scholarly journals Psychotropic medication use in hospitalized patients with borderline personality disorder

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.

A retrospective chart review: adolescents with borderline personality disorder, borderline personality traits, and controls

2016 ◽  
Vol 30 (2) ◽  
Author(s):  
Ellen N. Jopling ◽  
Sarosh Khalid-Khan ◽  
Shivani F. Chandrakumar ◽  
Shira C. Segal
Keyword(s):  
Mental Health ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Mortality Rate ◽  
Chart Review ◽  
Adult Population ◽  
Retrospective Chart Review ◽  
Borderline Personality ◽  
Control Group ◽  
Disruptive Disorders

Abstract With an estimated lifetime prevalence as high as 5.9% in the general population, borderline personality disorder (BPD) is a psychiatric disorder characterized by marked impulsivity as well as difficulties in interpersonal relationships, self-image, and affects. The burden on the health care system is immense with BPD patients accounting for 10%–20% of the patients in mental health outpatient facilities and 15%–40% in mental health inpatient facilities. Further, while 75%–80% of BPD patients attempt to commit suicide, 10% succeed; this mortality rate exceeds even that of anorexia nervosa which, with a weighted mortality rate of 5.1%, has often been considered to have the highest mortality rate of any mental disorder. In order to provide treatment and to implement preventative measures, a risk profile as well as clinical features must be identified within the adolescent population. This is presently crucial, as the current criteria for BPD are not developmentally focused, and as a result, criteria initially developed for the adult population are being applied in diagnoses of adolescents. A population of adolescents (n=80) between 16 and 19 years of age meeting the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria either for BPD traits (n=46) or for BPD (n=36) were included in a retrospective chart review; a control group consisting of n=30 mood and anxiety control subjects were included to allow for further comparisons. Complex significant differences were discovered between the three groups in the following areas: history of sexual abuse, suicidal ideation, internalizing/externalizing symptoms, interpersonal difficulties, impulsivity, pre-perinatal stress, bullying, substance abuse, anxiety disorders, disruptive disorders, and finally, learning disorders.

scholarly journals Pharmacotherapy of borderline personality disorder: what has changed over two decades? A retrospective evaluation of clinical practice

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Charles Timäus ◽  
Miriam Meiser ◽  
Borwin Bandelow ◽  
Kirsten R. Engel ◽  
Anne M. Paschke ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychotropic Drug ◽  
Inpatient Treatment ◽  
Medical Center ◽  
Borderline Personality ◽  
Mood Stabilizers ◽  
Main Diagnosis ◽  
Tetracyclic Antidepressants ◽  
Prescription Rates

Abstract Background The purpose of this study was to assess the pharmacological treatment strategies of inpatients with borderline personality disorder between 2008 and 2012. Additionally, we compared pharmacotherapy during this period to a previous one (1996 to 2004). Methods Charts of 87 patients with the main diagnosis of borderline personality disorder receiving inpatient treatment in the University Medical Center of Goettingen, Germany, between 2008 and 2012 were evaluated retrospectively. For each inpatient treatment, psychotropic drug therapy including admission and discharge medication was documented. We compared the prescription rates of the interval 2008–2012 with the interval 1996–2004. Results 94% of all inpatients of the interval 2008–2012 were treated with at least one psychotropic drug at time of discharge. All classes of psychotropic drugs were applied. We found high prescription rates of naltrexone (35.6%), quetiapine (19.5%), mirtazapine (18.4%), sertraline (12.6%), and escitalopram (11.5%). Compared to 1996–2004, rates of low-potency antipsychotics, tri−/tetracyclic antidepressants and mood stabilizers significantly decreased while usage of naltrexone significantly increased. Conclusions In inpatient settings, pharmacotherapy is still highly prevalent in the management of BPD. Prescription strategies changed between 1996 and 2012. Quetiapine was preferred, older antidepressants and low-potency antipsychotics were avoided. Opioid antagonists are increasingly used and should be considered for further investigation.

scholarly journals Hypothalamic-pituitary-adrenal axis response in borderline personality disorder without post-traumatic features

