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   therapeutic  modalities  is  made  based  on  an  overall  assessment  which  takes   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   euphoric  mood.  They  constitute  the  first-line  treatment  of  depressive  states  whatever  their   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   constitutes  a  beneficial  effect   during the first week of treatment (Clomipramine, Amitryptiline).   The  co-prescription  of  two  or  more  antidepressants  is  exceptional  because  of  little  proven  benefit  and,   above all, risk of additional side effects.   Different types   Tricyclics  remain  the  benchmark  in  terms  of  efficiency.  SSRIs  and  SNRIs  are  more  tolerated  and  have   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 either  as 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