This manuscript reviews principles of hospital management in the care of severe borderline patients with concomitant affective syndromes. The case presented highlights a process of experiential learning in a novice clinician (a beginning psychiatric resident) and illustrates several critical areas of concern with these patients. The following four facets of clinical management are discussed: 1) Failed attempts to understand borderline dynamics and subsequent countertransference reactions; 2) Staff resistance to consistent, honest and open acknowledgement of suicide potential; 3) Special risks when borderline dynamics are combined with affective syndromes; and 4) Possible suicide preventive measures and their relative effectiveness.
Hughes, MD, Kathleen A. and Santos, MD, Al
"The In-Hospital Suicide: A Psychological Autopsy of a System Involving Borderline Dynamics,"
Jefferson Journal of Psychiatry:
2, Article 7.
Available at: http://jdc.jefferson.edu/jeffjpsychiatry/vol7/iss2/7