Comorbidity of syndrome and PD

Question 1

Prev & life expectancy

Answer 1

8-13% of population have PD
In clinical population 65%
Comorbidity of 35-60% in mood/anxiety disorder

Life exp. -18 years. Can be due to
- Stress
- Meds
- Lifestyle
etc

Question 2

Treatment models

Answer 2

Sequential; Stepped care, most times starts with syndrome disorder bc of failure to recognise PD

Parallel; rare, but in case of eg phobia or PTSD. Only in case of (poly)pharmacy*

Integrated: Some PD treatment can integrate treatment for comorbid syndrome

• NOT recommended in PD

Question 3

Assessment

Answer 3

Detection; No (sufficient) early detection instruments

Specialised diagnostic, looking for PPP symptoms;

SCID-5-S/P and MINI

Question 4

Determining primary treatment

Answer 4

1. Request for help
2. Which problem was first
3. Which is most serious (EG anorexia, SUD)
4. Which is most urgent)

*Psychoeducation is important

Question 5

Treatment

Answer 5

NO meds. Can even increase risks

Supported psychosocial treat ico syndrome

Specialised psychotherapy ico boderline:
- Dialectical behaviour therapy (DGT)
- Schema Therapy (ST)
- Transference-Focused Psychotherapy (TFP)
- Mentalization-Based Treatment (MBT)

Other PD:
- ST
- specialised types of CBT
- psychodynamic psych.

Question 6

Empirical evidence

Answer 6

Often PD is seen as negative influence on treatment outcome, yet this is not the case. The outcome is at a lower level, but only because the starting point was lower too. The start point is not taken into account, masking the fact that the treatments are effective to the same degree

Question 7

Indication of less effective treatment

Answer 7

Strong beliefs of mistrust
Magical thinking
Need to control/avoid emotions
Dependence
Hopelessness