Depression borderline personality disorder

Dr. P decides to first address the alcohol abuse of Mr. B by asking him to stop drinking completely, which he agrees to do. But Dr. P is less sure about the dramatic presentation of Mrs. B s life story and the intensity of her affect. Although she says she is not suicidal, she does indicate deep despair. Dr. P internally considers possible diagnoses like depression, borderline personality disorder, or histrionic personality disorder. In addition. Dr. P attempts to clarify the terms for therapy Are they looking for individual or marital therapy Dr. P decides to address these questions directly with Mr. and Mrs. B. They both say that they want marital therapy but feel that Mrs. B s pain needs prompt attention also. She s looking for some relief. 

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. 

Soloff PH, Lynch KG, Kelly TM, et al. Characteristics of suicide attempts of patients with major depressive episode and borderline personality disorder a comparative study. Am J Psychiatry 2000 157 601-608. 

A 27-year-old married woman with a borderline personality disorder was admitted to hospital with depression and suicidal ideation (65). Over 3 weeks she was given fluvoxamine in doses up to 150 mg/day, but because of lack of response the dosage was increased to 200 mg/day 3 days later she reported that her sex drive was greater than it had ever been before and that she felt she could not control it. There was no evidence of mania. Within a week of withdrawal of fluvoxamine her sexual desire had returned to its previous level. 

A 34-year-old woman with a history of polysubstance dependence (alcohol, cannabis, and cocaine), depressive episodes associated with multiple suicide attempts, and borderline personality disorder, who had been incarcerated after conviction on charges of physical assault and possession of controlled substances, complained of difficulty in sleeping, poor impulse control, irritability, and depressed mood. She was given oral quetiapine 600 mg/day. On one occasion, she crushed two 300-mg tablets, dissolved them in water, boiled them, drew the solution through a cotton swab, and injected the solution intravenously. Apart from having the best sleep I ever had she described no dysphoric, euphoric, or other effects. She admitted to previous intranasal abuse of crushed quetiapine tablets. 

Barbara M., 35, was admitted to an inpatient psychiatric unit after she developed suicidal ideas and incidents in which she repeatedly sliced the inside of her calf. Her admitting diagnosis was major depression and borderline personality disorder. The borderline diagnosis was based on the rather bizarre self-mutilation. The treating psychiatrist informed the patient s family that her acute depression could indeed be treated, but that the apparent personality disorder would likely be a serious, ongoing problem and the prognosis was more guarded. 

In addition to these subtypes, it is important to keep in mind that many, if not most, borderline personalities have comorbid Axis I disorders—especially common are major depression and substance abuse. These coexisting disorders always complicate the picture and must be dealt with in any approach to treatment. In particular, longitudinal studies following the course and outcome of borderline personality disorders over the life span suggest very clearly that those patients who continue to do poorly are those who continue to abuse alcohol and other substances. Thus treatment of chemical dependency problems must be addressed. 

Antisocial Personality Disorder Borderline Personality Disorder Conduct Disorder Delirium Dementias Depression Explosive Disorder Medication-induced aggression Mania... 

Thioxanthenes are used in the treatment of psychosis, including schizophrenia, senile psychosis, pathological jealousy, and borderline personality disorder. Other uses include the treatment of pain, postoperative neuralgia, sedation, anxiety neurosis, childhood behavior problems, and depression. The maximum therapeutic daily oral dose for chlorprothixene, flupenthixol, and thiothixene is 600, 224, and 60 mg respectively the maximum intramuscular dose of each is 200 mg day 100 mg weekly, and 30 mg dayrespectively. Some thioxanthenes and thioxanthenones have shown signs in mice and in vitro assays of possible human therapeutic potential against tumors, and some thioxanthenes have been shown to have cytotoxic and antimicrobial activities. 

SSRIs in particular have come to be used increasingly in a variety of conditions other than major depression. Table 8.4 summarizes the uses for which SSRIs have been approved, based on the finding of significant beneficial effects in controlled clinical trials. In addition, agents in this class in controlled trials have shown usefulness in premenstrual dysphoria, borderline personality disorder, obesity, smoking cessation, and alcoholism (17). 

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. 

Borderline personality disorder (BPD) and major depressive disorder (MOD) are associated with low serotonergic activity (Coccaro et al, 1989 Oxenkrug, 1979 Siever et al, 1984). Serotonin abnormalities are also found in persons attempting suicide (Asberg,... 

Personality disorders can complicate management (e.g., borderline disorder with a superimposed MDD). Dual depression occurs in patients who have chronic dysthymic disorder and then experience a superimposed MDD. Substance abuse and dependence are frequently co-morbid with mood disorders and substantially increase depression-related morbidity and mortality rates (see Drug-Induced Syndromes ). 

Some data indicate that those who make multiple attempts (i.e., greater than five) are different from those who will die from suicide. Multiple suicide attempters tend to be younger and to have a diagnosis other than a depressive disorder (e.g., antisocial, histrionic, or borderline personality). Although they are likely to make future attempts, they do not constitute a substantial proportion of those who die of suicide. 

Developmental disabilities, which again through continued research are often referred to currently as cognitive disabilities, include Tourette s syndrome, dyslexia, and attention deficit hyperactivity disorder. Mental illness includes depression, schizophrenia, bipolar disorder, and borderline personality, to name only a few of the conditions that can destroy the lives of individuals and wreak havoc on family and friends. 

Psychiatric comorbidity includes depression (np to 80%), impulse-control problems, and substance abnse. Approximately 30% to 37% of bulimic patients have a personal history of snbstance abuse. Kleptomania is reported more commonly in patients with BN than in the general pnbhc. Patients commonly steal comfort items snch as laxatives, candies, and clothes. Personality disorders, especially borderline and avoidant types, are more common in these patients than in the general population. ... 

James, 48, has had intermittent contact with psychiatric services and numerous diagnoses over the years, including schizophrenia, borderline LD, and dependent personality disorder. He s presented to ED for the third time this week, seeking help - but is vague about his needs and doesn t appear suicidal, depressed or psychotic. 

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