Borderline Personality Disorder or First-Episode Psychosis? Challenges in Assessing Psychotic Features in Early Intervention: A Case Report

IF 2.2 4区 医学 Q3 PSYCHIATRY
Mie Sedoc Jørgensen, Stephen Fitzgerald Austin, Ole Jakob Storebø, Stig Poulsen, Sune Bo, Emma Beck, Erik Simonsen
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Abstract

Introduction

Adolescence is a crucial period for the onset of both borderline personality disorder (BPD) and first-episode psychosis. Although transient stress-related paranoid ideation and dissociative symptoms are one of the diagnostic criteria for BPD, determining when these psychotic features progress to early-stage schizophrenia remains unclear.

Methods

Two case studies aimed to explore the challenges in assessing and following up on psychotic features in BPD over time. Two adolescent girls aged 14 and 15 were initially diagnosed with BPD using semi-structured clinical interviews for DSM-IV personality disorder. Five years later, symptom development was explored using comprehensive diagnostic interviews.

Results

Both cases exhibited lapses in reality testing at baseline, interpreted as transient and stress-related symptoms. The first case illustrated the difficulties in distinguishing normative magical and imaginative thinking in youth from odd beliefs or bizarre fantasies and preoccupations, emphasizing the need for age-adapted and elaborate, detailed phenomenological assessment of the content, duration and frequency of these experiences and their impact on functioning. The second case demonstrated the progression of psychotic features from adolescence into early adulthood and the challenge of judging whether these features crossed the threshold to psychosis.

Conclusion

Both cases underscore the need for clinical training regarding differential diagnostics and management of psychotic features when present in early manifestations of BPD. This gap in care presents a missed opportunity for inclusion of patients in targeted early intervention programs for first-episode psychosis. We propose the implementation of a continuous monitoring strategy in BPD with psychotic features.

Abstract Image

边缘型人格障碍还是首发精神病?早期干预评估精神病特征的挑战:一个病例报告
青春期是边缘型人格障碍(BPD)和首发精神病发病的关键时期。虽然短暂的与压力相关的偏执观念和分离症状是BPD的诊断标准之一,但确定这些精神病性特征何时进展为早期精神分裂症尚不清楚。方法通过两例病例研究,探讨BPD患者精神病性特征的长期评估和随访所面临的挑战。两名年龄分别为14岁和15岁的青春期女孩最初通过DSM-IV人格障碍的半结构化临床访谈被诊断为BPD。五年后,使用综合诊断访谈探讨症状发展。结果两例患者在基线时均表现出现实测试失误,可解释为短暂的应激相关症状。第一个案例说明了在区分青少年规范的魔法和想象思维与奇怪的信仰或奇异的幻想和关注方面的困难,强调了对这些经历的内容、持续时间和频率及其对功能的影响进行年龄适应和详细的现象学评估的必要性。第二个病例显示了从青春期到成年早期精神病特征的发展,以及判断这些特征是否越过精神病的门槛的挑战。结论这两个病例都强调了在BPD早期表现时需要进行临床培训,以鉴别诊断和处理精神病性特征。这种护理上的差距错失了将患者纳入首发精神病有针对性的早期干预计划的机会。我们建议对具有精神病性特征的BPD实施连续监测策略。
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来源期刊
Early Intervention in Psychiatry
Early Intervention in Psychiatry 医学-精神病学
CiteScore
4.80
自引率
5.00%
发文量
112
审稿时长
6-12 weeks
期刊介绍: Early Intervention in Psychiatry publishes original research articles and reviews dealing with the early recognition, diagnosis and treatment across the full range of mental and substance use disorders, as well as the underlying epidemiological, biological, psychological and social mechanisms that influence the onset and early course of these disorders. The journal provides comprehensive coverage of early intervention for the full range of psychiatric disorders and mental health problems, including schizophrenia and other psychoses, mood and anxiety disorders, substance use disorders, eating disorders and personality disorders. Papers in any of the following fields are considered: diagnostic issues, psychopathology, clinical epidemiology, biological mechanisms, treatments and other forms of intervention, clinical trials, health services and economic research and mental health policy. Special features are also published, including hypotheses, controversies and snapshots of innovative service models.
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