Category: Borderline

How much is too much caffeine🕉

Photo by bruce mars on Pexels.com

A video of Dr. Ayala discussing caffeine’s impact on the heart is available here:

https://www.wbaltv.com/article/the-woman-s-doctor-how-much-is-too-much-caffeine/30824815

Tomas H. Ayala, M.D., FACC, is a general cardiologist in Baltimore, Maryland. He sees patients at The Heart Center at Reisterstown, a satellite location of The Heart Center at Mercy. Dr. Ayala provides a range of care to diagnose and treat cardiovascular disease. He has an interest in cardiac imaging, valvular heart disease and geriatric cardiology.

Dr. Tomas Ayala has provided adults of all ages comprehensive cardiology care for more than 15 years. With Fellowship training in Cardiology, Dr. Ayala offers personalized care, concentrating on the best treatment plans to improve patient health and quality of life. He treats patients with congestive heart failure, coronary artery diseasearrhythmiashypertension and valvular heart disease, among other heart conditions.

He is Board Certified in Cardiovascular Disease, Nuclear Cardiology and Internal Medicine. Dr. Ayala is a Fellow of the American College of Cardiology as well as a member of the American Society of Echocardiography and the American Society of Nuclear Cardiology.

Dr. Tomas Ayala is committed to providing focused care for his patients. He is currently a Testamur of the ASCeXAM in adult Echocardiology, signifying his achievement in passing the Board exam and progressing to the “Board Eligible” stage. Echocardiography Board Certification will place Dr. Ayala among a group of distinguished experts in cardiovascular ultrasound interpretation and enable him to offer enhanced patient care for cardiovascular disease.

Dr. Ayala works with his patients to help them prevent and manage heart disease and maintain proper heart health. He places emphasis on patient education and understanding of risk factors and medical conditions, encouraging patients to take an active role in their care.

Dr. Tomas Ayala uses comprehensive testing and diagnostic services, including transthoracic echocardiography, transesophageal echocardiogram (TEE) and nuclear myocardial perfusion imaging, to evaluate heart blood flow, pumping function and anatomy in the diagnosis and assessment of cardiac conditions.

PTSD is not just for veterans

That individuals who suffer with post-traumatic stress disorder, better known as PTSD, have experienced severe trauma at some point in their lives. The trauma could come in the form of sexual assault, a natural disaster, a car accident or anything that would prompt someone to have a harrowing reaction.

However, many believe that PTSD is a mental health condition that affects only those who have come back home from war, but this is not the case.

“We must see PTSD, and other trauma-related disorders, as mental health issues that face many survivors of human rights violations,” said Tina Kempin Reuter, associate professor in the University of Alabama at Birmingham’s College of Arts and Sciences and director for UAB Institute for Human Rights. “Whether they’re survivors of genocide, ethnic cleansing, racial or ethnic persecution, and other forms of direct and indirect violence, many of these individuals continue to battle their traumas across their lifetime.”

PTSD affects 3.5 percent of the U.S. adult population, according to the National Alliance on Mental Illness, or approximately 8 million Americans who live with the condition. Approximately 37 percent of people diagnosed with PTSD display serious symptoms.

The root cause of PTSD is a traumatic event, but the symptoms are what overwhelm people to the point where it is diagnosable. People with PTSD often have recurring, distressing and upsetting memories of the trauma, and continually have upsetting memories that are hard to stop.

Symptoms can include flashbacks, night sweats, insomnia, panic attacks, and isolating themselves from friends and family.

U.S. National Library of Medicine research indicates that, when people experience trauma firsthand, it changes the brain. Several areas of the brain are involved. A stress response includes the amygdala, hippocampus and the prefrontal cortex. PTSD and trauma can cause lasting changes in those areas of the brain.

There are other disorders and mental health conditions that can appear along with PTSD, including generalized anxiety disorder, obsessive compulsive disorder, depression, borderline personality disorder and substance abuse.

Many who experience PTSD also may struggle with suicidal ideation and may attempt to take their life.

Causes of PTSD:

  • A stressful experience
  • Trauma
  • Mental illness
  • Predisposition to mental illness or family history of mental illness

Risk factors for PTSD:

  • Long-lasting trauma
  • Childhood sexual abuse
  • Other childhood trauma
  • A job where you’re exposed to trauma, such as a military position
  • Lack of a sound support system
  • Seeing someone get hurt
  • A history of substance abuse

How to cope with trauma

PTSD is not necessarily preventable because individuals cannot control when trauma happens. However, they can be equipped to cope with the trauma afterward.

