Mie Sedoc Jørgensen, Stephen Fitzgerald Austin, Ole Jakob Storebø, Stig Poulsen, Sune Bo, Emma Beck, Erik Simonsen
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引用次数: 0
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.
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.