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Alprazolam
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Amitryptiline
Dialectical behavior therapy
Fluvoxamine
Classical conditioning
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This patient likely has borderline personality disorder and would benefit from dialectical behavioral therapy (DBT), a form of cognitive behavioral therapy (CBT) that focuses on behavior modification in patients with borderline personality disorder. The patient is displaying many features common to borderline personality disorder: splitting, desperate efforts to avoid abandonment, unstable and intense interpersonal relationship, impulsivity, suicidal threats/mutilation, mood instability, transient and stress-related paranoid ideation, and difficult-to-control anger. DBT strives to validate a patient's feelings while informing the patient that some feelings and behaviors are maladaptive. Likewise, DBT seeks to make the patient aware of the consequences of his/her actions while reducing splitting and impulsiveness. Angstman et al. review various personality disorders and their clinical features. On borderline personality they note its prevalence of 1.6 percent of the general population and the importance of appropriate physician boundaries with the patient. Physicians should strive to avoid excessive familiarity because transference and counter-transference can result in the breakdown of the therapeutic relationship. Stoffers et al., in a recent Cochrane review, found that second-generation antipsychotics, mood stabilizers, and dietary supplementation with omega-3 fatty acids have some beneficial effects in patients with borderline personality disorder. Incorrect Answers: 1. Benzodiazepines alone have not been shown to improve the course of borderline personality disorder. 2. Tricyclic antidepressants (TCAs) are contraindicated in patients who are suicidal, such as those with borderline personality disorder because of their significant toxicity in an overdose. 4. Fluvoxamine has been shown to significantly improve rapid mood shifts in female borderline patients but not impulsivity or aggression, and so it is less effective than DBT. 5. Classical conditioning has been used in systematic desensitization to treat common phobias but not borderline personality disorder.
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