Abstract
Borderline personality disorder (BPD) patients, when in crisis, are frequent visitors of emergency departments (EDs). When these patients exhibit symptoms such as aggressiveness, impulsivity, intense anxiety, severe depression, self-harm, and suicidal attempts or gestures, diagnosis, and treatment of the BPD becomes challenging for ED doctors. This review will, therefore, outline advice to physicians and health-care providers who face this challenging patient population in the EDs. Crisis intervention should be the first objective of clinicians when dealing with BPD in the emergency. For the patients with agitation, symptom-specific pharmacotherapy is usually recommended, while for non-agitated patients, short but intensive psychotherapy especially dialectical behavior therapy (DBT) has a positive effect. Although various psychotherapies, either alone or integrated, are preferred modes of treatment for this group of patients, the effects of psychotherapies on BPD outcomes are small to medium. Proper risk management along with developing a positive attitude and empathy toward these patients will help them in normalizing in an emergency setting after which treatment course can be decided.
Highlights
The Diagnostic and Statistics Manual for Mental Disorders, fifth edition [2] classifies borderline line personality disorder (BPD) as a cluster B personality disorder and describes it as “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins by early adulthood and is present in a variety of contexts” [2]
The results suggested that short-term intensive care at the general hospital may contribute to BPD emergency this treatment is not considered as an alternative to structured psychiatric acute treatment
Quetiapine 100–800 mg/day for The results showed that quetiapine may be effective in the 12 weeks treatment of impulsivity and affective symptoms in BPD
Summary
Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology [1], a search for relevant published literature was done using PubMed. The key words and phrases used together with Boolean operators included: “borderline personality disorder in emergency department” (Mesh), “borderline personality disorder pharmacotherapy and psychotherapy” (Mesh), “dialectical behavior therapy, cognitive behavioral therapy in borderline personality disorder” (Mesh), borderline personality disorder and cluster B personality disorders (Mesh), “borderline personality disorder and impulsivity, aggression, suicidality” (Mesh). Other relevant studies were found by a review of the primary studies obtained in the search as well as reference tracing of selected articles. Eligible studies were included if they were observational or interventional in which pharmacotherapy or psychotherapy were investigated as immediate or follow-up treatment. We included both observational and interventional studies whether with control groups or not. Peer-reviewed research studies, which were published in the English. From the 396 articles obtained, only 71 studies were relevant to the topic of review. After a full-text review, 56 of the 71 relevant articles were found and used to extract qualitative data and summarize the findings from this literature review (Tables 1 and 2)
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