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with Tamoxifen," BMJ (Feb. 2010): Vol. 340, electronic
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Borderline personality disorder (BPD) is a challenge to treat not
only because it is complicated and stigmatized, but also because
its symptoms reflect ingrained patterns of thinking and behavior.
Although it is heterogeneous in nature, causing different
clusters of symptoms in different people, the disorder has three
major clinical components: a fragile sense of self that impairs
relationships with other people, impulsiveness, and emotional
volatility. Many patients with BPD also have other mental health
problems, such as a mood disorder or post-traumatic stress
Drugs may be moderately helpful at reducing particular symptoms,
such as depression or anxiety, but they do not address core
personality traits and behaviors. As such, psychotherapy remains
the mainstay of treatment for patients with BPD, although there
is no "one-size-fits-all" treatment.
Dialectical behavior therapy is probably the most common
psychotherapy used for BPD, but other options have emerged. A
review of four psychotherapies concluded that all were equally
effective overall, but that each had specific advantages. As
such, clinicians and patients can decide on an individual basis
which treatment is most appropriate.
The impact of BPD extends well beyond the individual patient,
causing suffering in family members as well. Loved ones, like
therapists, may struggle with how to respond constructively to a
patient's volatile moods and demands. For that reason, family
members may also benefit from psychotherapy.
The new PORT guidelines focus on improving physical as well as
The Schizophrenia Patient Outcomes Research Team (PORT) has
issued updated treatment recommendations that not only include
detailed advice about medication and psychosocial treatments but
also address, for the first time, common problems in this
population such as smoking cessation, substance abuse treatment,
and weight loss. The authors note that the goal is not only to
help clinicians and patients understand how to increase chances
of schizophrenia recovery (albeit modest in scope), but also how
to reduce the risk of additional life-threatening medical
problems such as diabetes and cardiovascular disease.
The PORT recommendations, issued in 1998 and first updated in
2003, were funded by the Agency for Healthcare Research and
Quality and the National Institute of Mental Health. Researchers
at the University of Maryland wrote the latest update after
consulting with leading schizophrenia experts. In contrast to
efforts like the American Psychiatric Association practice
guidelines for schizophrenia and the Texas Medication Algorithm
Project, which attempt to address the full range of situations
clinicians encounter, the PORT review is more conservative in
scope. The PORT authors limit their recommendations to those
interventions that have been tested in randomized controlled
Approximately 20% to 30% of the women who take tamoxifen also use
antidepressants to alleviate depression, anxiety, or hot flashes.
Some antidepressants are such strong inhibitors of CYP2D6 that
women who take these drugs may not benefit from tamoxifen. Two
papers suggest that three antidepressants — paroxetine (Paxil),
fluoxetine (Prozac), and bupropion (Wellbutrin) — are most likely
to inhibit CYP2D6 and interfere with tamoxifen treatment.
In one paper, researchers at McGill University reviewed seven
clinical studies of women taking both tamoxifen and
antidepressants. They also examined laboratory studies to assess
the inhibitory effects of various antidepressants on the CYP2D6
enzyme in cell cultures. They found consistent evidence that two
selective serotonin reuptake inhibitors (SSRIs) — paroxetine and
fluoxetine — were strong inhibitors of CYP2D6. Indirect evidence
from the laboratory studies suggested that bupropion, an
antidepressant that affects the neurotransmitters norepinephrine
and dopamine, also severely inhibits CYP2D6. Other drugs had less
of an impact on this enzyme.
Researchers are investigating whether chewing gum improves the
brain's memory-forming ability, though as yet there is no
evidence to support this theory.
I've tried to quit smoking three times. A friend suggested that
instead of giving cigarettes up all at once that I try to kick
the habit gradually. Which method is best?
My 8-year-old son was diagnosed with bipolar disorder several
years ago. Now a new therapist thinks the problem might be temper
dysregulation disorder. What is that? How is it treated?