2007 ◽  
Vol 190 (4) ◽  
pp. 357-358 ◽  
Author(s):  
Jose L. Carrasco ◽  
Marina Díaz-Marsá ◽  
Jose I. Pastrana ◽  
Rosa Molina ◽  
Loreto Brotons ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Feedback Inhibition ◽  
Borderline Personality ◽  
Dexamethasone Suppression Test ◽  
Control Group ◽  
Hypothalamic Pituitary Adrenal ◽  
Suppression Test ◽  
Post Traumatic ◽  
Dexamethasone Suppression

SummaryHypothalamic–pituitary–adrenal (HPA) axis sensitivity was investigated in 32 non-medicated patients with borderline personality disorder without comorbid post-traumatic syndromes and in 18 normal individuals using a modified dexamethasone suppression test (0.25 mg). Enhanced cortisol suppression was found in the patients v. controls (P < 0.05) and the percentage of participant's with non-suppression was smaller in the patient (34%) than in the control group (89%) (P < 0.01). Baseline cortisol levels in the patients were also lower than in the controls (P < 0.05). The 0.25 mg dexamethasone suppression test reveals increased feedback inhibition of the HPA in borderline personality disorder.

When Trust Does Not Come Easily: Negative Emotional Information Unduly Influences Trustworthiness Appraisals for Individuals With Borderline Personality Features

2020 ◽  
Vol 34 (3) ◽  
pp. 394-409 ◽  
Author(s):  
Sara R. Masland ◽  
Jill M. Hooley
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Borderline Personality ◽  
Control Group ◽  
Undue Influence ◽  
Emotional Information ◽  
Consistent Finding ◽  
Emotional Context ◽  
State Dependent ◽  
Personality Features

Individuals with borderline personality disorder and subclinical borderline features perceive others as untrustworthy (e.g., Fertuck, Grinband, & Stanley, 2013). Trust difficulties may be influenced by emotional state and are formally articulated in the diagnostic criteria for the disorder as temporary state-dependent paranoia. The current study examines the influence of emotional information on trustworthiness appraisals. Seventy-seven community adults, ranging in age from 18 to 70 (M = 31.53, SD = 14.01), with three or more borderline personality disorder symptoms (n = 30) or two or fewer symptoms (n = 47), completed an affective priming paradigm. They were exposed to negative, neutral, or positive information before rating the trustworthiness of unfamiliar faces. Individuals with borderline pathology made more untrusting appraisals regardless of prime, and they were more greatly influenced by negative primes relative to the control group. Findings suggest that biased trustworthiness appraisal is a replicable and consistent finding for individuals with borderline pathology, and that emotional context, even if unrelated to the appraisal at hand, has undue influence.

Do Mood Stabilizers Help in Borderline Personality Disorder?

2017 ◽  
Vol 41 (S1) ◽  
pp. S47-S47
Author(s):  
B. Völlm ◽  
J. Stoffers-Winterling ◽  
J. Mattivi ◽  
E. Simonson ◽  
O.J. Storebø ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Meta Analysis ◽  
Cochrane Review ◽  
Evidence Base ◽  
Borderline Personality ◽  
Mood Stabilizers ◽  
Beneficial Effects ◽  
Drug Classes ◽  
Competing Interest

BackgroundDespite the relatively weak evidence base, individuals with borderline personality disorder are often treated with pharmacological interventions. Amongst the drugs, which have shown most promise, are mood stabilizers, which were one of the two drug classes with the most beneficial effects in a previous cochrane review though the robustness of findings was described as low (Stoffers et al., 2010). Here we present data on the latest evidence for mood stabilizers based on an updated cochrane review currently underway.MethodsA systematic review and meta-analysis of randomized controlled trials was conducted. All randomized comparisons of drug vs. placebo, drug vs. drug, or drug vs. a combination of drugs in adult BPD patients were eligible for inclusion. Outcomes comprised BPD core pathology as depicted by DSM criteria, associated pathology, i.e., depression and anxiety, general measures of overall psychopathology severity, tolerability, and adverse effects. Two researchers selected trials, assessed quality and extracted data independently.ResultsOnly a limited number of additional trials using mood stabilizers was identified since the publication of the last cochrane review, mainly utilizing Sodium Valproate. This added to the evidence base for mood stabilizers though the overall evidence remains very limited.ConclusionMood stabilizers show some initial evidence for their effectiveness in borderline personality disorder. However, these have to be replicated before wider conclusions can be drawn for clinical practice.Disclosure of interestThe authors declare that they have no competing interest.

