W04 - Good Psychiatric Management for Borderline Personality Disorder: Adaptations for Collaborative Care, the Psychiatric Emergency, and Tertiary Care Patients
Friday, 23 October
11:15 – 12:45 (1.5 hrs)
Paul S. Links*, MD, MSc, FRCPC; Philippe-Edouard Boursiquot, MD, FRCPC; James Ross, MD, MHPE, FRCPC
At the end of this session, participants will be able to: 1) Examine the development of good psychiatric management (GPM) for patients with borderline personality disorder (BPD); 2) Discuss the principles of GPM in the care of patients with BPD; and 3) Identify the benefits and challenges of adapting GPM to collaborative care, to acute emergency care, and to tertiary care settings.
Good psychiatric management (GPM) of patients with borderline personality disorder (BPD) is a generalist outpatient intervention that can be effectively delivered by independent community mental health professionals. GPM consists of psychotherapy management with dynamically informed psychotherapy, based on Gunderson’s formulation on interpersonal hypersensitivity; case management, particularly focusing on the risk of suicide; and symptom-targeted medication management. The evidence for GPM is primarily derived from a large randomized controlled trial, showing that the clinical efficacy of GPM equalled that of dialectical behaviour therapy (DBT) (McMain et al., 2009, 2012).
GPM has recently been modified for various settings and the current workshop will discuss adaptations for collaborative care, acute treatment in the psychiatric emergency service, and with patients who fail to respond to DBT.
In primary care, the lifetime prevalence rate of BPD is 6.4%. These patients often have significant medical comorbidities, higher rates of obesity, and the metabolic syndrome. GPM informs collaborative care by providing important management principles, such as framing problems using the core essence of BPD, use of validation, tolerating anger empathically, prescribing conservatively, and responding appropriately to self-harm and suicidal statements.
GPM has been integrated with DBT; however, some patients find GPM is more flexible, determined by the patient’s goals, open to pharmacotherapy and split treatments, and does not require an initial agreement to stop all self-harm. These adaptations of GPM will be illustrated through case vignettes involving audience participation and discussion of various clinical decision points.
McMain SF, Links PS, Gnam WH, et al. A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. Am J Psychiatry 2009;166:1365–74.
McMain SF, Guimond T, Streiner DL, et al. Dialectical behavior therapy compared with general psychiatric management for borderline personality disorder: clinical outcomes and functioning over a 2-year follow-up. Am J Psychiatry 2012;169:650–61.