Clinical Psychopharmacology Notes

Borderline Organization Personality Disorders

General Overview

• Personality disorders involve significant impairments in interpersonal functioning and self-identity.
• Each type can be classified by its severity, ranging from mild to extremely severe.

Key Concepts

• Borderline Organization
  • Characterized by a missing internal sense of continuity (integration vs. identity diffusion).
  • Employs primitive defenses such as:
  • Splitting
  • Projective identification
  • Omnipotence
  • Features variable reality testing.

Severity Ranges (Kernberg & Caligor, 2005)

• The figure illustrates the relationship between familiar personality types and their structural diagnosis with severity presented from mildest (top) to most severe (bottom).

Secondary Features of Borderline Organization

• Common secondary features include:
  • Aggression
  • Anxiety
  • Avoidance
  • Dissociation
  • Paranoia and Psychosis
  • Impulsivity

Treatment Options

• Medications:
  • Atypical Antipsychotics: Examples include Risperidone, Zyprexa, Seroquel.
  • SSRIs: Effective for mood stabilization.
  • Benzodiazepines: Useful for anxiety management.
  • Buspirone: An alternative for anxiety treatment.
  • Gabapentin: Utilized for neuropathic pain and mood stabilization.
  • Beta-blockers: Help with physical symptoms of anxiety.

Comorbidity with Medical Disorders

• Psychological disorders have physiological effects:
  • Depression: Can lead to physical decline.
  • Anxiety: Associated with immune suppression.
  • Chronic Pain: Often leads to fatigue and cognitive impairments.
  • Lifestyle Factors: Diet, smoking habits can impact immunological responses.

Geriatric Patients

• Risk Factors:
  • 30% of all prescriptions are taken by patients over 65 years.
  • 70% self-medicate with OTC medications.
  • 50% of accidental drug-related deaths occur in the elderly.
  • Drug reaction rates are twice that of other groups due to impaired organ function.
• Common drug effects include:
  • Hip fractures
  • Cognitive impairment
  • Neuroleptic-induced parkinsonism

Differentiating Side Effects from Psychiatric Symptoms

• It's critical to distinguish between side effects of medications and underlying psychiatric symptoms:
  • Akathisia vs. Agitation:
  • Akathisia: Compulsion to be in motion.
  • Agitation: Restlessness linked to anxiety.
  • Parkinsonian Symptoms vs. Depression:
  • Parkinsonianism: Tremors, stiffness, slowness.
  • Depression can lead to a similar appearance.
  • Acute Dystonia vs. Tardive Dyskinesia:
  • Dystonia involves sustained muscle contractions.
  • Tardive Dyskinesia involves abnormal rhythmic movements due to prolonged neuroleptic use.

Toxicity vs. Worsening Depression

• Antidepressant toxicity can mimic depression.
  • Symptoms include emotional blunting and apathy, but upon review may not reflect worsening depression.
  • Discontinuation of certain meds can alleviate toxicity symptoms, often by introducing dopamine agonists like bupropion.

Data sourced from Kernberg & Caligor (2005) and transcription of clinical psychopharmacology material.