Hersh Richard G
Department of Psychiatry, Columbia University, New York.
Focus (Am Psychiatr Publ). 2022 Oct;20(4):353-357. doi: 10.1176/appi.focus.20220054. Epub 2022 Oct 25.
Standard psychiatric risk management challenges are routinely amplified in the treatment of patients with primary or co-occurring borderline personality disorder diagnosis. Most psychiatrists receive limited guidance during training or as part of continuing medical education about specific risk management concerns in work with this patient population; nevertheless, these concerns can occupy a disproportionate amount of time and energy in clinical practice. The goal of this article is to review the frequently observed risk management quandaries encountered in work with this patient population. The more familiar risk management dilemmas related to management of suicidality, potential boundary violations, and patient abandonment, are considered. In addition, salient contemporary trends in prescribing, hospitalization, training, diagnostic classification, models of psychotherapeutic treatment, and use of emerging technologies in provision of care, are explored in terms of their impact on risk management.
在对原发性或共病边缘型人格障碍患者的治疗中,标准的精神科风险管理挑战通常会被放大。大多数精神科医生在培训期间或作为继续医学教育的一部分,接受的关于针对这类患者群体进行特定风险管理问题的指导有限;然而,在临床实践中,这些问题可能会占用过多的时间和精力。本文的目的是回顾在与这类患者群体工作中经常遇到的风险管理难题。文中考虑了与自杀倾向管理、潜在的边界侵犯和患者遗弃等更为常见的风险管理困境。此外,还探讨了在处方、住院治疗、培训、诊断分类、心理治疗模式以及在提供护理中使用新兴技术等方面的显著当代趋势对风险管理的影响。