Borderline Personality Disorder

‭Borderline Personality Disorder‬ ‭It is a general and persistent pattern of instability in relationships, in affects and in self-image.‬ ‭In this case :‬ ‭-There is no break with the previous state‬ ‭-The mood is labile, unstable, with marked reactivity during a stressor or an abandonment situation‬ ‭The differential diagnosis arises mainly with TB II.‬ ‭TREATMENT OF DEPRESSIVE DISORDERS‬ ‭The‬ ‭choice‬ ‭of‬ ‭means‬ ‭and‬ ‭therapeutic‬‭modalities‬‭is‬‭made‬‭based‬‭on‬‭an‬‭overall‬‭assessment‬‭which‬‭takes‬ ‭into‬ ‭account‬ ‭the‬ ‭patient's‬ ‭age,‬ ‭his‬ ‭or‬ ‭her‬ ‭history,‬ ‭the‬ ‭nature‬ ‭and‬ ‭intensity‬ ‭of‬ ‭the‬ ‭clinical‬ ‭picture and the degree of the emergency.‬ ‭Therapeutic means a-Hospitalization‬ ‭Different modalities are possible: free, at the request of a third party or automatically‬ ‭Hospitalization is indicated:‬ ‭ ‬ ‭As a first intention:‬ ➢ ‭➢‬ ‭Melancholy, delusional form‬ ‭➢‬ ‭Suicidal risk‬ ‭➢‬ ‭Comorbid form (alcohol, drug addiction)‬ ‭➢‬ ‭Necessary somatic care‬ ‭➢‬ ‭No strong, permanent support‬ ‭➢‬ ‭In 2nd intension: in case of resistance‬ ‭b-Therapeutic‬ ‭means‬ ‭Antidepressants‬ ‭These‬ ‭are‬ ‭psychotropic‬ ‭drugs‬ ‭capable‬ ‭of‬ ‭uplifting‬ ‭depressed‬ ‭mood‬ ‭and‬ ‭sometimes‬ ‭reversing‬ ‭it‬ ‭into‬ ‭euphoric‬‭mood.‬‭They‬‭constitute‬‭the‬‭first-line‬‭treatment‬‭of‬‭depressive‬‭states‬‭whatever‬‭their‬ ‭etiological form.‬ ‭Prescription rules‬ ‭The‬ ‭majority‬ ‭of‬ ‭antidepressants‬ ‭are‬ ‭administered‬ ‭orally‬ ‭and‬ ‭in‬ ‭progressive‬ ‭doses.‬ ‭Some‬ ‭exist‬ ‭in‬ ‭injectable‬ ‭form‬ ‭and‬ ‭are‬ ‭administered‬ ‭as‬ ‭an‬ ‭infusion,‬ ‭which‬ ‭constitutes‬‭a‬‭beneficial‬‭effect‬ ‭during the first week of treatment (Clomipramine, Amitryptiline).‬ ‭The‬‭co-prescription‬‭of‬‭two‬‭or‬‭more‬‭antidepressants‬‭is‬‭exceptional‬‭because‬‭of‬‭little‬‭proven‬‭benefit‬‭and,‬ ‭above all, risk of additional side effects.‬ ‭Different types‬ ‭Tricyclics‬‭remain‬‭the‬‭benchmark‬‭in‬‭terms‬‭of‬‭efficiency.‬‭SSRIs‬‭and‬‭SNRIs‬‭are‬‭more‬‭tolerated‬‭and‬‭have‬ ‭increasingly‬ ‭comparable‬ ‭effectiveness.‬ ‭MAOIs‬ ‭are‬ ‭rarely‬ ‭used‬ ‭because‬ ‭of‬ ‭their‬ ‭adverse‬ ‭effects and their interactions with several medications.‬ ‭Tricyclic antidepressants: Clomipramine (Anafranil*); Amitriptyline (Elavil* and Laroxyl*);‬ ‭Imipramine (Tofranil*)‬ ‭Selective serotonin reuptake inhibitors (SSRIs): Fluoxetine; Paroxetine; Sertraline; Fluvoxamine;‬ ‭Citalopram and Escitalopram‬ ‭Serotonin and norepinephrine reuptake inhibitor (SNRI): Venlafaxine (Effexor*) and Milnacipran‬ ‭(Ixel*).‬ ‭Monoamine oxidase inhibitors (MAOIs): Toloxatone (Humoryl*)‬ ‭Other antidepressants: Maprotiline (Ludiomil*); Tianeptine (Stablon*)‬ ‭Other medications‬ ‭Depending on the clinical picture, antidepressants can be combined with: Anxiolytics: at the start of‬ ‭treatment (anxiety, insomnia, lifting of inhibition) Sedative neuroleptics: Chlorpromazine‬ ‭(Largactil*), Levomepromazine (Nozinan*), in certain forms of melancholy (anxious and‬ ‭delusional).‬ ‭Thymoregulators‬‭: bipolar depressions and resistant depressions‬ ‭Other therapeutic means‬ ‭Electroconvulsive therapy‬‭(ECT)‬‭: Prescribed either‬‭as second-line treatment, after failure of‬ ‭antidepressant treatment, or as first-line treatment in the event of:‬ ‭●‬ ‭Delusional melancholy or with a marked motor component: significant slowing down or‬ ‭agitation (high suicidal risk).‬ ‭●‬ ‭Depression in the elderly (resistance to antidepressants)‬ ‭●‬ ‭Depression in pregnant women faced with the teratogenic risk of medications‬