PsychEd Episode 33: Treating Borderline Personality Disorder with Dr. Robert Biskin and Dr. Ronald Fraser

Welcome to PsychEd, the psychiatry podcast for medical learners, by medical learners. This episode covers the treatment of borderline personality disorder with expert guests: Dr. Robert Biskin, Associate Professor in the Department of Psychiatry at McGill University, and inpatient psychiatrist at the Borderline Personality Disorder Clinic at the McGill University Health Centre, as well as the inpatient psychiatrist at the Jewish General Hospital. Dr. Ronald Fraser, Associate Professor in the Department of Psychiatry at McGill University, Adjunct Professor at Dalhousie University, and head of the Inpatient Detoxification Services and Addictions Unit, as well as director of the Extended Care Borderline Personality Disorder Clinic at the McGill University Health Centre. The learning objectives for this episode are as follows:  By the end of this episode, you should be able to… Understand the frame and principles of care for the treatment of individuals with borderline personality disorder. Explore the approach to the treatment of individuals with borderline personality disorder: On presentation in crisis to the emergency department. During an inpatient psychiatric admission. In the context of psychiatric outpatient care. Understand the use of psychotherapy in the treatment of individuals with borderline personality disorder. Understand the use of pharmacotherapy in the treatment of individuals with borderline personality disorder Guest: Dr. Robert Biskin and Dr. Ronald Fraser Hosts: Dr. Sarah Hanafi (PGY3), Dr. Nima Nahiddi (PGY3), Audrey Le (CC4) Audio editing by Audrey Le Show notes by Dr. Nima Nahiddi Interview Content:  Introduction – 0:00 Learning objectives – 0:35 Principles of care for treatment of BPD – 1:16 The therapeutic frame – 5:40  Approach to the management of emergency department presentations – 9:10 Dialectical behaviour therapy (DBT) – 16:15 Suicidality and self-harm in BPD diagnosis – 21:05 Pharmacotherapy for symptom treatment – 22:40 Treatment of co-morbid disorders – 32:35  Management of safety risk – 39:30 Stigma in treatment of BPD – 46:05 Closing remarks – 52:00 Resources/Articles: The Treatment of Borderline Personality Disorder: Implications of Research on Diagnosis, Etiology, and Outcome | Annual Review of Clinical Psychology (annualreviews.org) Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis | Psychiatry | JAMA Psychiatry | JAMA Network National Education Alliance for Borderline Personality Disorder References:   Cristea I.A., Gentili C, Cotet CD, Palomba D, Barbui C, Cuijpers P. (2017) Efficacy of Psychotherapies for Borderline Personality Disorder: A Systematic Review and Meta-analysis. JAMA Psychiatry. 74(4):319–328. doi:10.1001/jamapsychiatry.2016.4287 Ingenhoven T, Lafay P, Rinne T, Passchier J, Duivenvoorden H  J. (2010) Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials. Clin Psychiatry. 71(1):14.  Paris J. (2009). The Treatment of Borderline Personality Disorder: Implications of Research on Diagnosis, Etiology, and Outcome. Review of Clinical Psychology. 5:1, 277-290 Stoffers J, Vollm BA, Rucker G, Timmer A, Huband N. (2010) Pharmacological interventions for borderline personality disorder. Cochrane Database of Systematic Reviews, Issue 6. Art. No.: CD005653. DOI: 10.1002/14651858.CD005653 Storebø  OJ, Stoffers-Winterling  JM, Völlm  BA, Kongerslev  MT, Mattivi  JT, Jørgensen  MS, Faltinsen  E, Todorovac  A, Sales  CP, Callesen  HE, Lieb  K, Simonsen  E.  (2020) Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, Issue 5. Art. No.: CD012955. DOI: 10.1002/14651858.CD012955.pub2     CPA Note: The views expressed in this podcast do not necessarily reflect those of the Canadian Psychiatric Association. For more PsychEd, follow us on Twitter (@psychedpodcast), Facebook (PsychEd Podcast), and Instagram (@psyched.podcast). You can provide feedback by email at [email protected]. For more information, visit our website at psychedpodcast.org.