Reuter says it is vital to seek mental health treatment in the form of therapy and, if needed, a psychiatrist, after someone experiences a traumatic event.

“Significant barriers can prevent many individuals living with PTSD and other trauma-related disorders from seeking the treatment they need,” Reuter said. “These barriers include lack of access or knowledge about mental health resources, lack of insurance to pay mental health providers, physical disability or other disability preventing individuals to access care, discrimination, and the stigma often associated with seeing a counselor.”

Reuter says that, in recent years, the global mental health community has worked to address these and other barriers by promoting “e-counseling” — that is, communicating with therapists and mental health professionals over the phone or computer. 

“Programs like BetterHelp can assist people living with PTSD to find and utilize the counseling they need,” Reuter said. “We hope that, as more individuals living with PTSD take advantage of these services, they are able to live fuller and healthier lives.”

Reuter notes that PTSD is a treatable mental illness, and many experiencing it are not alone. Seeking help from a mental health professional is a first step, whether that is working with someone in their local area or finding the help of an online counselor, like one at UAB partner BetterHelp, which provides treatment plans for those suffering with PTSD.

Healing from trauma can be difficult, but it is possible. If you are experiencing PTSD, seek help from available resources. And if you know someone who is experiencing PTSD, encourage them to do the same. The Substance Abuse and Mental Health Services Administration national helpline is 1-800-662-HELP (4357).

About UAB
Known for its innovative and interdisciplinary approach to education at both the graduate and undergraduate levels, the University of Alabama at Birmingham is an internationally renowned research university and academic medical center, as well as Alabama’s largest employer, with some 23,000 employees, and has an annual economic impact exceeding $7 billion on the state. The five pillars of UAB’s mission include education, research, patient care, community service and economic development. UAB is a two-time recipient of the prestigious Center for Translational Science Award. Learn more at www.uab.edu. UAB: Powered by will.

Borderline Personality Disorder Potentially at Higher Risk for Heart Attacks

Mental health professionals should recommend screening patients for cardiovascular risks

Middle-aged adults who show symptoms of borderline personality disorder may be at greater risk for a heart attack, as they show physical signs of worsening cardiovascular health more than other adults, according to research published by the American Psychological Association.

“Although borderline personality disorder is well studied for its relationship to psychological and social impairments, recent research has suggested it may also contribute to physical health risks,” said Whitney Ringwald MSW, MS, of the University of Pittsburgh and lead author of the study. “Our study suggests that the effects of this disorder on heart health are large enough that clinicians treating patients should recommend monitoring their cardiovascular health.”

The study was published in Personality Disorders: Theory, Research, and Treatment.

Borderline personality disorder is characterized by intense mood swings, impulsive behaviors, and extreme emotional reactions. Their inability to manage emotions often makes it hard for people with borderline personality disorder to finish school, keep a job, or maintain stable, healthy relationships. According to the National Institute of Mental Health, 1.4% of adults have BPD, but that number does not include those with less severe symptoms, who nevertheless may experience clinically significant impairments, said Aidan Wright, PhD, of the University of Pittsburgh and another author of the study.

“It can be challenging to treat BPD because you are seeking to change a person’s longstanding patterns of thinking, feeling and behaving that are very well ingrained,” he said. “There are several evidence-based treatment options that can be helpful, so there are many reasons to be optimistic, but treatment may take a long time.”

The researchers analyzed health data from 1,295 participants in the University of Pittsburgh Adult Health and Behavior Project. This is a registry of behavioral and biological measurements from non-Hispanic white and African American adults, 30 to 50 years old, recruited between 2001 and 2005 in southwestern Pennsylvania. The researchers looked at self-reported basic personality traits, as well as those reported by up to two of the participants’ friends or family members, and self-reported symptoms of depression. By combining several physical health measurements, including blood pressure, body mass index and the levels of insulin, glucose, cholesterol and other compounds in the blood after a 12-hour fast, the researchers established a relative cardiovascular risk score for each participant.

They found a significant association between borderline personality traits and increased cardiovascular risk. The researchers also looked at the potential role of depression, as people with BPD are also often depressed. While borderline personality traits and depression were both significantly associated with cardiovascular risk the effect of borderline traits was independent of depression symptoms.

