RESUMEN
INTRODUCTION: Borderline personality disorder is the most common personality disorder, with a global prevalence rate between 1.6% and 6%. It is characterized by affective disturbance and impulsivity, which lead to a high number of self-harm behaviors and great amount of health services use. International guidelines recommend psychotherapy as the primary treatment for borderline personality disorder. This paper reviews evidence about the effects and efficacy of cognitive-behavioral oriented psychological treatments for borderline personality disorder. MATERIAL AND METHODS: A literature review was conducted in Medline and PubMed databases, using the following keywords: borderline personality disorder, cognitive-behavioral psychotherapy and efficacy. RESULTS: Sixteen randomized clinical trials were evaluate in this review, which analyzed the effects of several cognitive-behavioral oriented psychotherapeutic interventions, namely dialectical behavioral therapy, cognitive behavioral therapy, schema-focused therapy and manual-assisted cognitive therapy. All above stated treatments showed clinical beneficial effects, by reducing borderline personality disorder core pathology and associated general psychopathology, as well as by reducing the severity and frequency of self-harm behaviors, and by improving the overall social, interpersonal and global adjustment. Dialectical behavioral therapy and schema-focused therapy also caused a soaring remission rate of diagnostic borderline personality disorder criteria of 57% and 94%, respectively. DISCUSSION: Although there were differences between the psychotherapeutic interventions analysed in this review, all showed clinical benefits in the treatment of borderline personality disorder. Dialectical behavioral therapy and schema-focused therapy presented the strongest scientific data documenting their efficacy, but both interventions are integrative cognitive-behavioral therapies which deviate from the traditional cognitive-behavioral model. CONCLUSION: In summary, the available studies support cognitive-behavioral psychological treatments as an efficacious intervention in borderline personality disorder. However, the existing scientific literature on this topic is still scarce and there is need for more studies, with higher methodological rigor, that should validate these results.
Introdução: A perturbação borderline da personalidade é a perturbação da personalidade mais comum, ocorrendo em 1,6 a 6% da população geral. É caraterizada por instabilidade nos afetos e impulsividade, havendo um elevado número de comportamentos autolesivos e consumo de recursos de saúde. A psicoterapia é recomendada por várias diretrizes internacionais, como sendo a abordagem terapêutica primária desta patologia. Neste trabalho efetuou-se uma revisão dos efeitos e da eficácia das intervenções psicoterapêuticas de base cognitivo-comportamental no tratamento da perturbação borderline da personalidade. Material e Métodos: Revisão bibliográfica, através da Medline e PubMed, utilizando como palavras-chave: 'borderline personality disorder', 'cognitive-behavioral therapy', 'efficacy'. Resultados: Foram incluídos 16 ensaios clínicos aleatorizados que avaliaram a eficácia de diversas intervenções psicoterapêuticas de base cognitivo-comportamental, nomeadamente da terapia comportamental-dialética, terapia cognitivo-comportamental, terapia focada nos esquemas e terapia cognitiva por manual. Todas as intervenções psicoterapêuticas analisadas demonstraram benefícios clínicos, quer ao nível da redução da psicopatologia geral e específica da perturbação borderline da personalidade, quer ao nível comportamental, com redução da frequência e gravidade dos comportamentos autolesivos, e com melhoria do funcionamento social, interpessoal e global. Foi observada uma taxa de remissão diagnóstica elevada com terapia comportamental-dialética (57%) e terapia focada nos esquemas (94%). Discussão: Apesar de existirem diferenças entre as intervenções psicoterapêuticas analisadas, todas apresentaram benefícios clínicos no tratamento da perturbação borderline da personalidade. A terapia comportamental-dialética e a terapia focada nos esquemas foram as intervenções que apresentaram uma maior robustez científica na documentação da sua eficácia, porém ambas são terapias integrativas de base cognitivo-comportamental que se afastam do modelo cognitivo-comportamental tradicional. Conclusão: Os resultados dos vários ensaios clínicos comprovam a eficácia das terapias de base cognitivo-comportamental no tratamento da perturbação borderline da personalidade. Contudo, a evidência científica é ainda parca e carece de estudos de elevado rigor metodológico que corroborem estes resultados.
Asunto(s)
Trastorno de Personalidad Limítrofe/terapia , Terapia Cognitivo-Conductual , HumanosRESUMEN
Electroconvulsive therapy (ECT) is an efficient, safe and even life saving treatment for several psychiatric disorders, namely depressive disorder, bipolar disorder and schizophrenia. Many were the doubts with it utilization, namely until the 1980s. After that it became more accepted with the publication of guidelines for many international associations of Psychiatry. Even with the development of psychopharmacology, ECT is still used with very good results, namely with affective disorders. Nowadays it is used almost exclusive with refractory patients but many studies show its efficacy in all the phases of psychiatric disorders where is indicated. The authors' review, based on literature, the history, indications, mechanism of action, procedure and adverse effects of ECT. The recent development of many procedures of magnetic stimulation could put ECT as a secondary treatment but the efficacy of that technique in comparison with ECT is still to be demonstrated, and ECT remains the most efficient treatment of psychiatry disorders.
Asunto(s)
Terapia Electroconvulsiva , Trastornos Mentales/terapia , Terapia Electroconvulsiva/efectos adversos , Terapia Electroconvulsiva/métodos , HumanosRESUMEN
Through the use of case reports, this article reviews frequent causes that origin the need for psychiatric intervention in patients hospitalized in medical and surgical wards. Particular diagnosis aspects are focused, so is the necessity of integration of the biological, psychological and social dimensions of the patient. The integrated approach by the various members of the medical staff is also emphasised. The cases presented were observed in the Liaison Psychiatry Consult of the Psychiatry Service of Hospital Santa Maria, in Lisbon, between November 2007 and January 2008. Seven cases were selected because they reflect paradigms in the intervention of the Liaison Psychiatrist, and reflect the following psychiatric diagnosis: Panic Disorder; Paranoid Schizophrenia; Bipolar Disorder; Personality Disorder; Major Depression, Dementia and Abstinence Syndrome.