Personality disorder, borderline

Discontinuation of antidepressant medication should be concordant with the guidelines for treatment duration (see Acute Major Depression subsection in the preceding section). It is advisable to taper the dose while monitoring for signs and symptoms of relapse. Abrupt discontinuation is also more likely to lead to antidepressant discontinuation symptoms, often referred to as withdrawal symptoms. The occurrence of these symptoms after medication discontinuation does not imply that antidepressants are addictive. 

Discontinuation symptoms appear to occur most commonly after discontinuation of short-half-life serotonergic drugs (Coupland et al. 1996), such as fluvoxamine, paroxetine, and venlafaxine. 

Patients describe symptoms as flu-like these symptoms include nausea, diarrhea, insomnia, malaise, muscle aches, anxiety, irritability, dizziness, vertigo, and vivid dreams (Coupland et al. 1996). Often, and for unknown reasons, patients who experience this constellation of symptoms have transient electric shock sensations. This unique symptom is diagnostically useful and strongly suggests to the clinician that the patient is in fact experiencing withdrawal because the symptom rarely occurs in other conditions, such as viral infections, or as a side effect of a new medication. 

Abrupt discontinuation of TCAs commonly results in diarrhea, increased sweating, anxiety, and dizziness. These symptoms were previously attributed to cholinergic rebound, but the occurrence of similar symptoms after the discontinuation of many of the newer serotonergic antidepressants suggests that the pathophysiology may be more closely related to changes in serotonin. 

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Psychoses, when they occur, appear to be due to drug effect interacting with a vulnerable personality organization (Luisada 1978). Our experience has been that some adolescents with borderline personality disorders, as well as adolescents at risk of schizophrenic decompensation, may have this vulnerability. Although we do not have hard data to support the hypothesis that patients with PCP psychoses that are most resistant to treatment have the poorest long-term prognosis (Erard et al. 1980), our observations have been that persistence of symptoms of psychosis after the first 2 to 3 weeks of treatment often correlates with extended periods of impai rment. 

Trull, Widiger, and Guthrie (1990) examined the latent structure of the DSM-III-R (American Psychiatric Association, 1987) criteria for borderline personality disorder, as well as criteria for dysthymia. Dysthymia is not classified as a personality disorder in the DSM, but it tends to be chronic and is quite similar to personality disorders in this respect. To assist in the interpretation of the borderline personality disorder analyses, dysthymia was... 

Trull, T. J., Widiger, T. A., Guthrie, P. (1990). Categorical versus dimensional status of borderline personality disorder. Journal of Abnormal Psychology, 99, 40-48. 

Professionals working with a suicidal drug client may wish to determine whether the person meets criteria for Borderline Personality Disorder. Borderline clients often have a history of suicidal behavior and high utilization of health and mental health care services. Most people who meet criteria for Borderline Personality Disorder are women, but not all. As mentioned, some professionals find it difficult to work with borderline clients without becoming very upset or cynical. If you cannot work with such a client respectfully, then it is recommended that a referral be made to someone who can (see Chapter 3). Treating the client with dignity is important if trust and a solid therapeutic alliance are to develop. 

Linehan, M. M. (1993). Cognitive-behavioral treatment of Borderline Personality Disorder. New York Guilford Press. 

Clnster B includes the so-called dramatic and emotional disorders. This group is comprised of antisocial personality disorder (ASPD), borderline personality disorder (BPD), narcissistic personality disorder (NPD), and histrionic personality disorder (HPD). In each of these disorders, the person is attention seeking, is emotionally unstable, and finds it difhcnlt to conform to social norms. Unlike the odd and eccentric Cluster A patients and the anxious and withdrawn Cluster C patients, those with Cluster B personality disorders seldom escape clinical attention for very long. The disruptive nature of these personality disorders often leads them to psychiatric or legal intervention no later than their early adult life. 

Borderline personality disorder (BPD) is the most common and best described of all the personality disorders. These patients lack stability in their relationships, have a clonded concept of their own identity, and have trouble modulating their mood. Their lives are often characterized by chaos as they frantically seek intensely... 

Borderline Personality Disorder (BPD). In selecting a treatment for BPD, there are two key considerations. First, one should choose the treatment that will... 

Borderline Personality Disorder, Histrionic Personality Disorders. The... 

Bohus M, Schmahl C, Lieb K. New developments in the neurobiology of borderline personality disorder. Curr Psychiatry Rep 2004 6(1) 43-50. 

There is some debate about whether DST hypersuppression reflects trauma exposure in psychiatric patients or PTSD per se. Using the combined DEX/CRF challenge in women with borderline personality disorder with and without PTSD relating to sustained childhood abuse, Rinne et al. (2002) demonstrated that chronically abused patients with borderline personality disorder had a sig-niflcantly enhanced ACTH and cortisol response to the DEX/CRF challenge... 

I Unlabeled Uses Treatment of anorexia, apathy borderline personality disorder, Huntington s disease maintenanceof long-term treatment response in schizophrenic patients nausea vomiting... 

Most of such studies have excluded women. In one study of 1272 female pretrial detainees, over 80% met criteria for at least one psychiatric disorder, with substance abuse and post-traumatic stress disorder (PTSD) being the most common (Teplin et al., 1996). Similar results were found in 805 women felons, with high rates of substance abuse, borderline personality disorders, and ASP, compared to respective rates in the community (Jordan et al., 1996). 

Borderline personality disorder Bipolat affective disotdet... 

Soloff, P.H., Meltzer, C.C., Greer, P.J., Constantine, D., and Kelly, T.M. (2000) A fenfluramine-activated FDG-PET study of borderline personality disorder. Biol Psychiatry 47 540-547. 

Herman, J.L., and van der Kolk, B.A. (1987) Traumatic antecedents of borderline personality disorder. In van der Kolk, B.A., ed. Psychological Trauma. Washington, DC American Psychiatric Press, pp. 303-327. 

American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder. Washington, DC, American Psychiatric Association, 2001... 

Salzman C, Wolfson AN, Schatzberg A, et al Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. J Clin Psychopharmacol 15 23-29, 1995... 

Soloff PH Psychopharmacology of borderline personality disorder. Psychi-atr Clin North Am 23 169-192, 2000... 

Zanarini MC, Frankenburg FR, Parachini EA A preliminary, randomized trial of fluoxetine, olanzapine, and the olanzapine-fluoxetine combination in women with borderline personality disorder. J Clin Psychiatry 65 903-907, 2004... 

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