“We were surprised by the strength of the effect and we found it particularly interesting that our measure of borderline personality pathology had a larger effect, and a unique effect, above and beyond depression in predicting heart disease.” said Wright.  “There is a large focus on depression in physical health, and these findings suggest there should be an increased focus on personality traits, too.”

The researchers said their findings have important implications for primary care doctors and mental health professionals who treat patients with BPD.

“Mental health practitioners may want to screen for cardiovascular risk in their patients with BPD, ” said Wright. “When discussing the implications of a personality disorder diagnosis with patients, practitioners may want to emphasize the link with negative health outcomes and possibly suggest exercise and lifestyle changes if indicated. Primary care physicians should attend to personality as a risk factor when monitoring patients for long-term health as well.”

Article: “Borderline Personality Disorder Traits Associate with Midlife Cardiometabolic Risk,” by Whitney R. Ringwald, MSW, MS, Aidan G.C. Wright, PhD,  Stephen B. Manuck, PhD, University of Pittsburgh; and Taylor A. Barber, BS, Philadelphia College of Osteopathic Medicine. Personality Disorders: Theory, Research, and Treatment, published online Oct. 28, 2019.

No Empathy!

Research Links Borderline Personality Traits with Lowered Empathy

Photo by Abigail Keenan

Those with borderline personality disorder, or BPD, a mental illness marked by unstable moods, often experience trouble maintaining interpersonal relationships. New research from the University of Georgia indicates that this may have to do with lowered brain activity in regions important for empathy in individuals with borderline personality traits.

The findings were recently published in the journal Personality Disorders: Theory, Research and Treatment.

“Our results showed that people with BPD traits had reduced activity in brain regions that support empathy,” said the study’s lead author Brian Haas, an assistant professor in the Franklin College of Arts and Sciences psychology department. “This reduced activation may suggest that people with more BPD traits have a more difficult time understanding and/or predicting how others feel, at least compared to individuals with fewer BPD traits.”

Credit: University of Georgia
Brian Haas is an assistant professor in the University of Georgia’s psychology department.

For the study, Haas recruited over 80 participants and asked them to take a questionnaire, called the Five Factor Borderline Inventory, to determine the degree to which they had various traits associated with borderline personality disorder. The researchers then used functional magnetic resonance imaging to measure brain activity in each of the participants. During the fMRI, participants were asked to do an empathetic processing task, which tapped into their ability to think about the emotional states of other people, while the fMRI measured their simultaneous brain activity.

In the empathetic processing task, participants would match the emotion of faces to a situation’s context. As a control, Haas and study co-author Joshua Miller also included shapes, like squares and circles, that participants would have to match from emotion of the faces to the situation.

“We found that for those with more BPD traits, these empathetic processes aren’t as easily activated,” said Miller, a psychology professor and director of the Clinical Training Program.

Haas chose to look at those who scored high on the Five Factor Borderline Inventory, instead of simply working with those previously diagnosed with the disorder. By using the inventory, Haas was able to obtain a more comprehensive understanding of the relationship between empathic processing, BPD traits and high levels of neuroticism and openness, as well as lower levels of agreeableness and conscientiousness.

“Oftentimes, borderline personality disorder is considered a binary phenomenon. Either you have it or you don’t,” said Haas, who runs the Gene-Brain-Social Behavioral Lab. “But for our study, we conceptualized and measured it in a more continuous way such that individuals can vary along a continuum of no traits to very many BPD traits.”

Haas found a link between those with high borderline personality traits and a decreased use of neural activity in two parts of the brain: the temporoparietal junction and the superior temporal sulcus, two brain regions implicated to be critically important during empathic processing.

The research provides new insight into individuals susceptible to experiencing the disorder and how they process emotions.

“Borderline personality disorder is considered one of the most severe and troubling personality disorders,” Miller said. “BPD can make it difficult to have successful friendships and romantic relationships. These findings could help explain why that is.”

In the future, Haas would like to study BPD traits in a more naturalistic setting.

“In this study, we looked at participants who had a relatively high amount of BPD traits. I think it’d be great to study this situation in a real life scenario, such as having people with BPD traits read the emotional states of their partners,” he said.

