Presentation Information
[P-32-07]Shattered Reflections: A Case Report on Good Psychiatric Management in a Filipina patient with Borderline Personality Disorder and Meningioma
*Charisse Jae Rongcal Faa, Mark Anthony Pascual (National Center for Mental Health(Philippines))
Keywords:
Borderline Personality Disorder,Good Psychiatric Management,Meningioma
Objective:This case explores the clinical presentation, diagnosis, and treatment of a 39-year-old Filipina with a traumatic childhood, overlapping depressive symptoms, and neurologic issues. It highlights the application of Good Psychiatric Management (GPM) in Borderline Personality Disorder (BPD) and the challenges of managing psychiatric and medical comorbidities.
Methodology:Ava, presented with severe facial pain and depressive symptoms. Her history revealed a traumatic childhood with repeated sexual abuse, unstable family dynamics, and neglect, further compounded by emotional abuse and infidelity in her marriage. She suffered chronic depressive symptoms and engaged in impulsive self-harm behaviors but never sought psychiatric help. Ava also faces significant health challenges, including a cerebellopontine angle mass, and trigeminal neuralgia, all untreated due to financial constraints. She was started on Amitryptyline 25 mg, 1 tablet once a day, to address both the increasing pain and mood symptoms. She underwent Left Lateral Suboccipital Craniotomy as a definitive management. The therapist handling her underwent an 8-hour online training for GPM at Harvard Medical School.
Results:Ava’s emotional struggles stemmed from instability in relationships and self-image exacerbated by impulsivity and fear of abandonment. Her tumultuous relationships, self-destructive actions, and dissociative episodes under stress indicated Borderline Personality Disorder. Combined with Major Depressive Disorder (MDD), her treatment involved GPM and psychopharmacology, focusing on psychoeducation, therapeutic alliance, and structured sessions. Improvements in BPD symptoms facilitated reductions in depressive symptoms, enabling Ava to resume functioning and find symptom relief.
Conclusion:Ava’s case highlights the interconnectedness of psychiatric and neurologic disorders, showing how early trauma and prolonged HPA axis dysregulation can lead to chronic medical and mental health issues. Training of the therapist for GPM appeared to help Ava in controlling her self-harm behavior and other impulsivity. This is compatible to the study that showed that patients with borderline personality disorder with complex comorbid conditions and impulsivity may benefit from GPM
Methodology:Ava, presented with severe facial pain and depressive symptoms. Her history revealed a traumatic childhood with repeated sexual abuse, unstable family dynamics, and neglect, further compounded by emotional abuse and infidelity in her marriage. She suffered chronic depressive symptoms and engaged in impulsive self-harm behaviors but never sought psychiatric help. Ava also faces significant health challenges, including a cerebellopontine angle mass, and trigeminal neuralgia, all untreated due to financial constraints. She was started on Amitryptyline 25 mg, 1 tablet once a day, to address both the increasing pain and mood symptoms. She underwent Left Lateral Suboccipital Craniotomy as a definitive management. The therapist handling her underwent an 8-hour online training for GPM at Harvard Medical School.
Results:Ava’s emotional struggles stemmed from instability in relationships and self-image exacerbated by impulsivity and fear of abandonment. Her tumultuous relationships, self-destructive actions, and dissociative episodes under stress indicated Borderline Personality Disorder. Combined with Major Depressive Disorder (MDD), her treatment involved GPM and psychopharmacology, focusing on psychoeducation, therapeutic alliance, and structured sessions. Improvements in BPD symptoms facilitated reductions in depressive symptoms, enabling Ava to resume functioning and find symptom relief.
Conclusion:Ava’s case highlights the interconnectedness of psychiatric and neurologic disorders, showing how early trauma and prolonged HPA axis dysregulation can lead to chronic medical and mental health issues. Training of the therapist for GPM appeared to help Ava in controlling her self-harm behavior and other impulsivity. This is compatible to the study that showed that patients with borderline personality disorder with complex comorbid conditions and impulsivity may benefit from GPM