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    Cases from the Psychiatry Letter - II: Cases from the Psychiatry Letter, #2
    Cases from the Psychiatry Letter - II: Cases from the Psychiatry Letter, #2
    Cases from the Psychiatry Letter - II: Cases from the Psychiatry Letter, #2
    Ebook38 pages33 minutes

    Cases from the Psychiatry Letter - II: Cases from the Psychiatry Letter, #2

    By Nassir Ghaemi

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    About this ebook

    Following up on volume 1, eleven more cases from the monthly Psychiatry Letter are provided in this ebook. Each case is provided with recommendations for an approach consistent with the PL philosophy and with links to further explanations on the PL website or to scientific articles. 

    Case 1. Ending suicidality by stopping antidepressants in supposed borderline personality

    Case 2. Life events, not trauma

    Case 3.  A  mixed depressive suicide

    Case 4.  Your treatment is as good as your diagnosis

    Case 5.  Adolescent bipolar illness

    Case 6. When it's okay to prescribe benzodiazepines

    Case 7.  Stopping antidepressants for "depression"

    Case 8. Carbamazepine to the rescue

    Case 9.  Hyperthymic temperament

    Case 10. Treating anxiety symptoms in PTSD

    Case 11.  Preadolescent depression versus bipolar illness

    LanguageEnglish
    PublisherNassir Ghaemi
    Release dateSep 30, 2019
    ISBN9781393964063
    Cases from the Psychiatry Letter - II: Cases from the Psychiatry Letter, #2
    Author

    Nassir Ghaemi

    S. Nassir Ghaemi MD MPH is a psychiatrist and author. He is Professor of Psychiatry at Tufts University and Lecturer on Psychiatry at Harvard Medical School. He has published multiple academic books, including Clinical Psychopharmacology (Oxford University Press, 2019), and is author of A First-Rate Madness: Exploring the LInks between Mental Illness and Leadership (Penguin, 2011), a New York Times bestseller. He has published over 200 scientific articles, over 50 book chapters, and is a peer reviewer for many scientific journals, as well as Associate Editor of Acta Psychiatrica Scandinavica Disclosure: Since 2017, Dr. Ghaemi also has been employed at Novartis Institutes for Biomedical Research in Cambridge, MA as a director of early drug discovery research in psychiatry. The views expressed here are his alone, and do not necessarily reflect those of any of his employers. 

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      Book preview

      Cases from the Psychiatry Letter - II - Nassir Ghaemi

      Case 1. Ending suicidality by stopping antidepressants in supposed borderline personality

      A25 year old adopted Asian female is treated with bupropion 300 mg/d and atomoxetine 60 mg/d. She reports chronic and constant suicidal ideation for the past 10 years.  She has abused alcohol and marijuana regularly for years, and cocaine as well more recently. She was hospitalized once at age 14, has had many overdoses and some cutting behavior. She also has bulimia at times. She was adopted, so biological family information is not available. She grew up in a wealthy, white, upper-class suburb. Her mother accompanied her and the family appears very supportive of her. She went to excellent schools and never experienced any trauma of any kind. She was never married, has no children, graduated from college, and lives alone while working for a retail store. 

      She describes past manic symptoms as follows: I’m always rushing around, racing thoughts, pretty hyper, I can get so much shit done. This is associated with talkativeness and distractibility: I’m always confident. She has impulsive behavior of all kinds: sexual, spending, reckless driving. I’ve always been nocturnal, I like to stay up at night. Normally, she sleeps at 4 AM and wakes up at 8 AM, without being tired. When she’s depressed, she has very low energy and sleeps over 13 hours nightly. There are no definable episodes of mania above this baseline. 

      She was diagnosed with borderline personality disorder plus MDD at age 15 and has received weekly psychotherapy for 10 years; she also has taken antidepressants for the past 5 years. She briefly received lithium at age 15, added to citalopram, without benefit. 

      Her course of illness was rapid-cycling: 3 months earlier, she had a depressive episode for one month; followed by her hyperthymic baseline.

      The PL diagnosis and clinical impression

      The PL diagnosis is hyperthymic temperament.   As reviewed on the PL website, mood temperaments exist, but DSM only recognizes dysthymia and cyclothymia.  Hyperthymia was also described a century ago by Kretschmer, who formalized the definitions of dysthymia and cyclothymia as well.  As a state of constant mild manic symptoms as part of one's personality, hyperthymic temperament can produce unstable interpersonal relationships and constant irritability, which may be mistaken for borderline personality.  In the absence of sexual

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