Browsing by keyword "ENIGMA-Major Depressive Disorder Working Group"
Now showing items 1-5 of 5
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Borderline Personality Disorder: Considerations for Inclusion in the Massachusetts Parity List of "Biologically-Based" DisordersBorderline Personality Disorder (BPD) is a common and severe mental illness that is infrequently included under state mental health parity statutes. This review considers BPD parity, using the Massachusetts mental health parity statute as a model. While BPD can co-occur with other disorders, studies of its heritability, diagnostic validity/reliability, and response to specific treatments indicate it is best considered an independent disorder, one that negatively impacts the patient's treatment response to comorbid disorders, particularly mood disorders. Persons with BPD are high utilizers of treatment, especially emergency departments and inpatient hospitalizations-the most expensive forms of psychiatric treatment. While some patients remain chronically symptomatic, the majority improve. The findings from psychopharmacologic and other biologic treatment data, coupled with associated brain functioning findings, indicate BPD is a biologically-based disorder. Clinical data indicate that accurately diagnosing and treating BPD conserves resources and improves outcomes. Based on this analysis, insuring BPD in the same manner as other serious mental illnesses is well-founded and recommended.
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Moving on to strengthsIT CAN NO LONGER BE in doubt: a quarter of the women who physicians see every day have had some experience of sexual abuse, and fully a third have sustained physical abuse. The article by Sansone et al in this issue of the ARCHIVES confirms the commonality of past abuse experiences among middle-class women in the health maintenance organization setting. Their finding of a 25.8% rate of prior sexual abuse among women seeking Papanicolaou tests at a health maintenance organization in Tulsa, Okla, is comparable to the frequency of prior sexual abuse among women seen in family practice settings across the country. Without statistically validated instruments, the Tulsa data are not strictly comparable with other research; nevertheless, their results are consistent with the rate of prior sexual abuse of 22.1% that was found among women attending a rural clinic in Wisconsin and of 26.0% at a Michigan family . .
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Treating revolving-door patients who have "hospitalphilia": compassion, coercion, and common senseTreatments applicable to the frequently rehospitalized psychiatric patient--the so-called revolving-door patient--have been poorly delineated. One subgroup of these patients includes those for whom recidivism has become a way of life; they may be said to suffer from "hospitalphilia." Neither refractoriness to treatment nor noncompliance with medications explains their frequent admissions. The author presents ten clinical principles to guide treatment planning for this subgroup of patients. The principles emphasize cooperation between the patient and the treatment agencies in creating a comprehensive, consistent, and enforceable plan to reduce unnecessary hospitalizations. Four treatment strategies based on the principles are outlined: unlimited access to hospitalization, a chit or voucher system, a rationing system, and an approach centered on the patient's expressed ability to avoid hospitalization.
