The final assignment for this class will be a 10-page critical review of the drug treatment for a psychiatric disorder (broadly defined to include psychological and neurological disorders as well). Th
Running head: BORDERLINE PERSONALITY DISORDER 0
Borderline Personality Disorder
Heather Yant
PSY 630 Psychopharmacology
Instructor: Stefanie Gwaltney-Hausch
2/18/18
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Borderline Personality Disorder
Borderline personality disorders is a complex disorder which showcases persistence problem in regulating emotion, controlling impulses and instability in interpersonal relationship and self-image. The purpose of this research on borderline personality disorder is to examine the contribution of neurotransmitter and receptors and other anatomic features associated with disruption of a neurocognitive process and memory system (Rhoads, & Murphy, 2015). As well, the research will outline critical classes of drugs used in treating borderline personality disorder, examining the agonist-antagonist activity of the drug. Also, the study will explore receptors agonist-antagonist action and side effects of drugs and evaluation of risk benefits of drug use for this disorder.
Borderlines personality disorder is challenging to diagnose because some of the symptoms associated with the diseases are shared by other mental disorders. Therefore proper evaluation of client longitudinal history and interview is done to identify some of the client symptoms. These procedures help in reducing misdiagnosis. According to DSM-V, (2013), an individual with Borderline personality disorders has to experience the following symptoms. First, the client experiences impairments in self-function (a) and (b). According to APA,( 2013), Impairment (a) associated with unstable self-image, excessive self-criticism, a chronic feeling of emptiness and dissociative states of stress.
Impairment (b) associated with instability in goal, aspiration, and value or career plan. Besides, the client experience impairment in interpersonal functional (a) and (b) for example Empathy which is associated with ability interpersonal hypersensitivity. Intimacy which is associated with unstable and conflicted close relationship marked mistrust and others factors. Besides, an individual with borderline disorder experiences emotional liability, for example, frequent mood changes, anxiousness, separation insecurity because of fear of rejection depressive. Pathological personality traits according to DSM V, (2013) include Disinhibition and Antagonism.
Disinhibition is associated with impulsivity, for example, acting on the spur of the moment in response to immediate stimuli. Risk-taking includes engagements in dangerous and risky activities. Antagonism involves hostility, for example, persistent and angry feelings. In category C, according to DSM V, (2013), the impairment in personality functioning and individual personality traits is stable across time and consistency across situation. Category D according to DSM V, (2013), entails that, the personality functioning and personality traits expression are associated or understood as normative for individual developmental stages or social environment.
Category E according to DSM V, (2013) entails that an individual impairment should not be linked to direct physiological effects of substance abuse or severe brains injury. Therefore if an individual has two or more of the following impairments behaviors he or she qualifies diagnoses of borderline personality disorder. Qualified mental physicians recommend medications and drugs for the borderline personality disorder. Mesolimbic dopaminergic is a pathway in the human brain that carries dopamine from one area of the brain to the other. This pathway associated with the function of movement, preservation, and compulsion. If Mesolimbic dopaminergic is induced by physiological stimuli or psychotropic drugs, then the chemical messages from neurotransmitter are sent to initiate pleasures.
Therefore intakes of certain substances result in the intense and fast feeling of pleasure caused by an increase of dopamine in the mesolimbic systems. Some of the antidepressant drugs used to treat borderline disorders include Selective serotonin reuptakes inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors and melatonergic agents. The antidepressant medications for SSRIs can be administered when there is evidence of aminergic systems which is influencing inhibitory control or resisting urge and control of compulsive repetition. The aminergic system includes key biogenic amines responsible regulating emotion, controlling impulses and other variables.
Those biogenic amines include serotonin (5-HT), norepinephrine (NE), dopamine (DA), and acetylcholine (ACh). Serotonergic drug work efficiently in serotonergic dysregulation, impulse, and symptoms associated with the obsessive-compulsive spectrum (Kayser, Titulaer, Gresa-Arribas, & Dalmau, 2013). Oppositely, selective serotonin reuptakes inhibitor has insignificant effects on impulsive aggression in Borderline personality disorders, but it has a significant impact on decreasing anxiety and depression. Other researchers indicate that some drugs such as amitriptyline, tricyclic antidepressant have positive effects on borderline symptoms outside major depressive disorders.
Amitriptyline in BDP is recommended only to be used on limited occasion because it is highly toxic when an individual overdose. On the other side, monoamine oxidase inhibitor (MAOIs) approved for treating patients with atypical depression. These patients are characterized by rejection sensitivity and efficiently reactivity. MAOIs use improves aggression and anxiety that according to an earlier study on the effects of these drugs to patients. The drug still has side effects if used continuously because it leads to hypertensive crises during dietary indirection. Besides, the drug is limitedly used for patients with severe impulsivity or suicidality (Kayser, Titulaer, Gresa-Arribas, & Dalmau, 2013).
All these drugs in one way or the other effect how neurotransmitter communicates with each neuron. When an individual takes certain types drugs, the drugs interact with serotonin, dopamines and other neurotransmitters. As a result s sense of happiness and well-being may be affected in one way or the other because the drugs may interfere with normal secretion of serotonin possible for happiness. SSRIs drugs are said to have mild side effects when used to treat patients with severe symptoms of depression. The drug works by blocking the brain reabsorption of serotonin. It remains in the synaptic cleft where it continues to bind to receptors and activates them.
