Emotionally Unstable Personality Disorder in Primary Care: A Thematic Review and Novel Toolkit.

Emotionally Unstable Personality Disorder (EUPD) causes significantly impaired personality functioning to include feeling of emptiness, lack of identity, unstable mood and relationships, intense fear of abandonment and dangerous impulsive behaviour including severe episodes of self-harm. The vast majority of EUPD patients are managed in the community, and have less contact with specialist psychiatric services when compared to patients with other mental illnesses. Despite the burden of this condition on primary care, the academic literature focuses on EUPD in psychiatric inpatients. This paper therefore aims to redress this balance through, first, establishing the key themes present in the available body of work on EUPD in the community, and second, highlighting areas for future research. Further, in the spirit of reducing stigma surrounding mental illness, the authors present a novel and non-pejorative toolkit for the recognition of EUPD in primary care.

What are the risks associated with the use of NSAIDs as an adjunct to SSRIs for treatment of depression? An evaluation of current evidence.

BACKGROUND: Over the past twenty years, psychiatric researchers have recognised the important role played by inflammation in the pathogenesis of depression. There has been increasing interest in the use of anti-inflammatory drugs, such as non-steroidal anti-inflammatory drugs (NSAIDs), as a way to enhance the efficacy of antidepressant treatments. It is essential that psychiatrists and GPs who prescribe these drugs in conjunction, understand possible interactions, particularly the risk of bleeding. SUBJECTS AND METHODS: This paper is a literature review regarding NSAID co-prescription with SSRIs and the potential risks and benefits. The objectives of this systematic review are to assess the evidence for the use of NSAIDs as an adjunct to standard antidepressant drugs and evaluate this against the evidence contraindicating such a treatment combination. RESULTS: Our research suggests that there is evidence to support both the anti-inflammatory benefits of NSAIDs for treating depression, as well as evidence suggesting that NSAIDs increases the risk of bleeding when co-prescribed with SSRIs. CONCLUSIONS: When a broad consideration of the risks and benefits is done, the review is inconclusive about guidelines for co-prescription. More research is required to make strong claims about whether the type of NSAID and duration of treatment influences the risk (or benefit) of co-prescription.