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      Role of Electroconvulsive Therapy in Major Depressive Disorder with Borderline Personality Disorder: Case Report and Literature Review

      , 1 , 2 , 3 , 4 , 2

      ,

      Cureus

      Cureus

      major depressive disorder, bpd, ect, electroconvulsive therapy

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          Abstract

          Major depressive disorder (MDD) becomes difficult to treat when the patient has a comorbid personality disorder. For such patients, even a combination of psychotherapy and pharmacotherapy has been ineffective. Electroconvulsive therapy (ECT) has been the first line of therapy for the treatment-resistant depression. We used this mode of therapy for a patient who had MDD along with borderline personality disorder and had failed trials of multiple medications and psychotherapy. ECT was very successful in our patient.

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          Most cited references 18

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          The Collaborative Longitudinal Personality Disorders Study: baseline Axis I/II and II/II diagnostic co-occurrence.

          To describe baseline diagnostic co-occurrence in the Collaborative Longitudinal Personality Disorders Study. Six hundred and sixty-eight patients were reliably assessed with diagnostic interviews for DSM-IV Axis I and II disorders to create five groups: Schizotypal (STPD), Borderline (BPD), Avoidant (AVPD), Obsessive-Compulsive (OCPD) and Major Depressive Disorder (MDD) without personality disorder (PD). Mean number of Axis I lifetime diagnoses was 3.4; STPD and BPD groups had more diagnoses than AVPD, OCPD, and MDD groups. Significant Axis I co-occurrences emerged for Social Phobia/ AVPD, PTSD/BPD and Substance Use/BPD. Mean number of co-occurring PDs was 1.4; STPD had more than BPD group which had more than AVPD and OCPD groups. Significant PD co-occurrence emerged for: STPD/ Paranoid and Schizoid PDs, BPD with Antisocial and Dependent PDs, and lower frequency for OCPD/Antisocial PD. Diagnostic co-occurrences generally followed base rates, while significant departures resemble those of controlled literature.
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            Comorbidity of borderline personality disorder and posttraumatic stress disorder in the U.S. population.

            While placed on different axes of the DSM classification system, borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) have important relationships with trauma, and overlap between these disorders has long been recognized. The current study is the first to examine comorbidity of PTSD and BPD in a large nationally representative sample using a reliable and valid method of assessing Axis I and II mental disorders. Data came from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Wave II (N = 34,653; response rate 70.2%). Multiple regression models were used to examine differences in psychopathology, traumatic events and health-related quality of life across individuals with PTSD alone (n = 1820), BPD alone (n = 1290) and those with comorbid PTSD-BPD (n = 643). The lifetime prevalence of PTSD and BPD were 6.6% and 5.9%, respectively. Of individuals with BPD, 30.2% were also diagnosed with PTSD, whereas 24.2% of individuals with PTSD were also diagnosed with BPD. Individuals with comorbid PTSD-BPD had a poorer quality of life, more comorbidity with other Axis I conditions, increased odds of a lifetime suicide attempt, and a higher prevalence of repeated childhood traumatic events than individuals with either condition alone. These results show that PTSD and BPD have a high degree of lifetime co-occurrence but are not entirely overlapping. Their concurrence is associated with poorer functioning compared to either diagnosis alone, emphasizing the clinical utility of diagnosing both conditions. Future research should explore the determinants of having either or both diagnoses with an aim toward improved identification, prevention, and intervention. Copyright © 2010 Elsevier Ltd. All rights reserved.
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              Personality pathology in recurrent depression: nature, prevalence, and relationship to treatment response.

              Personality assessments of 119 treatment-responsive patients with recurrent unipolar depression revealed that nearly half of the patients (48%) showed some personality disturbance. The most common personality features were avoidant (30.4%), compulsive (18.6%), and dependent (15.7%). Factor analyses of personality data in this homogeneous population yielded results that were consistent with previous factor analytic studies of personality features and clinical descriptions of depressed patients. Most notably, a discriminant function analysis using personality variables alone was able to distinguish (with 65% accuracy) between patients who responded normally to treatment and those who responded more slowly.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                27 August 2018
                August 2018
                : 10
                : 8
                Affiliations
                [1 ] Psychiatry, University of Health Sciences, Islamabad, PAK
                [2 ] Psychiatry, University of North Dakota School of Medicine and Health Sciences, Fargo, USA
                [3 ] Graduate, Dow University of Health Sciences, Karachi, PAK
                [4 ] Psychiatry, Sindh Medical, Ontario, CAN
                Author notes
                10.7759/cureus.3211
                6205878
                Copyright © 2018, Wasiq et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Categories
                Psychiatry

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