me, seeking help untangling his relationship problems. As a psychotherapist, I strive to be warm, nonjudgmental and encouraging. I am a bit unsettled, then, when in the midst of describing his painful experiences, he says, “I'm sorry for being so negative.”

A crucial goal of therapy is to learn to acknowledge and express a full range of emotions, and here was a client apologizing for doing just that. In my psychotherapy practice, many of my clients struggle with highly distressing emotions, such as extreme anger, or with suicidal thoughts. In recent years I have noticed an increase in the number of people who also feel guilty or ashamed about what they perceive to be negativity. Such reactions undoubtedly stem from our culture's overriding bias toward positive thinking. Although positive emotions are worth cultivating, problems arise when people start believing they must be upbeat all the time.

In fact, anger and sadness are an important part of life, and new research shows that experiencing and accepting such emotions are vital to our mental health. Attempting to suppress thoughts can backfire and even diminish our sense of contentment. “Acknowledging the complexity of life may be an especially fruitful path to psychological well-being,” says psychologist Jonathan M. Adler of the Franklin W. Olin College of Engineering.

Meaningful Misery

Positive thoughts and emotions can, of course, benefit mental health. Hedonic theories define well-being as the presence of positive emotion, the relative absence of negative emotion and a sense of life satisfaction. Taken to an extreme, however, that definition is not congruent with the messiness of real life. In addition, people's outlook can become so rosy that they ignore dangers or become complacent [see “Can Positive Thinking Be Negative?” by Scott O. Lilienfeld and Hal Arkowitz; Scientific American Mind, May/June 2011].

Eudaemonic approaches, on the other hand, emphasize a sense of meaning, personal growth and understanding of the self—goals that require confronting life's adversities. Unpleasant feelings are just as crucial as the enjoyable ones in helping you make sense of life's ups and downs. “Remember, one of the primary reasons we have emotions in the first place is to help us evaluate our experiences,” Adler says.

Adler and Hal E. Hershfield, a professor of marketing at New York University, investigated the link between mixed emotional experience and psychological welfare in a group of people undergoing 12 sessions of psychotherapy. Before each session, participants completed a questionnaire that assessed their psychological well-being. They also wrote narratives describing their life events and their time in therapy, which were coded for emotional content. As Adler and Hershfield reported in 2012, feeling cheerful and dejected at the same time—for example, “I feel sad at times because of everything I've been through, but I'm also happy and hopeful because I'm working through my issues”—preceded improvements in well-being over the next week or two for subjects, even if the mixed feelings were unpleasant at the time. “Taking the good and the bad together may detoxify the bad experiences, allowing you to make meaning out of them in a way that supports psychological well-being,” the researchers found.

Negative emotions also most likely aid in our survival. Bad feelings can be vital clues that a health issue, relationship or other important matter needs attention, Adler points out. The survival value of negative thoughts and emotions may help explain why suppressing them is so fruitless. In a 2009 study psychologist David J. Kavanagh of Queensland University of Technology in Australia and his colleagues asked people in treatment for alcohol abuse and addiction to complete a questionnaire that assessed their drinking-related urges and cravings, as well as any attempts to suppress thoughts related to booze over the previous 24 hours. They found that those who often fought against intrusive alcohol-related thoughts actually harbored more of them. Similar findings from a 2010 study suggested that pushing back negative emotions could spawn more emotional overeating than simply recognizing that you were, say, upset, agitated or blue.

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Η Γνωσιακή-Συμπεριφορική Θεραπεία της 293.83 Αγχώδης  Διαταραχής Οφειλόμενης σε Γενική Σωματική Κατάσταση

 

Άρθρο της Βασιλικής Γ. Βενέτη, Post MA Επιστημονική Υπεύθυνη ΔΔΕΕΨΥ-Ελλάδα, Υπεύθυνη Διεύθυνσης Veneti CPT Services Ltd-Κύπρος

Σύμφωνα με τα διαγνωστικά κριτήρια του DSM-4 στην κλινική εικόνα της Αγχώδης Διαταραχής Οφειλόμενης σε Γενική Σωματική Κατάσταση

προεξάρχουν το έντονο άγχος, οι Προσβολές Πανικού ή οι ιδεοληψίες ή οι ψυχαναγκασμοί ενώ, Υπάρχει απόδειξη από το ιστορικό, τη φυσική εξέταση ή τα εργαστηριακά ευρήματα ότι η διαταραχή αποτελεί την άμεση φυσιολογική συνέπεια μιας γενικής σωματικής κατάστασης.

Η διαταραχή προκαλεί κλινικά σημαντική ενόχληση ή έκπτωση της κοινωνικής, επαγγελματικής ή άλλων σημαντικών περιοχών της λειτουργικότητας του ατόμου αν και δεν εμφανίζεται αποκλειστικά κατά τη διάρκεια της πορείας ενός ντελίριου.

