Borderline personality disorder is approached here through assessment, treatment frame, and what happens in the room, not just a list of behaviours. The episode is most useful for the reminder that depression, self-harm, or substance misuse should not end the assessment before personality structure is explored.

Less immediate for the next shift, but useful if mood disorders cross your practice. It puts lithium back into bipolar disorder, acute mania and recurrent depression, and flags adjunctive allopurinol as an evidence-supported off-label option in acute mania.

The action is to document function, triggers and successful supports instead of making legal conclusions. Open this when autism care spills into school forms, benefits, driving, employment or police contact, because it shows how to stay useful without slipping into a forensic role.

The pitfall is using loose labels around sexual risk and personality pathology. This forensic psychiatry discussion is useful when assessment demands diagnostic precision, clear safeguarding, and separation of pedophilic disorder, attraction to pubertal adolescents, antisocial traits, and offending behaviour.

Suicide risk is not reduced by grandiosity. This psychiatric teaching point highlights that narcissistic and antisocial traits can coexist with severe self-harm risk, and that formulation should separate impulsivity, entitlement and planning rather than relying on loose labels such as the dark triad.

In adolescent depression, fluoxetine still has the clearest drug signal, but medication is not the whole plan. Start with psychological therapy, review early for suicidality, and taper antidepressants slowly; TMS may have a role as augmentation for persistent symptoms where services and suitability align.

Persistent aggressive conduct problems with callous-unemotional traits predict later antisocial personality disorder more reliably than isolated animal cruelty. Clinically, adolescent sexual histories must document age gaps and authority roles, because apparent consent does not remove exploitation when power is unequal.