Symptoms borderline personality disorders

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. 

Beck et al. (38) reported that hopelessness in the context of major depression was the MDD symptom most often associated with suicide. This finding was replicated by Fawcett et al. (39), who found that hopelessness with anhedonia, mood cycling within an episode, loss of mood reactivity, and psychotic delusions were high-risk factors for a subsequent suicide. Soloff and associates ( 40) also found that hopelessness and impulse aggression independently increased the risk of suicidal behavior in patients with borderline personality disorder and in patients with major depression. Negative life events (e.g., the death of a loved one or humiliating events such as financial ruin) often precede suicide. 

Other differential considerations include attention-deficit-hyperactivity disorder or more severe characterological (or Axis II) disturbances. For example, several of the criteria for borderline personality disorder in the DSM-IV overlap with symptoms for hypomania, including the following ... 

FIGURE 10-5. Aggressive symptoms and hostility are associated with several conditions in addition to schizophrenia, including bipolar disorder, attention deficit hyperactivity disorder (ADHD) and conduct disorder (conduct dis.), childhood psychosis, Alzheimer s and other dementias, and borderline personality disorder, among others. 

Although aggressive symptoms are common in schizophrenia, they are far from unique to this condition. Thus, these same symptoms are frequently associated with bipolar disorder, childhood psychosis, borderline personality disorder, drug abuse, Alzheimer and other dementias, attention deficit hyperactivity disorder, conduct disorders in children, and many others (Fig. 10—5). 

In an 8-week, double-blind, placebo-controlled study of topiramate 250 mg/day in the treatment of aggression in 42 men with borderline personality disorder there was significant weight loss of 5.0 kg (95% Cl = 3.4, 6.5) (1129). There were no psychotic symptoms or other... 

The Cluster B patients typically engender the desire for effective medical management of personality disorders however, there is no medication known to manage, much less cure, these personality disorders. However, the patient with borderline personality disorder in particular may develop specific target symptoms that require medication, sometimes emergently (this is discussed below). 

George, A., and P. H. Soloff. 1986. Schizotypal symptoms in patients with borderline personality disorder. American Journal of Psychiatry 143 212-15. 

The primary uses for the SSRIs include MMD and bipolar depression (fluoxetine, paroxetine, sertraline, and citalopram), atypical depression (i.e., depressed patients with unusual symptoms, e.g., hypersomnia, weight gain, and interpersonal rejection sensitivity fluoxetine, paroxetine, sertraline, and citalopram), anxiety disorders, panic disorder (sertraline and paroxetine), dysthymia, premenstrual syndrome, postpartum depression, dysphoria, bulimia nervosa (fluoxetine), obesity, borderline personality disorder, obsessive-compulsive disorder (fluvoxamine, fluoxetine, paroxetine, and sertraline), alcoholism, rheumatic pain, and migraine headache. Among the SSRIs, there are more similarities than differences however, the differences between the SSRIs could be clinically significant. 

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