Borderline Personality Disorder in Older Adults: Emphasis on Care in Institutional Settings

$230.00

Ana Hategan (Editor)
Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario

Series: Psychiatry – Theory, Applications and Treatments
BISAC: MED105000

With the book Borderline Personality Disorder in Older Adults: Emphasis on Care in Institutional Settings, Drs. Hategan, Bourgeois, and Xiong address an often underappreciated clinical problem that is likely increasing with the aging of the population. Geriatric patients with borderline personality disorder, like their younger counterparts, experience social and relationship challenges, comorbid psychiatric illness (including but not limited to substance use disorders), comorbid systemic illness, and are high utilizers of medical and social services. With the aging of the population worldwide, more older patients with chronic/progressive illnesses are to be found in various institutional settings such as skilled nursing facilities, rehabilitation units, and residential care, as well as in the general hospital. However, these patients’ habitual patterns of behavior (including affective dyscontrol, externalizing of blame, “splitting” the external world into groups who are “all good” and “all bad”) make the compromises and need for collectivity in institutional settings more challenging than for any other easily defined and demarcated patient group.

The Editors have assembled a large team of authors and co-authors to produce a clinical handbook that addresses the clinical, social, and administrative needs of this particular group of patients. They include an overview of the development of the diagnosis of borderline personality disorder over several issues of the Diagnostic and Statistical Manual of Mental Disorders classification system; the epidemiology and comorbidity, personality and aging, clinical diagnosis and productive use of psychometrics; clinical interventions including psychotherapy, psychopharmacology and advanced somatic treatments; and chapters devoted to medical-legal matters, systems of care, therapeutic alliance, and palliative care approaches. In all chapters, the authors have endeavored to focus specifically on the challenges posed for the patient, the clinician, and the larger system for geriatric patients with borderline personality disorder.

The authors and the editors hope that this volume summarizes the current clinical literature pertinent to the care of this population, with a focus on clinical encounters, clinical decision making, and techniques for interventions with patients and clinical systems of care to enhance the opportunities for favorable clinical outcomes for these patients, who typically have difficulty coping with the major existential challenges of old age, infirmity, and mortality. Greater awareness of borderline personality disorder in this population and greater clinician attunement to its understanding and management may serve the patient and the care system in this regard. (Imprint: Nova)

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Table of Contents

Table of Contents

Foreword
Calvin Hirsch, MD

Preface

Contributors

Section I Fundamentals of Borderline Personality Disorder in Older Adults

Chapter 1 – Overview of Borderline Personality Disorder in Older Patients: Evolution and Complexity (pp. 3-14)
James A. Bourgeois, OD, MD, Ana Hategan, MD, Albina Veltman, MD and Elise Hall, MD (Clinical Professor, Psychiatry, Department of Psychiatry/Langley Porter Psychiatric Institute, University of California San Francisco, Consultation-Liaison Service, University of California San Francisco, Medical Center, San Francisco, California, USA, and others)

Chapter 2 – Personality and Aging (pp. 15-22)
Julie Hylton, MD and Andreea L. Seritan, MD (Psychiatry Resident, University of California, Davis, Department of Psychiatry and Behavioral Sciences, Sacramento, CA, USA, and others)

Chapter 3 – Etiology and Epidemiological Correlates of Borderline Personality Disorder in Older Adults (pp. 23-30)
Mariam Abdurrahman, MD and Ana Hategan, MD (McMaster University, Hamilton, Ontario, Canada, and others)

Section II Assessment and Evaluation

Chapter 4 – Clinical Diagnosis (pp. 33-42)
Elise Hall, MD and James A. Bourgeois, OD, MD (University of California San Francisco and SFVAMC Psychosomatic Medicine Fellow, Department of Psychiatry, University of California San Francisco, San Francisco, California, USA, and others)

Chapter 5 – Comorbidities in Borderline Personality Disorder: Role of Consultation and Collaboration (pp. 43-50)
Glen L. Xiong, MD, Tricia K. W. Woo, MD, and Mariam Abdurrahman, MD (Health Sciences Associate Clinical Professor, Psychiatry, Department of Psychiatry and Behavioral Sciences, University of California, at Davis, California, USA, and others)

Chapter 6 – Psychological Assessment of Borderline Personality Disorder in Geriatric Patients (pp. 51-58)
Jelena P. King, PhD, Christina B. Gojmerac, PhD and Heather E. McNeely, PhD (Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada, and others)

Section III Management

Chapter 7 – Therapeutic Alliance and Boundary Issues (pp. 61-70)
Usha Parthasarathi, MBBS and Brian Holoyda, MD (Associate Clinical Professor, Psychiatry, McMaster University, Hamilton, Ontario, Canada, and others)

