A 26-year-old man is brought to the physician by his former girlfriend, who became alarmed after receiving an email message in which he threatened suicide. The patient says he went into an overwhelming state of panic and depression when he heard that his former girlfriend was dating a new man and "wanted to get back at her." The patient has a history of "mood swings" since his teens and rage attacks when he feels that people are unsupportive. He has no delusions or hallucinations and no suicidal intent or plan. He describes his mood as "a deep pit of emptiness." Physical examination is normal except for cigarette burns on his thighs that he explains as self-harming behavior performed to relieve tension.
Which of the following is the best treatment for this patient?

Question

A 26-year-old man is brought to the physician by his former girlfriend, who became alarmed after receiving an email message in which he threatened suicide.  The patient says he went into an overwhelming state of panic and depression when he heard that his former girlfriend was dating a new man and "wanted to get back at her."  The patient has a history of "mood swings" since his teens and rage attacks when he feels that people are unsupportive.  He has no delusions or hallucinations and no suicidal intent or plan.  He describes his mood as "a deep pit of emptiness."  Physical examination is normal except for cigarette burns on his thighs that he explains as self-harming behavior performed to relieve tension.
Which of the following is the best treatment for this patient?

Quizplus · Accepted Answer

11ec193a_98b2_4462_853d_338f86f8e79f_MD0002_00 This patient's suicidal threat in the setting of feeling abandoned is characteristic of borderline personality disorder. Patients with this condition frequently come to health care settings during interpersonal crises and exhibit a persistent pattern of unstable relationships, mood lability, and impulsivity. They may engage in non-suicidal self-injury (eg, cutting, burning) to alleviate tension or feelings of numbness. The primary treatment for borderline personality disorder is psychotherapy. Dialectical behavioral therapy is a form of cognitive behavioral therapy developed specifically for borderline personality disorder. This treatment integrates techniques of emotion regulation, principles of mindfulness, and distress tolerance to target the affective instability, impulsivity, unstable relationships, and poor self-image that characterize borderline personality disorder. There is no medication approved by the US Food and Drug Administration for the treatment of borderline personality disorder. Pharmacological treatments may be used adjunctively, but they do not treat the core pathology. (Choices A and E) Antidepressants have been shown to be of minimal benefit in borderline personality disorder and are generally used to treat comorbid depressive or anxiety disorders. (Choice B) Lithium is a mood stabilizer used primarily in the treatment of bipolar disorder; it has not shown efficacy in borderline personality disorder. However, anticonvulsant mood stabilizers have been used as adjuncts in borderline personality disorder to target aggression and impulsivity. (Choice C) Olanzapine is a second-generation antipsychotic. This class of medications may be used as an adjunct to psychotherapy to better target impulsivity, aggression, and cognitive distortions. Educational objective: Psychotherapy, particularly dialectical behavioral therapy, is the first-line treatment for borderline personality disorder. __________ References: Borderline personality disorder in the primary care setting. (http://www.ncbi.nlm.nih.gov/pubmed/25134872) State of the art in the pharmacologic treatment of borderline personality disorder. (http://www.ncbi.nlm.nih.gov/pubmed/21140245)

A 26-Year-Old Man Is Brought to the Physician by His