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Dr. Kaushik
Dr. Kaushik, Psychiatrist
Category: Mental Health
Satisfied Customers: 4505
Experience:  MD Psychiatry
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Hi Doctor Kaushik, Hope you are well & happy. What are

Resolved Question:

Hi Doctor Kaushik,
Hope you are well & happy.

What are the main concerns with a gay, male patient (31) with a Borderline Personality & adult ADHD, treated with Abilify, Lyrica, Dexedrine & Remeron?
Would CBT be a useful intervention?

Thankyou.
Submitted: 7 years ago.
Category: Mental Health
Expert:  Dr. Kaushik replied 7 years ago.

Hi there ,

 

Welcome to Just answer !

 

Kindly answer a few questions ..

 

1) why the patient is started on lyrica ( pregabalin ) ?

 

2) are abilify , remeron , lyrica and dexedrine the drugs on which he is currently placed upon?

 

3) presently what are the symptoms of the patient which have not yet been controlled and for which there is a concern ?

 

kindly answer the questions against their numbers and i shall get back to you with an approriate reply.

 

Regards..

Customer: replied 7 years ago.
1. Patient is on 600mg Lyrica for GAD.

2. Yes, those are the current meds. Plus milnacipran 100mg x 2 to augment the mirtazapine.

3. The patient may need social/financial skills development. The patient wants to explore their 'mental situation' more and by doing so translate their thoughts into life to solve some of their 'problems'.

Thank you.
Expert:  Dr. Kaushik replied 7 years ago.

Ok , thanks for the reply .

 

Well, the patient has been rightly placed on the current mix of drugs , so he shall continue the same , but as far as CBT is concerned , on this i would suggest that for a borderline personality patient , Dielectical behaviour therapy ( DBT ) is a better psychotherapy type than Cognitive behaviour therapy . DBT is a 4 stage therapy , with special attention given to the acts of self harm and self destructive traits which are shown by borderline patients , with later stages dwelling on better adaptability to the surroundings .

 

So, the patient shall seek DBT for Borderline personality while continuing the above mentione drugs for adhd and borderline .

 

Also, since the patient is already placed on 2 anti depressants such remeron and milnacipran , which are quite effective themselves in treating GAD , so the use of lyrica , which is an anti seizure drug somehow bothers me , because of its side effects , although agree it is also used in GAD , but when one is already placed on sufficient drugs to treat the same , so why unnecessary over load the patients with drugs and make him succeptible to side effects ..

 

So, you shall discuss the use of pregabalin with his doctor , citing the already use of 2 anti depressants , which themselves are anxiolytic agents used effectively in GAD.

 

Kindly kook at the links below , which support my claims..

 

http://en.wikipedia.org/wiki/Borderline_personality_disorder#Psychotherapy

 

http://en.wikipedia.org/wiki/Mirtazapine#Indications

 

http://en.wikipedia.org/wiki/Milnacipran

 

http://www.lyrica.com/

 

So, i suggest that the patient should seek Dialectical behaviour therapy ( DBT) , rather than CBT , for borderline disorder , while continuing on the above mentioned drugs , it is just that the use of pregabalin should be discussed again with the doctor , whether it is of any consequence or not .ALSO, IF SOMEHOW , DBT practicing psychologist is difficult to find , then you shall go for CBT , as a second option.

 

I hope this helps..

 

I wish the patient all the best...

 

Please press the ACCEPT button if you are satisfied with the answer as only then will i be credited for my sevice .

 

Regards..

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