I just ran into a potential snag. I'm on ECT this month, and the attending I was working with took an impromptu vacation. He stressed he wanted a thorough evaluation of every pt because even the wards are sometimes to brief with their interview. He left, and I ended up seeing one or two patients that were eventually discharged and my note was never signed by an attending lol. Anyways....
I saw one patient that is clearly borderline. He hits points 1-7 in DSM 5, doesn't self mutilate or have transient paranoia/psychosis. He has attempted suicide or made a gesture 1-2x/year. He was admitted for "major depressive disorder" and "cluster b traits." He was in DBT for nearly 2 years in the past. No one ever explained to him why he continued to feel the way he felt, why he idealized and devalued people seemingly on the flip of a dime, etc. the attending covering him ordered an ect consult for "depression." I saw him - he denied depressive symptoms, denied lethality, and was looking forward to being discharged to a group home so he could be around people.
I believe his Axis I diagnosis is (dsm 5) Persistent Depressive Disorder with Intermittent Major Depressive Episodes. Axis II is borderline. ECT has been shown to reduce depressive symptoms minimally in borderline pts, even in a MDE, and the benefits, if present, are short lasting. He has been admitted numerous times, referred for ECT by this same attending, and denied ECT each time.
Now, even after discussing with the attending that I spoke to this pt about BPD, she wants a re-consult because the PATIENT is asking for ECT. I don't know what I'm supposed to do with that. He's been on another antidepressant for.....3 days now but it's not working....so re-consult.... I spent almost 2 hours with this pt and discussed my line of thought, the likelihood of both BPD and depression playing a role with him, and the unlikelihood that ECT would be of lasting benefit. He wasn't even sure if ECT was worth it to begin with. Not sure if I'm "in the wrong" for talking about, but isn't our job to diagnose and treat? Shouldn't I be allowed to justify why ECT is NOT the treatment of choice for this guy?