The reason behind keeping a high level of neurotransmitter between the nerve cells is to strengthen circuits in the brain which regulates moods. MAOIs drugs keep the serotonin from being metabolized and excreted from the neurons. The serotonin is converted into melatonin in the pineal glands in the hypothalamus hence helps in controlling sleep patterns and sexual urges. Psychedelic drugs raise serotonin level in the brain which is responsible for moods stabilization and happiness. The agonist is a chemical which initiates psychological response with a receptor while the antagonist is chemical or drugs that bind to receptors to block initiation of psychological response.
There are several drugs which help in psychological Responses or blocking initiation of psychological response. For example, opioid receptors antagonist, for example, naltrexone and nalmefene prevent the reinforcing effects of opioids and reduces substance consumptions and craving. The Opioid receptors analogists mainly prescribed for alcoholism and heroin dependence. The second generation antipsychotic drugs and first-generation drugs act as antagonist drugs in the dopamine D2 receptors. These drugs block the types two serotonin (5-HT2) receptors for 5-HT2A and 5- HT2C (Steiner, Teegen, Schiltz, Bernstein, Stoecker, & Bogerts, 2014).
Examples of drugs responsible for blockage of 5-HT2A subtypes of receptors include trazodone and nefazodone. The action of blocking type two serotonin receptors effect forebrain norepinephrine and dopamine neurotransmission. On the contrary, 5-HTIA receptors agonist enhances the release of norepinephrine and dopamine. Dopamine regulates emotional and motivation behaviors through the mesolimbic dopaminergic pathways. Some subtypes of serotonin receptors indicate differing effects on impulsive aggression for example Antagonist of 5-HT2A receptors reduces the impulsivity while a typical neuroleptics with prominent 5-HT2A antagonism have anti-aggression efficacy in a clinical population.
Agonist, on the other hand, reduces impulsivity at 5-HT2C receptors. This indicates that's the two receptors subtypes are responsible for regulating aggression. Agonist –Antagonist’s drugs are characterized by lesser tendency to produce physical dependence and by ceiling effects for respiratory depression. These drugs may have some side effects for patients receiving agonist opioids. Some agonist drugs such as Aripiprazole bind to and activate dopamine receptors in the brain (Steiner, Teegen, Schiltz, Bernstein, Stoecker, & Bogerts, 2014). This drug exerts impact through various receptors such as subtypes of serotonin, dopamine, adrenergic, adrenergic, muscarinic acetylcholine and histamine receptors.
This drug can be used to treat schizophrenia and bipolar disorders. Also, the drug can be used to treat major depressive disorders, obsessive-compulsive disorders, and irritability. Aripiprazole partial agonistic drug affects dopamine receptors by decreasing dopamine production and stabilizing dopamine system. The side effects associated with the drug include pain in the limbs and headache, nervousness, and many other side effects. Asenapine drug is categorized in the antipsychotic medication. The drug works by changing the action of the chemical in the brain. This drug act as dopamine antagonist drugs which block serotonin receptors subtypes from initiating their function within the human mind. This drug used in treating schizophrenia in adults and bipolar I disorders in adults and children.
This drug has many side effects such as high fever, sweating, confusion, tremors, uncontrollable high movement and other effects. Mental specialist recommends some medication for Borderline personality disorders after they have evaluated the risk involved in the drug use. The dangers of taking some drugs can be justified after the drug benefits outweigh its possible benefits. For example, symptoms of borderline personality disorder such as emotional dysregulation and impulsivity can be controlled by use of mood stabilizer which in one way or the other may have side effects to the user. The best method to deal with mood dysregulation is through psychotherapy.
The reason for using drugs is because they help in treating mental disorder efficiently because psychotherapy may not be useful because BPD has interlinked symptoms. Drugs associated with SSRIs have fewer side effects to the user, and therefore recommendation of the drug will be effective in stabilizing moods and happiness
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Kayser, M. S., Titulaer, M. J., Gresa-Arribas, N., & Dalmau, J. (2013). Frequency and characteristics of isolated psychiatric episodes in anti–N-methyl-d-aspartate receptor encephalitis. JAMA Neurology, 70(9), 1133-1139.
Oquendo, M. A., Placidi, G. P., Malone, K. M., Campbell, C., Keilp, J., Brodsky, B., ... & Mann, J. J. (2003). Positron emission tomography of regional brain metabolic responses to a serotonergic challenge and lethality of suicide attempts in major depression. Archives of general psychiatry, 60(1), 14-22.
Rhoads, J., & Murphy, P. J. M. (2015). Clinical consult to psychiatric nursing for advanced practice.
Schmidt, S., & Petermann, F. (2009). Developmental psychopathology: Attention deficit hyperactivity disorder (ADHD). BMC Psychiatry, 9(1), 58.
Steiner, J., Teegen, B., Schiltz, K., Bernstein, H. G., Stoecker, W., & Bogerts, B. (2014). Prevalence of N-methyl-D-aspartate receptor autoantibodies in the peripheral blood: healthy control samples revisited. JAMA Psychiatry, 71(7), 838-839.