Q. I am a student from the Philippines. I just would like to ask a very important favor from you. I am presently taking the course “Assessment and Intervention of Individual Mental Disorders,” which happens to discuss borderline personality disorder. We were asked by our professor, who is a psychiatrist, if we can present a profile of a borderline. With this regard, I would like to request from you an assessment of a patient you have treated (name withheld)and the intervention you did for his/her healing process.

Thank you very much in advance. Hoping for your favorable response.

borderline personality disorder, BPD, mental disorders, mental health, SSRI, prozac, zoloft, depakote(1811 bytes)

A. 9/10/98 John Doe

cc: fatigue

S. 34 year old white male C/O chronic fatigue. Angry. Hx of alcohol abuse. No medications. NKDA. PMHX with appendectomy 1994, two concussions at age 9 (horse related injuries). Broke right hand smashing it through a wall when first wife left (with the children), required surgical repair. Family Hx with early CAD, ETOH, “nervous breakdown.” Social Hx: smokes 2ppd, divorced twice. No longer drinking, but uses marijuana daily. Two DUI convictions. ROS: fatigue, memory loss, anger, sleep problems, heartburn, chest pain, joint pains, numbness and tingling, unsteadiness, muscle spasm – particularly in legs, chronic headaches, grinding teeth, constipation. Chronic psych Sx: moody, anger problems, empty/bored, paranoid under stress. Feels he was physically abused by alcoholic father – he used to hide when his father returned home drunk. Prozac 20mg daily didn’t help him a few years ago. Has tried Wellbutrin, Zoloft, Luvox, Tofranil, Paxil, Serzone – no positive effects, only side effects. A friend advised he come to see me.

O. Looks well. Overweight (245 lbs). HENT neg. Neck supple without adenopathy. Lungs clear. Cor without murmurs, gallops or rubs. Abd soft, non-tender, without masses or hepatosplenomegaly. Zung index very high at 84 (normal <50). Dysphoria (anxiety, rage, depression and despair) is chronic. Chronically experiencing deja vu, unreality. Seems to “check in and out a lot.” Feels like he’s “never there.” Fits 8/9 BPD criteria (anxiety, rage, depression and despair) and frequent dissociation and likely complex partial seizures
2) depression
3) fatigue
4) positive ROS
5) Hx alcohol problems

P. 1) Prozac 20mg daily x 4 days, then 40mg daily
2) on day 7 of Prozac take Tegretol 200mg x 1 dose
3) labs: CBC, chem, UA, T7, TSH, B12
4) rto 8 days

9/18/98 John Doe

cc: medication follow up

S. Dramatically better. Had no change at all from Prozac. Tegretol’s effect was dramatic. Dysphoria (anxiety, rage, depression and despair), deja vu, unreality and spaciness went away 3 hours later. Starting to recur. “I didn’t think I’d ever feel good again.” Moodiness, emptiness, boredom gone for a day as well.

O. Looks great. Smiling and happy. The change is dramatic. Haldol 1mg in office had no effect. Labs: CBC, chem, UA, T7, TSH normal. B12 very low normal at 210.

A. 1) BPD with chronic dysphoria (anxiety, rage, depression and despair) and dissociation dramatically better on Prozac/Tegretol combination
2) fatigue multifactorial – B12 deficiency a part
3) B12 deficiency
4) depression

P. 1) continue Prozac at 20mg daily
2) will Rx with Tegretol 200mg in early evening only for now to stop nighttime dysphoria (anxiety, rage, depression and despair) and hopefully avoid morning grogginess that could interfere with work
3) Haldol 1mg prn – given instruction sheet
4) referred for psychological counseling
5) personalized affirmations
6) read “Happiness is a Choice” by Barry Neil Kaufman, “Embraced By the Light” by Betty Eadie, “Your Erroneous Zones” by Wayne Dyer, “Looking Out for Number One” by Robert Ringer, and “How to Win Friends and Influence People” by Dale Carnegie
7) get Zig Ziglar’s tape series and listen daily
8) B12 1000ug Daily
9) RTO 1 wk, needs CBC due to Tegretol

Permission by Leland M. Heller, M.D.

 

4 Responses to Example of Assessment and Intervention of the Borderline Personality Disorder

  1. Selsa says:

    I suspect my husband is has borderline personality disorder. He is undiagnosed. My husband had become increasingly critical, paranoid, verbally abusive, unpredictable behavior with mood swings since he has been out of a job. He calls my daughter and I names and claims I am not supporting him and we are conspiring to get him out of the house, at times he is overly solicitious and would like to do everything for us. Right now he seeing a therapist but I believe this therapist’ specialty is a “life coach” who is helping him boost himself with the job search. How can I convince him to get treatment with the right therapist?

  2. phyllis says:

    excellent article. Do you ever comment on thoughts about children with extreme anger issues, aggression, poor comprehension, chaotic families, anger,aggression at school, but not at home and or teens hearing voices and poor sleep habits, seeing strange things awake or sleep, high achievers?

  3. Tyler says:

    Did the patient come back the next day and still describe his mood as elevated? When you say “Moodiness, emptiness, boredom gone for a day” do you mean that the patient felt those symptoms reduced only in the moment of contact with a positive perceptual change? Does the combination remain effective on a continual basis?

  4. Debra Berg says:

    I enjoyed your article about your history with BPD. I just wanted to mention that the link to you CV isn’t going to the right place … it’s someone else’s photo and there’s a 404 error.

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