From the Guidelines
Borderline Personality Disorder (BPD) is now characterized by problems in functioning of aspects of the self and/or interpersonal dysfunction in ICD-11, with severity differentiated into mild, moderate, and severe, and may optionally be specified by the presence of one or multiple maladaptive personality traits. The diagnosis of BPD has undergone significant changes from ICD-10 to ICD-11, with a shift towards a more dimensional approach 1. This change reflects the continuous graded severity of psychopathology and the need for a more nuanced understanding of personality disorders. The ICD-11 approach allows for a more detailed description of the severity and characteristics of BPD, which can inform treatment decisions and improve clinical utility 1.
Some key features of the ICD-11 diagnosis of BPD include:
- Problems in functioning of aspects of the self, such as identity
- Interpersonal dysfunction, such as managing conflict in relationships
- Severity differentiated into mild, moderate, and severe
- Optional specification by the presence of one or multiple maladaptive personality traits, including:
- Negative affectivity
- Detachment
- Dissociality
- Disinhibition
- Anankastia
- Borderline pattern
The ICD-11 approach to BPD is designed to be more clinically useful and simple than previous categorical approaches, while still capturing the complexity and nuance of personality disorders 1. By providing a more detailed and dimensional understanding of BPD, clinicians can develop more effective treatment plans and improve patient outcomes.
From the Research
Definition and Diagnosis of BPPV
- BPPV is a common condition that causes brief symptoms of vertigo due to head and body movements, resulting from wayward crystals in the semicircular canals of the inner ear 2.
- Diagnosis can be made using maneuvers to elicit symptoms and nystagmus, such as the Dix-Hallpike test 3, 2.
- The nystagmus pattern can help determine the location of the crystals and guide treatment 2.
Treatment Options for BPPV
- The Epley maneuver is a commonly used treatment for posterior canal BPPV, which is the most common form of the condition 3, 4, 5.
- Other treatment options include the Semont maneuver and Gufoni's maneuver, which are also effective for posterior canal BPPV 6.
- Alternating between different maneuvers, such as the Epley and Semont maneuvers, may be more effective than repeating the same maneuver 4.
- Vestibular rehabilitation is also an option, but the Epley maneuver may be more effective at 1-week follow-up 5.
Management and Outcomes
- Bedside tests and treatment with positional maneuvers can reduce resource utilization, ED length of stay, and use of ineffective medications 3.
- Effective treatment can improve patient-centered outcomes, such as symptom reduction and reduction of radiation exposure and side effects from medications 3.
- Some patients may not respond to treatment and may require further investigation to identify recurrences, multiple canal involvement, or associated comorbidities 6.