RESUMO
El diagnóstico de trastorno de personalidad límite en la adolescencia suele ser un tema controvertido. A continuación se presenta un caso clínico que expone las características habituales de presentación en la adolescencia y se discute además la necesidad de tener en cuenta los factores precursores del trastorno de personalidad límite a la vez que se relaciona la presencia de determinados trastornos de conducta como futuros precursores. Se insiste en la necesidad de usar programas de intervención precoz para este tipo de pacientes con los modelos que existen actualmente.
Diagnosing borderline personality disorder during adolescence is usually controversial. In this paper we present a clinical case in which an outline of the main characteristics of borderline personality disorder during adolescence is summarised. The need of taking into consideration the precursor characteristics of borderline personality disorder in young people is also highlighted. At the same time, other significant behavioural disorders found in young people are emphasized as possible forerunners of a borderline personality disorder diagnosis. Finally, we insist upon the need to implement early intervention programmes for these patients based on current models.
RESUMO
Many pharmacological treatments were proved effective in the treatment of panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), post-traumatic stress disorder (PTSD), and obsessive-compulsive disorder (OCD); still many patients do not achieve remission with these treatments. Neurostimulation techniques have been studied as promising alternatives or augmentation treatments to pharmacological and psychological therapies. The most studied neurostimulation method for anxiety disorders, PTSD, and OCD was repetitive transcranial magnetic stimulation (rTMS). This neurostimulation technique had the highest level of evidence for GAD. There were also randomized sham-controlled trials indicating that rTMS may be effective in the treatment of PTSD and OCD, but there were conflicting findings regarding these two disorders. There is indication that rTMS may be effective in the treatment of panic disorder, but the level of evidence is low. Deep brain stimulation (DBS) was most studied for treatment of OCD, but the randomized sham-controlled trials had mixed findings. Preliminary findings indicate that DBS could be affective for PTSD. There is weak evidence indicating that electroconvulsive therapy, transcranial direct current stimulation, vagus nerve stimulation, and trigeminal nerve stimulation could be effective in the treatment of anxiety disorders, PTSD, and OCD. Regarding these disorders, there is no support in the current literature for the use of neurostimulation in clinical practice. Large high-quality studies are warranted.