Pharmacotherapy for borderline patients: business as usual or by default?
In their analysis of a representative sample from the Prescribing Observatory for Mental Health in the UK health services, Paton et al found that 92% of patients with borderline personality disorder (BPD) received prescriptions for psychotropic medications. Although international guidelines recommend pharmacotherapy for comorbid psychiatric disorders whenever necessary, 82% of the UK BPD patients without such comorbid conditions nevertheless received pharmacotherapy "by default," mostly off-label polypharmacy without adequate psychiatric controls for effectiveness and tolerability. Business as usual? Bad care? International practice guidelines for the treatment of BPD all recommend evidence-based psychological treatment whenever possible (especially manualized psychotherapy like dialectical behavior therapy, schema-focused therapy, mentalization-based treatment, transference-focused psychotherapy) as the first-choice treatment.
Symfora Group, Treatment Center for Personality Disorders, Wim Sonneveldlaan 53, Utrecht, 3584ZP, The Netherlands t.ingenhoven@tip.nl.
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Ingenhoven
D000342:Affective Symptoms / Q000188:drug therapy* / Q000453:epidemiology*; D001883:Borderline Personality Disorder / Q000188:drug therapy* / Q000453:epidemiology*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010554:Personality Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D013222:State Medicine / Q000706:statistics & numerical data*
D011619:Psychotropic Drugs