Persistence of impulsivity in an adolescent with Borderline Personality Disorder

Adolescence is a period of transition and changes where borderline personality traits can influence the manifestations of a depressive illness. Adolescents may present dysphoric features and extreme sensitivity to rejection, which can sometimes culminate in self-harm. The thoughtless and explosive behaviors are a group of impulsive acts whose purpose is to choose immediate and short responses as well as to select the most likely options regardless they are less rewarding, which represents a high risk for suicide. The pathogenesis of Borderline Personality Disorder (BPD) involves interactions between genetic, biological and environmental factors, resulting in fluctuations in mood, impulsivity, and cognitive dysfunctions. This is the case of an adolescent with major depressive disorder and BPD after numerous unsuccessful therapeutic regimens, including Selective Serotonin Reuptake Inhibitors (SSRIs), antipsychotics, and mood stabilizers, achieves improvement after medication with amitriptyline, a tricyclic antidepressant. There is no specific drug for treatment. The multidimensional nature of the factors involved makes drug management complex. Psychotherapeutic treatment is essential to modulate some target symptoms.

青春期是一个过渡与变革的时期，边缘型人格特质可能影响抑郁疾病的临床表现。青少年可能表现出忧郁特征和对拒绝的极端敏感，有时可能导致自我伤害。无思虑且爆发性的行为是一系列冲动行为，其目的在于选择即时和短暂的回应，以及无论其奖励程度如何都倾向于选择最可能的结果，这代表着极高的自杀风险。边缘型人格障碍（BPD）的发病机制涉及遗传、生物学和环境因素的相互作用，导致情绪、冲动性和认知功能障碍的波动。这是指一名患有重度抑郁症和边缘型人格障碍的青少年，在经历了包括选择性5-羟色胺再摄取抑制剂（SSRIs）、抗精神病药物和情绪稳定剂在内的多种治疗方案均未成功后，通过服用三环类抗抑郁药阿米替林后实现了病情的改善。治疗上尚无特效药物。涉及因素的多维性质使得药物治疗复杂化。心理治疗对于调节某些靶症状至关重要。