A 27-year-old woman with borderline personality disorder has distressing brief episodes of paranoid ideation and dissociation under stress, along with marked mood lability. Alongside psychotherapy, which pharmacological class is the most appropriate first choice for these transient cognitive-perceptual symptoms?
- A Lithium at standard mood-stabilising dose
- B Low-dose second-generation antipsychotic ✓
- C High-dose tricyclic antidepressant
- D Long-term benzodiazepine maintenance
Correct answer: B. Low-dose second-generation antipsychotic
Explanation
Transient stress-related paranoia and dissociative symptoms in borderline personality disorder respond to low-dose antipsychotics such as olanzapine or quetiapine, which are recommended for cognitive-perceptual symptoms. Benzodiazepines carry risks of disinhibition and dependence in these patients, tricyclics can worsen impulsivity and are dangerous in overdose given recurrent self-harm, and lithium is reserved for selected impulsive-aggressive cases rather than first-line use.
Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.
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