Medical Literature

What Is A Character Disorder?

QUESTION:

Dear Dr. Heller,

I’m doing some research on the book ‘Girl, Interrupted’ by Susanna Kaysen. One of the topics that I need to cover in my report is “Character Disorders,” since this is what the girl was plagued with in the book. I would really appreciate it if you could supply some information for me on this specific topic, or at least a good place to look.

Thank you very much for your time.

PS- If you know anything about McLean Hospital, please let me in on what you know.

ANSWER:

Surprisingly character disorder is not a specific diagnosis, nor is it discussed in the major psychiatric texts or DSM.

What it means is that the person deliberately lies, cheats, steals, etc. when they are rational (and not psychotic) and when better choices are available. When personality traits such as reliability, remorse, dependability, honesty, integrity, and trustworthiness are absent the individual is felt to have a disorder involving their character.

I’m not sure where to look for any specific information beyond that. Part of the reason borderlines have difficulty getting care is that those with both a character disorder and the BPD are so difficult to manage and tend to get involved with psychiatric hospitals and the legal system.

McLean Hospital in Massachusetts is a very famous hospital with an excellent reputation.

 

2000 April Questions

 

Ask the Doctor

 

QUESTION:

Dear Dr. Heller,

I have been diagnosed with BPD within the past year.  I had taken Zoloft, with positive results, and than switched to Celexa, with not so positive results.  My doctor has now prescribed Lamictal.  Though I can now get off the couch for more than 30 minutes at a time, my mood swings seem to be back again for the first time since before the Zoloft.  Is there anything that can relieve all the symptoms, or can SSRI’s and anti convulsants be taken together?  If Lamictal takes a short amount of time to feel its effects (I have been taking it for 3 weeks) then why do I still have to battle the severe mood swings?

 

ANSWER:

The SSRI’s are not interchangeable.  In my experience the best is Prozac.  If one works better than another, then clearly you should be taking the more effective medication. All of the “mood stabilizing” epilepsy medications (Depakote, Tegretol, Lamictil, Neurontin) can help some individuals with the BPD.  I’ve found Tegretol to be the most effective by far.  I’ve been very disappointed with Lamictil, and it can be difficult to take. In general the Prozac / Tegretol combination has been the best for my patients.  Whatever other diagnoses that are also present need to be treated as well.  The medication sheet I give to my patients is available at: http://pks.947.myftpupload.com/20a.htm

QUESTION:

Dear Dr. Heller,

Hello.  My friend has been taking Celexa for about a week now and has been having the common side effects for this anti-depressant.  My question is, in your opinion, how long do the side effects generally last?

Thank you for taking your time to answer my question.  It is greatly appreciated.

 

ANSWER:

While some side effects go away, some persist – particularly the lack of orgasms.  If the person has the generalized anxiety disorder (particularly if PTSD is also present [post traumatic stress disorder]) then additional medications will be needed to treat those problems and reverse the effects Celexa had on worsening those conditions.

Is Celexa Causing My Diarrhea?

QUESTION:

Dear Dr. Heller,

Hello.  I have now been taking this medication for four months.  This has made an amazing difference in my life.  I now seem in control of, and have a better zest for, my life.  I am now enjoying my family more, my job, and day to day routines.  One difference I have noticed since being on Celexa is the frequency of diarrhea and gas.  I am also presently taking Losec, for my reflux problem (10 years now).  Are these medications okay to take with each other?  I take Losec in the evening and Celexa in the morning.  I have found no literature stating that this is a side effect.  Is diarrhea a side effect of Celexa?

Thanks.

 

ANSWER:

While any medication can cause any side effect, it’s more likely due to the Losec (omeprazole or Prilosec).  Switching to a different acid suppressing medication like Protonix or Aciphex may stop the problem. There are many other possibilities.  If you have the generalized anxiety disorder, particularly the cognitive component, Celexa could be triggering the diarrhea.  You could have a bowel infection causing the diarrhea that has absolutely nothing to do with the medications.  Pancreatic insufficiency may be to blame.  Thyroid disorders, B12 deficiency and other diagnoses are possible. Chronic diarrhea is not an acceptable condition and I encourage you to find out what’s causing it and what to do for it.

 

2001 May Questions

 

Ask the Doctor

 

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QUESTION:

Dear Dr. Heller, My girlfriend takes Celexa to control anger; she also drinks between 3-6 beers almost daily.  I have noticed that when she drinks her mood swings become quite distinct and extremely unpleasant.  When I talk to her about the alcohol use, she often denies being under its effects.  Now my question is, does the alcohol combined with Celexa cause or make more severe the mood swings, or is she an alcoholic?  The symptom is often attributed to alcoholism. Thank you

ANSWER:

Anything more than one drink per day for a woman is considered abuse, and based on what you wrote she is probably an alcoholic.  Alcohol by itself can cause moodiness, and it can worsen many mental health problems.  I’d highly recommend you attend an AlAnon meeting. It’s more likely that the alcohol is preventing the Celexa from working properly.

QUESTION:

Dear Dr. Heller,

I get sweaty and breathe real heavy and get dizzy and feel like I’m going to vomit when I’m in crowds, help me.

 

ANSWER:

You likely have a combination of “social phobia” and panic disorder.  I would highly encourage you to read more about them and particularly to get them treated. Finding all the diagnoses and comprehensively treating them is an excellent idea as well.  The screening test I use for my patients may be of help to you.