Mismatch negativity in treatment-resistant depression and borderline personality disorder

Personality disorders are a divergent group of diagnoses which are pervasive in nature and, until recent years, were thought to be treatment-resistant. While the majority of current treatments have evolved on the basis of psychoanalytic and behavioural theories of personality development, there is an emerging understanding of the underlying neurobiology. Current neuroscientific evidence, supported by the theoretical underpinnings of successful psychotherapeutic interventions, converges on social functioning and mood regulation as key treatment targets in personality disorder, and specifically in borderline personality disorder.

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Clinical Cases

Clinical Psychopharmacology ◽

10.1093/med/9780199995486.003.0044 ◽

2018 ◽

pp. 447-469

Author(s):

S. Nassir Ghaemi

Keyword(s):

Young Adult ◽

Personality Disorder ◽

Adolescent Depression ◽

Case Reports ◽

Treatment Resistant Depression ◽

Treatment Resistant ◽

Bipolar Illness ◽

Affective Illness ◽

Narcissistic Personality ◽

Resistant Depression

Seventeen case reports are provided applying the principles described in this volume, including the following triad of principles: 1. Treat diseases, not symptoms. 2. Do not use DSM-based diagnoses. 3. Focus on the course of the illness, not just its symptoms, when you are making diagnoses. In addition, specific pharmacological aspects of medications as used in practice are explored in the context of specific cases—mood illnesses; PTSD; personality states; purported ADD; seasonality in affective illness; stopping antidepressants for “depression”; first depression in a young adult; pre-adolescent depression versus bipolar illness; when benzodiazepines are preferable to SRIs for anxiety; hyperthymia misdiagnosed as treatment-resistant depression; premenstrual mood dysphoric disorder; low-dose divalproex for misdiagnosed narcissistic personality disorder; suicidality and antidepressants in borderline personality—and more.

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Bridging the gap: the assessment and treatment of adolescent personality disorder in routine clinical care

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-310072 ◽

2016 ◽

Vol 102 (1) ◽

pp. 103-108 ◽

Cited By ~ 12

Author(s):

Carla Sharp

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Empirical Evidence ◽

Treatment Guidelines ◽

Clinical Care ◽

Borderline Personality ◽

Treatment Resistant ◽

Routine Clinical Care ◽

Assessment And Treatment ◽

Personality Disturbance

Despite a marked increase in research supporting the assessment, diagnosis and treatment of personality disorder (PD) in adolescence, clinicians continue to be reluctant to apply treatment guidelines and psychiatric nomenclature in routine clinical care. This gap arises from several beliefs: (1) psychiatric nomenclature does not allow the diagnosis of PD in adolescence; (2) certain features of PD are normative and not particularly symptomatic of personality disturbance; (3) the symptoms of PD are better explained by other psychiatric syndromes; (4) adolescents' personalities are still developing and therefore too unstable to warrant a PD diagnosis; and (5) because PD is long-lasting, treatment-resistant and unpopular to treat, it would be stigmatising to label an adolescent with borderline personality disorder (BPD). In this paper, the empirical evidence challenging each of these beliefs is evaluated in the hope of providing a balanced review of the validity of adolescent PD with a specific focus on BPD. The paper concludes with recommendations on how routine clinical care can integrate a PD focus.

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