Pharmacologic management of borderline personality disorder: a case study.
General principles of the "outcome-focused" model of psychopharmacologic management of patients with BPD are illustrated using the case of Ms. A, a patient with borderline personality disorder (BPD) experiencing impulsivity such as suicidal behavior, chronic insomnia and concurrent substance abuse. The model includes (1) measurement of specific behavioral outcomes related to functioning; (2) assessment of the role of substance use/abuse in patients with BPD; (3) consideration of interventions to clarify and strengthen the boundaries of the therapeutic relationship-including short lengths of time between prescription refills, medication contracts outlining consequences if substances are obtained outside of the relationship, and urine testing to ascertain compliance; (4) an understanding of the psychodynamic meanings attributed to medication while positive and negative medication effects are monitored with treatment response or transference issues, and; (5) use of the N-of-1 approach to test the new medication vs previous medications using patient specific outcomes that are anticipated to change with the pharmacologic management.
Links
Paul S
PS
Mental Health Service, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Cook
Michele
M
Quastel
Adam
A
D000328:Adult; D001883:Borderline Personality Disorder / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006801:Humans; D019966:Substance-Related Disorders / Q000628:therapy