POSTER ABSTRACT: Non-Psychotic Aggression In A 22-Year-Old Male With Poor Response To Psychotropic Medication: A Case Report

BACKGROUND: An aggressive patient presenting at a Mental Health Care Facility may be diagnosed with a psychotic disorder and administration of psychotropics may obscure the existence of a long-standing Personality Disorder. AIMS: To highlight the challenges in diagnosis and management of a case of non-psychotic aggression in a 22-year-old male with history of aggressive outbursts since childhood. METHODS: Standardised scales like Brief Psychiatric Rating Scale (BPRS), Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HAM-D), and ICD 10 International Personality Disorder Examination (IPDE) were used to rule out any psychotic/mood disorders and to assess the personality of the patient, respectively. RESULTS: Trial of psychotropics in the past and after in-patient treatment showed little response and the patient’s scores on IPDE suggested a mixed disorder comprising Dissocial Personality Disorder, Emotionally Unstable Personality Disorder: Impulsive Type and/or Borderline Type. The patient started showing improvement only with Dialectical Behaviour Therapy (DBT) and Family Therapy along with Sodium Valproate 500mg BD. CONCLUSION: Personality Disorders may present with extreme aggression and poor response to psychotropics where we should consider entertaining a diagnosis of a Personality Disorder which carry poor prognosis and need Psychotherapeutic intervention more than Psychopharmacological intervention alone.