Κατά την κλινική διάγνωση χρειάζεται να προσδιορίσουμε τον τύπο της ψυχικής διαταραχής διαχωρίζοντας τον τύπο

Γενικευμένου Άγχους: αν στην κλινική εικόνα προεξάρχει υπερβολικό άγχος ή υπερβολική ανησυχία για μια σειρά γεγονότων ή δραστηριοτήτων

Τον τύπο Προσβολών Πανικού: αν στην κλινική εικόνα προεξάρχουν Προσβολές Πανικού

Και Με Ιδεοψυχαναγκαστικά Συμπτώματα: αν στην κλινική εικόνα σημειώνονται ιδεοληψίες ή ψυχαναγκασμοί

Στις αιτίες πυροδότησης των συμπτωμάτων της διαταραχής θα συναντήσουμε την γενετική προδιάθεση της διαταραχής καθώς και την διάγνωση μιας σοβαρής σωματικής ασθένειας.

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It's all in our heads

Consciousness has long been the province of philosophers and mystics, but Michael Graziano is putting it in its scientific place.

By Tori DeAngelis

Cognitive psychologist Michael Graziano, PhD, has a low-key, affable manner that belies his stature as a trailblazer of neuroscience research. As director of the Sensory Motor Laboratory at Princeton University's Neuroscience Institute, he has conducted an extended series of studies showing how a set of multisensory neurons in the brain encode and protect the space immediately around the body, for example by signaling the presence of an object near to or touching part of the body whenever a person sees, feels, hears or even remembers that object.

His subsequent research landed on an even bigger discovery: that the classic map of how the motor cortex links to the body — the so-called homunculus, familiar to any student of neurology — fails to capture the true brain-body dynamic. It depicts the connection between specific areas of the cortex and specific muscles in the body and face, but Graziano showed that when you stimulate areas of a monkey cortex over time, entire behavioral repertoires emerge — the hand reaches up to the mouth to eat, the arms move in a defensive posture, the legs ready themselves to leap.

"It suddenly became apparent why the traditional muscle map was so lousy," Graziano explains. "All of these movements and functions are in fact not discrete. Instead, they all intermingle and overlap."

Lately, Graziano has turned his attention to the even bigger quarry of consciousness, a topic that has eluded philosophers for centuries and neuroscientists for at least 30 years. In "Consciousness and the Social Brain" (Oxford University Press), due out in September, he will explicate the notion that consciousness isn't as mysterious as we think: It can be understood as a function of a brain that for various evolutionary reasons holds great stake in attributing the property of awareness to itself and others.

Graziano spoke with the Monitor about his new book, his radically rationalist views on consciousness and his other endeavors, which include composing music, writing darkly imaginative adult fiction, and penning equally inventive children's books under the pseudonym B.B. Wurge, a Mensa-level orangutan who lives in a New York City elevator.

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Veneti CPT Services Ltd-Κύπρος: Σεμινάριο–Εργαστήριο Ιουνίου 2013: Βασικές Αρχές Ψυχοπαθολογίας. Από το DSM-IV-TR στο DSM-5

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Η Veneti Counseling, Psychotherapeutic and Training Services Ltd στα πλαίσια της Επιμόρφωσης των Ειδικών στην κοινότητα της Ψυχικής Υγείας διοργανώνει Σεμινάριο-Εργαστήριο με θέμα: Βασικές Αρχές Ψυχοπαθολογίας. Από το DSM-IV-TR στο DSM-5

Η Θεματολογία του Σεμιναρίου-Εργαστηρίου
Η θεματολογία του Σεμιναρίου-Εργαστηρίου περιλαμβάνει την λεπτομερή αναφορά στις ομάδες των ψυχικών διαταραχών σύμφωνα με το DSM-IV-TR & το DSM-5, την συσχέτιση και την διαφοροποίηση των ψυχικών διαταραχών κατά το DSM-5 και γενικότερα θέματα που αφορούν στην κατηγοριοποίηση των ψυχικών διαταραχών σύμφωνα με την νέα έκδοση του Διαγνωστικού και Στατιστικού Εγχειριδίου.

Στο εργαστηριακό μέρος του σεμιναρίου, οι συμμετέχοντες θα έχουν την δυνατότητα να παρακολουθήσουν συνεντεύξεις και ομιλίες από τους ειδικούς ψυχικής υγείας αναφορικά με την έκδοση του DSM-5 και να εξασκηθούν πρακτικά στην μελέτη βιβλιογραφικών περιστατικών προχωρώντας σε εκτίμηση σύμφωνα με τα Διαγνωστικά Κριτήρια του DSM-5.

Το Σεμινάριο-Εργαστήριο απευθύνεται σε:
√ Σπουδαστές & Φοιτητές Ψυχολογίας και λοιπών Ανθρωπιστικών Σπουδών
√ Συμβούλους
√ Ψυχολόγους
√ Ψυχιάτρους
√ Ψυχοθεραπευτές
√ Ειδικούς & Επαγγελματίες Ψυχικής Υγείας

Εισηγήτρια: Βασιλική Βενέτη, Post MA, Υπεύθυνη Διεύθυνσης της Veneti CPT Services Ltd
Διάρκεια Σεμιναρίου-Εργαστηρίου:12 ώρες,
Σάββατο 8 Ιουνίου 2013 10:00-16:00
Κυριακή 9 Ιουνίου 2013, 10:00-16:00
Τόπος Διεξαγωγής: Λευκωσία, Κύπρος
Χορηγείται:
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