Home Nervous System A Case of Epilepsy with Suicide Attempt
Clinical History
Examination
Investigations
Diagnosis
Treatment
Discussion
References

A 18-year-old Mr. N residing in a semi urban area from a nuclear family presented to the emergency department with the complaints of attempt of life, fever and head ache, due to consumption of surface disinfectant. After being stable, was referred to psychiatry department. With informed consent, history of irritability was noted for past 3 months he had reduced sleep, empty feelings, and occasional chest pain. However, parents noted from very young age, he was irritable, impulsive and had shallow attachment. He had a tendency to harm himself and had cut his wrist many times. He was also taking antiepileptics (Levetiracetam 1gm/day) for his Generalized tonic-colonic seizures.

General physical examination: Moderately built and nourished, Vitals were normal. Hesitation cut marks on right wrist was noted. No other abnormality detected. 

Mental status examination: 

The patient MSE was in normal range with thought content he was worried about his present behaviour, suicidal ideas are present. 

Following investigation were sent complete blood picture, 

ASSESSMENTS: 

Hamilton Depression Rating Scale (HDRS): Patient scored 23 which indicate that he has moderate depression. 

International personality Disorder Examination: He got highest score in impulsivity: 6 and Paranoid: 5 traits. Profile analysis shows that the he has issues in controlling anger. And also have impulsivity traits more. 

COPE Inventory: administered to assess the patient’s responds when they confront difficult or stressful events in their life’s. the client has highest score in Active coping 13 which indicate the he can cope with the stress better, but planning and seeking support was very less 

Modified Scale for Suicidal Ideation (MSSI):  He got a score of 4 which indicate low suicidal ideation. 

According to WHO-ICD-10: Moderate Depression with Deliberate Self harm with Emotionally Unstable Personality Disorder with Generalized tonic-colonic seizures

Pharmacological Management:

 Anti-Epileptic medications were shifted to Sodium Valproate in view of possible depression secondary to Levetiracetam and better effect on personality disorder. Antidepressant Cap Fluoxetine (SSRI) 20mg OD was started.

Non pharmacological Management: 

Psychoeducation, Dialectical behavior therapy (DBT) and schema-focused therapy was given on weekly basis 

Epilepsy is independent risk factor for psychiatric conditions is well recognized and depression being common. Emotionally unstable, borderline personality disorder (EUPD or BPD) is a challenging condition. It is characterized by pervasive patterns of affective instability, self-image disturbances, instability of interpersonal relationships, marked impulsivity, and suicidal behavior (suicidal ideation and attempt) causing significant impairment and distress in individual’s life.1 The lifetime prevalence of emotionally unstable personality disorder is approximately 5.9% and the point prevalence of this disorder is 1.6% although the prevalence of borderline personality disorder is not higher than other personality disorders in the general population.

Clinical Features and Comorbidities of emotionally unstable personality disorder was initially thought to emerge during adolescence and continue into adulthood. Comorbid psychiatric disorders are common in patients with EUPD. According to an epidemiologic survey, 85% of patients have at least one comorbid psychiatric disorder. Mood disorders, especially depressive disorder, bipolar disorder, anxiety disorder, posttraumatic stress disorder (PTSD), substance use disorder, or other personality disorder and neurodevelopmental disorder such as attention-deficit/hyperactivity disorder (ADHD). 2,3

According to the literature, the pharmacological treatment for emotional unstable personality disorder is limited. Mood stabilizers are found to be more effective for impulsivity, aggression, and behavior control in EUPD. Dialectical behavior therapy is considered most beneficial along with pharmacological management.

  1. Chanen, A.M. Borderline Personality Disorder in Young People: Are We There Yet? J. Clin. Psychol. 2005;71: 778–791.
  1. Kulacaoglu, F, Kose, S. Borderline Personality Disorder (BPD): In the Midst of Vulnerability, Chaos, and Awe. Brain sciences. 2018;8: 11-14.
  1. Lieb K, Zanarini M.C, Borderline personality disorder. Lancet. 2004; 364:453–461.

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