Chapter 8 – Suicidality in Geriatric Borderline Personality Disorder: Clinical Approaches and Management (pp. 71-80)
Jessica E. Waserman, MD, Karen Saperson, MBChB Christina B. Gojmerac, PhD and Christine Stanzlik-Elliott, MSW (Psychiatry Resident, Department of Psychiatry and Behavioural Neurosciences, Michael G. DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada, and others)

Chapter 9 – Psychiatry and the Law: Perspectives in Geriatric Borderline Personality Disorder (pp. 81-88)
Usha Parthasarathi, MBBS, Yuri A. Alatishe, MD and Daniel L. Ambrosini, PhD (Associate Clinical of Professor, Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada, and others)

Chapter 10 – Psychotherapy (pp. 89-98)
Laura E. Kenkel, MD and Andreea L. Seritan, MD (University of California, Davis Department of Psychiatry and Behavioral Sciences, Sacramento, California, USA)

Chapter 11 – Pharmacotherapy (pp. 99-110)
Barbara J. Kocsis, MD and Lorin M. Scher, MD (Department of Psychiatry and Behavioral Sciences, University of California, Davis, School of Medicine)

Chapter 12 – Somatic and Novel Pharmacological Treatments (pp. 111-122)
Gary M. Hasey, MD and Glen L. Xiong, MD (Faculty of Health Sciences, Department of Psychiatry and Behavioural Neurosciences, School of Biomedical Engineering, Department of Electrical and Computer Engineering, McMaster University, and others)

Chapter 13 – Palliative and End-of-Life Care (pp. 123-128)
Margaret W. Leung, MD, Sheila Lahijani, MD and Tua-Elisabeth Mulligan, MD (Palliative Medicine Fellow, Harvard Medical School, Palliative Medicine, Boston, MA, USA, and others)

Section IV New Developments and Future Directions

Chapter 14 – Geriatric Borderline Personality Disorder in the Era of the DSM-5 and ICD-11 (pp. 131-138)
Liesel-Ann Meusel, PhD, Margaret McKinnon, PhD and Peter J. Bieling, PhD (Rotman Research Institute, Baycrest, Toronto, Ontario, Canada, and others)

Chapter 15 – Systemic Challenges and Strategies for Institutional Settings (pp. 139-146)
Caroline Giroux, MD, Andrew M. Bein, PhD and Glen L. Xiong, MD (Health Sciences Assistant Clinical Professor, University of California, at Davis, Sacramento, California, APSS Stockton Clinic Medical Director, and others)

Chapter 16 – Considerations for Accountable Care Organizations and Medical Homes (pp. 147-154)
Shannon Suo, MD and Sid Stacey, MHSc (Associate Clinical Professor, University of California, at Davis, Department of Psychiatry and Behavioral Sciences, and others)

Index

FOREWORD

Reviews

Click here, to read the review by – Calvin Hirsch, MD, FACP, Professor of Clinical Internal Medicine (Geriatrics) and Public Health Sciences, University of California, Davis Health System, Sacramento, CA USA

“Given our propensity to think “brain” disease, such as neurocognitive disorders or white matter damage in depression, borderline personality disorder (BPD) is a rare topic for clinicians to discuss in mainstream geriatric mental health circles. Nevertheless, the authors of this volume make a most compelling case in a thorough yet easily digested book that BPD is not only prevalent but also overlooked in the diagnosis and treatment of older adults, especially in long term care facilities. They bring a rich background of many years study of BPD to the attention of clinicians working with older adults, unique in my view (I have not encountered such a volume in my 40 years working in geriatric psychiatry). The field should be most grateful to the authors and editors for expanding our perspective and filling in a gap in our knowledge.” – Dan G Blazer MD, MPH, PhD, JP Gibbons Professor of Psychiatry Emeritus, Duke University Medical Center

“In this volume, the authors address one of the complicated implications of the biological imperative: the recognition, understanding and management of Borderline Personality Disorder in late life. Combining the expertise of a broad variety of authorities, they have assembled a text of uniform style and focus. Clinically-centered and evidence-based, it encompasses a humanistic view of these complicated individuals and their circumstances, always rooted in sound science. Chapter authors have combed a wide array of the field’s literature and gleaned the most relevant. Each chapter is summarized in “Key points” that organize the topic for the reader. Case histories illuminate and clarify throughout. This text will prove indispensable to students, trainees and practitioners in a variety of settings” – David Bienenfeld, M.D., Professor of Psychiatry, Wright State University

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