Q. I was recently in the hospital following a suicide attempt and experienced a psychotic episode prior to and during hospitalization. I was given a possible diagnosis of borderline personality disorder and have begun dialectical behavior treatment. I do not know if I have been experiencing seizures but I definitely feel shaky all the time. I throw up daily and I'm guessing that is nerves. My question concerns cognitive ability and memory - I have a high I.Q. and attended an ivy league. Now I can't seem to organize information at all. My memory is completely unreliable and has zapped my ability to function. If someone tells me something, I will forget what they said within seconds, minutes. I was taking 25 mg of Seroquel but have been off for a few days. I am also on 40 mg of Prozac. I have been told that this sort of brain drain is normal but I'm looking for an honest prognosis/discussion about the possibility of recovering what appears to be a never-to-return mental faculty.

A. The antipsychotic Seroquel (which you stopped), unequivocally will diminish your cognitive capacity. The illness itself, if untreated, will too. It is effectively untreated. You should be on enough medication to work, and this would be 80 mg per day of Prozac. Have your doctor read my paper on treating borderline personality disorder in the American Journal of Psychiatry from August 1991. It takes 80 mg/day to work. If he or she wants, I will be glad to email them data they need for medication management of BPD.

I do not think dialectic behavioral therapy is very good until the medications kick in. It is like talking to a diabetic to lower their blood sugar. An exercise in futility until they have insulin in them. I have qualms about anyone who does not maximize treatment options. Get on enough medication (correct dosing) and then do therapy.