An abstract of the study, “Borderline Personality Traits and Brain Activity During Emotional Perspective Taking,” is available at http://www.ncbi.nlm.nih.gov/pubmed/26168407.

Borderline Personality Disorder—as Scientific Understanding Increases, Improved Clinical Management Needed

Even as researchers gain new insights into the neurobiology of borderline personality disorder (BPD), there’s a pressing need to improve diagnosis and management of this devastating psychiatric condition.

The special issue comprises seven papers, contributed by experts in the field, providing an integrated overview of research and clinical management of BPD. “We hope these articles will help clinicians understand their BPD patients, encourage more optimism about their treatability, and help set a stage from which the next generation of mental health professionals will be more willing to address the clinical and public health challenges they present,” according to a guest editorial by Drs. Lois Choi-Kain and John Gunderson of the Adult Borderline Center and Training Institute at McLean Hospital, Belmont, Mass.

Borderline Personality Disorder—Research Advances, Emerging Clinical ApproachesAlthough the diagnostic criteria for BPD are well-accepted, it continues to be a misunderstood and sometimes neglected condition; many psychiatrists actively avoid making the diagnosis. Borderline personality disorder accounts for nearly 20 percent of psychiatric hospitalizations and outpatient clinic admissions, but only three percent of the research budget of the National Institute of Mental Health. (The NIMH provides information about BPD online at www.nimh.nih.gov/health/topics/borderline-personality-disorder)

The Guest Editors hope their special issue will contribute to overcoming the disparity between BPD’s public health importance and the attention received by psychiatry. Highlights include:• A research update on the neurobiology of BPD. Evidence suggests that chronic stress exposure may lead to changes in brain metabolism and structure, thus affecting the processing and integration of emotion and thought. This line of research might inform new approaches managing BPD—possibly including early intervention to curb the neurobiological responses to chronic stress.• The urgent need for earlier intervention. A review highlights the risk factors, precursors, and early symptoms of BPD and mood disorders in adolescence and young adulthood. While the diagnosis of BPD may be difficult to make during this critical period, evaluation and services are urgently needed.• The emergence of evidence-based approaches for BPD. While these approaches have raised hopes for providing better patient outcomes, they require a high degree of specialization and treatment resources. A stepped-care approach to treatment is proposed, using generalist approaches to milder and initial cases of BPD symptoms, progressing to more intensive, specialized care based on clinical needs.• The critical issue of BPD in the psychiatric emergency department. This is a common and challenging situation in which care may be inconsistent or even harmful. A clinical vignette provides mental health professionals with knowledge and insights they can use as part of a “caring, informed, and practical” approach to helping BPD patients in crisis.

The special issue also addresses the critical issue of resident training—preparing the next generation of mental health professionals to integrate research evidence into more effective management for patients and families affected by BPD. Drs. Choi-Kain and Gunderson add, “For clinicians, educators, and researchers, we hope this issue clarifies an emerging basis for earlier intervention, generalist approaches to care for the widest population, and a more organized approach to allocating care for individuals with BPD.”

About the Harvard Review of PsychiatryThe Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer-reviewed and not industry sponsored. It is the property of Harvard University and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals. Articles encompass all major issues in contemporary psychiatry, including (but not limited to) neuroscience, psychopharmacology, psychotherapy, history of psychiatry, and ethics.

About Wolters KluwerWolters Kluwer is a global leader in professional information services. Professionals in the areas of legal, business, tax, accounting, finance, audit, risk, compliance and healthcare rely on Wolters Kluwer’s market leading information-enabled tools and software solutions to manage their business efficiently, deliver results to their clients, and succeed in an ever more dynamic world.

Wolters Kluwer reported 2015 annual revenues of €4.2 billion. The group serves customers in over 180 countries, and employs over 19,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands. Wolters Kluwer shares are listed on Euronext Amsterdam (WKL) and are included in the AEX and Euronext 100 indices. Wolters Kluwer has a sponsored Level 1 American Depositary Receipt program. The ADRs are traded on the over-the-counter market in the U.S. (WTKWY). Wolters Kluwer Health is a leading global provider of information and point of care solutions for the healthcare industry. For more information about our products and organization, visit www.wolterskluwer.com, follow @WKHealth or @Wolters_Kluwer on Twitter, like us on Facebook, follow us on LinkedIn, or follow WoltersKluwerComms on YouTube.