Pro Re Nata (As Needed) Psychotropic Medication Use in Patients With Borderline Personality Disorder and Subjects With Other Personality Disorders Over 14 Years of Prospective Follow-Up

A Type 2 randomized clinical trial (RCT) of psychosocial treatment for avoidant personality disorder compared three group-administered behavioral interventions (graded exposure, standard social skills training, intimacy-focused social skills training) with a wait-list control; although all three treatments were more efficacious than the control condition, no differences among the treatments were identified either after the 10-week treatment or at follow-up. For the treatment of borderline personality disorder, a Type 1 RCT randomized 101 women with recent suicidal and self-injurious behaviors and borderline personality disorder to either dialectical behavior therapy (DBT) or community-treatment-by-experts psychotherapists (CTBE). Over the 2-year treatment and follow-up period, DBT was superior to CTBE on rates of suicide attempt, hospi-talization for suicide ideation, and overall medical risk (combining suicide attempts and self-injurious acts). Patients in the DBT group were also less likely to drop out of treatment and had fewer psychiatric emergency room visits and fewer psychiatric hospitalizations. There were no significant group differences on measures of depression, reasons for living, and suicide ideation, with patients in both treatment groups improving significantly on these measures. Four additional Type 2 and Type 3 studies support the efficacy of DBT as a treatment for borderline personality disorder with or without comorbid substance abuse or dependence. No RCTs of psychological treatment for other personality disorders have been reported. Several review articles have found a consistent adverse impact of personality disorders on outcomes of treatment for a wide range of Axis I disorders.

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Psychotropic medication use in hospitalized patients with borderline personality disorder

Mental Health Clinician ◽

10.9740/mhc.2016.03.68 ◽

2016 ◽

Vol 6 (2) ◽

pp. 68-74

Author(s):

Karen E Moeller ◽

Amad Din ◽

Macey Wolfe ◽

Grant Holmes

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Psychotropic Medication ◽

Medication Use ◽

Retrospective Chart Review ◽

Borderline Personality ◽

Hospitalized Patients ◽

Mood Stabilizers ◽

Control Group ◽

Sedative Agents

Abstract Introduction: Use of medications to treat symptoms of borderline personality disorder (BPD) is controversial. The purpose of this study was to describe psychotropic medication use in hospitalized patients with BPD and compare with a control group. Methods: A retrospective chart review was conducted on hospitalized patients aged 18-65 years having a diagnosis of BPD and compared them with a control group of patients with a diagnosis of major depressive disorder (MDD) without a personality disorder. Patients were excluded from the BPD group if other personality disorders were recorded. Charts were reviewed for demographics and psychotropic medication usage both prior to admission and at discharge. Results: This study included 165 patients (85 in BPD; 80 in MDD). Prior to admission and upon discharge, patients in the BPD group were prescribed significantly more psychotropic medications than patients with MDD (3.21 vs 2.10; P < .001 and 2.87 vs 2.35; P < .05, respectively). Patients in the BPD group were significantly more likely to be prescribed antipsychotics, mood stabilizers, and miscellaneous agents compared with the MDD group. On admission, significantly more BPD patients were prescribed multiple sedative agents (37.6% vs 21.3%; P < .05), but because of the discontinuation of sedative agents, this difference was nonsignificant upon discharge. Discussion: This study found increased medication utilization among patients with BPD. Polypharmacy may increase the risk of side effects, drug interactions, and drug toxicity for BPD patients. Clinicians need to carefully evaluate the efficacy and risk of medications prescribed in patients with BPD.

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Predictors of Slower Time-to-Cessation of Individual Therapy for Borderline Patients Over 16 Years of Prospective Follow-Up

Journal of Personality Disorders ◽

10.1521/pedi_2018_32_335 ◽

2019 ◽

Vol 33 (1) ◽

pp. 135-144

Author(s):

Dana B. Borkum ◽

Frances R. Frankenburg ◽

Garrett M. Fitzmaurice ◽

Argyro Athanasiadi ◽

Christina M. Temes ◽

...

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Personality Disorders ◽

Childhood Adversity ◽

Borderline Personality ◽

Individual Therapy ◽

Childhood Neglect ◽

Borderline Patients ◽

History Of

The current study assesses time-to-cessation of individual therapy for patients with borderline personality disorder (BPD) and comparison subjects with other personality disorders (OPD) after 16 years of prospective follow-up. It also details the multivariate factors that predict this outcome for those with BPD. At baseline, 290 patients met criteria for BPD and 72 met criteria for OPD. Individuals with BPD had a significantly slower time-to-cessation of individual therapy than OPD comparison subjects. Seven baseline variables were found to be significant multivariate predictors of a slower time-to-cessation of individual therapy: older age, being white, severity of childhood neglect, history of a mood disorder, an IQ less than 90, poor vocational record prior to index admission, and higher level of trait neuroticism. The results of this study suggest that prediction of slower time-to-cessation of individual therapy is multifactorial in nature, involving factors related to demographics, childhood adversity, comorbidity, individual competence, and temperament.

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Predictors of 18-month outcome for patients with borderline personality disorder

European Psychiatry ◽

10.1016/s0924-9338(11)72731-6 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 1026-1026 ◽

Cited By ~ 1

Author(s):

D. Karaklic ◽

J. Thuile ◽

B. Granger ◽

I. Secret ◽

C. Bungener

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Personality Disorders ◽

Life Events ◽

Borderline Personality ◽

Self Report ◽

Global Functioning ◽

Borderline Patients

IntroductionFor quite a long time, borderline personality disorder (BPD) has been viewed as a chronic disorder and borderline patients as extremely difficult to treat. However, those views are changing and there is an increasing recognition that the BPD has a far more benign course than previously thought, but predictors of its outcome remain poorly explored.Objective and aimsThe purpose of this study was to determine the most clinically relevant predictors of the outcome of BPD at the 18-month follow-up.MethodsBorderline patients (n = 75) were compared to patients with other personality disorders (OPD) (n = 40). All subjects were assessed at baseline and 6, 12, and 18 months with a series of semi structured interviews (personality disorders, global functioning, mental disorders, life events, …) and self-report measures (alexithymia and impulsivity). Logistic regression was used to estimate hazard ratios.ResultsAt the 18-month follow up, 57 BPD patients and 22 with OPD have been evaluated, 45% of borderline subjects and 50% of the OPD subjects achieved remission. Low impulsivity, low alexithymia, good global functioning, and older age at onset of symptoms were found to be significant predictors of good outcome of BPD. Our clinical data suggest that life events and the quality of current relationships are determinant in the outcome of BPD.Conclusions45% of patients with BPD are likely to improve in 18-months. Specific factors, such as impulsivity, alexithymia, life events and quality of current relationships, determine the short-term outcome of this disorder.

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