In the May 2015 issue of Psychiatric Times, Dr Eric M Plakun, MD wrote this article, “Correcting Psychiatry’s False Assumptions and Implementing Parity.” The link?
There were several important points in the article, but this one in particular was the “gotcha” moment most of my colleagues have dropped and discarded years ago, hence why they f— up patients’ care and I often wind up trying to “fix” the numerous mistakes these providers made by overmedicating, if by falsely medicating in the first place:
“Again using depression as an example, we are learning how important comorbid personality disorders are to treatment outcome—especially comorbid borderline personality disorder (BPD). The large, multisite Collaborative Longitudinal Personality Disorders Study (CLPS) concluded that the presence of personality disorders, especially BPD, “robustly predicted persistence” of MDD, suggesting diagnosis and treatment of personality disorders are essential in treating depression lest it become treatment-resistant.6
However, in our focus on the medical model, personality disorders are underdiagnosed. In DSM-IV, the most frequent Axis II diagnosis made was “deferred,” and there is no reason to think this will change with DSM-5. Biological tunnel vision can lead to missing the reality of clinical complexity and interfere with provision of optimal patient care.”
Personally, I don’t focus on Borderline PD, as there is often no pure Borderline patient out there, but a smorgasbord of borderline traits, along with Narcissistic, dependent, Histrionic, and Avoidant features as well.
So, just to note briefly to readers, why there are so many “Treatment Resistant patients” out there, is because there are medication resistant, or just not medication responsive issues out there with some patients.
Just my imperfect opinion. The “REALLY” series to continue this week with Part 2, about patients’ issues, so this a lead in???