Testing an APA practice guideline: symptom-targeted medication utilization for patients with borderline personality disorder.
BACKGROUND
The goal of this study was to test whether the use of psychotropic medication treatment for borderline personality disorder (BPD) was consistent with proposals in the recently published American Psychiatric Association's Practice Guideline for the Treatment of Patients with Borderline Personality Disorder.


METHODS
Medication utilization by patients with BPD was assessed prospectively over a 2-year period prior to the publication of the Guideline. Three BPD symptom clusters--cognitive-perceptual, affective dysregulation, and impulsive-behavioral dyscontrol--along with demographic and functioning variables were used to predict the use of five classes of medication.


RESULTS
Symptoms of impulsive-behavioral dyscontrol significantly predicted use of both neuroleptics and anticonvulsants. Cognitive-perceptual symptoms were inversely related to anticonvulsant use.


CONCLUSIONS
While some pre-Guideline medication practices with BPD patients were consistent with the recommended algorithms, physicians may also have been influenced by a variety of considerations, including level of functional impairment and the presence of comorbid Axis I conditions.
Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston 29425, USA.
John M
JM
Oldham
Donna S
DS
Bender
Andrew E
AE
Skodol
Ingrid R
IR
Dyck
Charles A
CA
Sanislow
Shirley
S
Yen
Carlos M
CM
Grilo
M Tracie
MT
Shea
Mary C
MC
Zanarini
Edd John G
EJ
Gunderson
Thomas H
TH
McGlashan
D000293:Adolescent; D000328:Adult; D000339:Affect; D001883:Borderline Personality Disorder / Q000188:drug therapy* / Q000523:psychology; D003072:Cognition Disorders; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012955:Societies, Medical; D014600:Utilization Review