Personality Changes Later in Life: Diagnostic and Treatment Considerations

Topics: Bipolar Disorder | Borderline Personality Disorder | Disinhibition | Frontotemporal dementia | Hypomania | Mania | MOCA | Neuropsychological testing | Personality Disorders | Self-injury | Stimulants | Suicide

CGPR: What is the course of personality disorders as people age? Dr. Tampi: Personality usually doesn’t change much. People with borderline personality disorder (BPD), for example, don’t usually experience significant changes once they reach middle age. Experiences over a person’s lifespan may teach them skills that blunt their sharp edges, but

Addiction and Borderline Personality Disorder

Topics: Borderline Personality Disorder | Comorbidity | Dialectical Behavioral Therapy | Psychotherapy

CATR: Please introduce yourself. Dr. Pierson: I am a clinical psychologist and an assistant professor at Yale University School of Medicine. I serve as the director of dialectical behavior therapy (DBT) services at Yale New Haven Psychiatric Hospital. CATR: What is a useful way for addiction treatment providers to conceptualize borderline personal

Borderline Personality Disorder in the ED

Topics: Borderline Personality Disorder | Countertransference | Emergency Department | emotion dysregulation | Good Psychiatric Management | interpersonal stressors | Personality Disorders | Suicidality | Working With Families

CHPR: What are some common issues that you encounter with patients with borderline personality disorder (BPD) in the psychiatric emergency department (ED)? Dr. Hong: First, we should remember that individuals with BPD are prevalent in every psychiatric setting, but especially the ED. About 10%–15% of all psychiatric ED patients have BPD, and these pa

Deliberate Foreign Body Ingestion

Topics: Borderline Personality Disorder | Deliberate foreign body ingestion | DFBI | Free Articles | Gastroenterology | Malingering | Management | Obsessive compulsive disorder/OCD | Personality Disorders | Pica | Psychosis | Self-injury | Swallowing

During morning rounds at your inpatient unit, you are informed by staff that your patient M, a 32-year-old woman with bipolar disorder and borderline personality disorder, has swallowed a small pencil. This is her fourth swallowing episode since her admission to the unit 2 weeks ago. Even though you had restricted her access to sharp objects, she has ma

Working With Severe Personality Disorders

Topics: Borderline Personality Disorder | BPD | Patient relationship | Personality Disorders | Psychoanalysis | Psychodynamic therapy | Psychotherapy

TCPR: People with severe personality disorders are notoriously difficult to treat. Can they benefit from psychotherapy? Dr. Buie: Nearly all seriously ill patients can benefit from some form of psychotherapy. Supportive psychotherapy, group skills training, and behavioral treatments can be helpful in almost any illness, including psychotic disorders. P

Overdiagnosis in Psychiatry

Topics: Adult ADHD | Bipolar II | Borderline Personality Disorder | BPD | Diagnosis | DSM | PTSD | Stigma

TCPR: Which disorders are the most overdiagnosed in psychiatry? Dr. Paris: At the top of the list are major depression, PTSD, bipolar II, adult ADHD, and—this one is a recent addition because it used to be underdiagnosed—borderline personality disorder. Each of these conditions may be underdiagnosed in some settings as well, but they have also been

How to Use Lamotrigine

Topics: Bipolar Depression | Bipolar Disorder | Bipolar II | Borderline Personality Disorder | BPD | Hypomania | Lamictal | Lamotrigine | Medication | Mood Stabilizers | OCD | Pharmacology | Psychopharmacology

Lamotrigine is FDA approved as maintenance treatment for bipolar disorder—that is, for delaying episodes of depression, hypomania, or mania. However, it is not approved for active depression or mania—which has given it a reputation as a “light” mood stabilizer. For patients who appreciate tolerability, that’s a good thing, but it isn’t the f

Take a Breather: A Mindful Tactic for Borderline Dysphoria

Topics: Agitation | Behavior therapy | Borderline Personality Disorder | BPD | Crisis intervention | Mindfulness | Psychotherapy | Self-injury | Therapy during medication appointment | Therapy with Med Management

Managing the intense, explosive dysphoria experienced by patients with borderline personality disorder (BPD) is one of the tougher challenges we face. These complex states, with elements of anxiety, rage, depression, and shame, are hard for patients to tolerate, let alone examine. Worse, they can generate dangerous solutions: suicide, self-harm, and o

A Pragmatic Approach to Borderline Personality Disorder

Topics: Borderline Personality Disorder | BPD | Brief psychotherapy | Psychotherapy | Therapy during medication appointment | Therapy with Med Management

TCPR: Tell us about this new approach to borderline personality disorder (BPD): good psychiatric management. Dr. Choi-Kain: We have many effective therapies for BPD. There’s dialectical behavior therapy (DBT), transference-focused therapy, and mentalization-based therapy. Good psychiatric management borrows from the other approaches, but differs in t

The Modafinils in Bipolar Depression

Topics: ArModafinil | Bipolar Disorder | Borderline Personality Disorder | BPD | Modafinil | Novel Medications | Nuvigil | Personality Disorders | Provigil | Psychopharmacology

Your patient has recovered enough from bipolar depression to leave the hospital, but not enough to return to work. He is inactive, he can’t concentrate, and it takes him 4 hours to wake up in the morning. What can you add to his regimen of lithium, lamotrigine, and lurasidone? Modafinil (Provigil) and armodafinil (Nuvigil) are wakefulness-promoting