scholarly journals Mentalizing Based on External Features in Borderline Personality Disorder Compared With Healthy Controls: The Role of Attachment Dimensions and Childhood Trauma

2019 ◽  
Vol 33 (6) ◽  
pp. 736-750 ◽  
Author(s):  
Martijn Van Heel ◽  
Patrick Luyten ◽  
Celine De Meulemeester ◽  
Dominique Vanwalleghem ◽  
Rudi Vermote ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Childhood Trauma ◽  
Mental States ◽  
Borderline Personality ◽  
Control Group ◽  
Healthy Controls ◽  
Avoidant Attachment ◽  
The Mind ◽  
Attachment Dimensions

Extant research suggests that borderline personality disorder (BPD) is associated with impairments in mentalizing, that is, comprehending behavior in terms of underlying mental states. However, the precise nature of these impairments remains unclear. The literature is mixed concerning mental-izing based on external features of others, and specifically facial emotion recognition (FER) in BPD patients. This study investigated FER differences in 79 BPD patients and 79 matched healthy controls using the Reading the Mind in the Eyes Test (RMET). The authors also investigated attachment dimensions and childhood trauma in relation to mentalizing based on external features. Results showed that BPD patients performed worse on positive and negative emotions. Furthermore, avoidant attachment was negatively related to FER for neutral emotions, particularly in the control group. Trauma was negatively related to FER at trend level, particularly in BPD patients. The implications for this understanding of mentalizing based on external features in BPD are discussed.

Differential Diagnosis of Borderline Personality Disorder from Bipolar Disorder

2010 ◽  
Vol 32 (3) ◽  
pp. 189-205 ◽  
Author(s):  
Gregory Hatchett
Keyword(s):  
Bipolar Disorder ◽  
Differential Diagnosis ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Atypical Antipsychotics ◽  
Treatment Approach ◽  
Borderline Personality ◽  
Mood Stabilizers ◽  
Health Counseling ◽  
Dsm V

Many psychiatrists have reconceptualized borderline personality disorder (BPD) as a variant of bipolar disorder and, consistent with the treatment of bipolar disorder, emphasize the use of mood stabilizers and atypical antipsychotics in treatment. This change in diagnostic practice is unfortunate. BPD is a distinct diagnostic construct, and clients who fit this pattern require a fundamentally different treatment approach than what is typically recommended for bipolar disorder. The purpose of this article is to update counselors on the expansion of bipolar disorder in the psychiatric literature, present evidence for the validity of BPD, discuss strategies for the differential diagnosis of it from bipolar disorder, review proposed changes in DSM-V, and integrate the literature into a mental health counseling framework.

Facial emotional expression in reaction to social exclusion in borderline personality disorder

2011 ◽  
Vol 41 (9) ◽  
pp. 1929-1938 ◽  
Author(s):  
K. Staebler ◽  
B. Renneberg ◽  
M. Stopsack ◽  
P. Fiedler ◽  
M. Weiler ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Social Exclusion ◽  
Social Contexts ◽  
Emotional Reactions ◽  
Borderline Personality ◽  
Emotional Expressions ◽  
Control Group ◽  
Coding System ◽  
Emotional Facial Expressions

BackgroundDisturbances in social interaction are a defining feature of patients with borderline personality disorder (BPD). In this study, facial emotional expressions, which are crucial for adaptive interactions in social contexts, were assessed in patients with BPD in response to social exclusion.MethodWe examined facial emotional reactions of 35 patients with BPD and 33 healthy controls when playing Cyberball, a virtual ball-tossing game that reliably induces social exclusion. Besides self-reported emotional responses, facial emotional expressions were analyzed by applying the Emotional Facial Action Coding System (EMFACS).ResultsPatients with BPD showed a biased perception of participation. They more readily reported feeling excluded compared to controls even when they were included. In BPD, social exclusion led to an increase in self-reported other-focused negative emotions. Overall, EMFACS analyses revealed that BPD patients reacted with fewer positive expressions and with significantly more mixed emotional expressions (two emotional facial expressions at the same time) compared to the healthy control group when excluded.ConclusionsBesides a negative bias for perceived social participation, ambiguous facial emotional expressions may play an important role in the disturbed relatedness in patients with BPD.

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