Abstract
BackgroundThe 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).MethodsCharts 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.Results94% 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.ConclusionsIn 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.
Highlights
The purpose of this study was to assess the pharmacological treatment strategies of inpatients with borderline personality disorder between 2008 and 2012
With respect to the period 1996 to 2004 we found 142 patients being eligible for inclusion out of a total of 198 treated patients. 56 patients were excluded as borderline personality disorder (BPD) was not main diagnosis, patients were exclusively treated in an outpatient setting or no further data were available
Outdated, recommendations of the APA (American Psychiatric Association) [45] suggested a syndrome-oriented use of medication, the newer NICE-Guideline of the United Kingdom in 2009 [46], which was recently confirmed by the NICE surveillance report of personality disorders [47], and the most recent Australian NHMRC guideline do not recommend psychotropic substances as a basic therapeutic strategy in BPD per se and emphasize the superiority of psychotherapy
Summary
The purpose of this study was to assess the pharmacological treatment strategies of inpatients with borderline personality disorder between 2008 and 2012. We compared pharmacotherapy during this period to a previous one (1996 to 2004). A large epidemiologic study published in 2008 and a revised study in 2010 estimated the lifetime prevalence of borderline personality disorder (BPD) at 5.9% or 2.7%, respectively [1, 2]. Epidemiologic data show a high prevalence of patients with BPD in the medical care system. BPD is found in 50% of inpatients having attempted to suicide in the last two previous years and in 15–28%. All studies reporting long-term efficacy of treatments for BPD have to be seen in the light of spontaneous remission. Direct and indirect costs to society are enormous and better treatment strategies are needed [12]
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