Pharmacotherapy of patients with borderline personality disorder: Comparing data from routine clinical care with recommended guidelines Marta Farkas, Friedrich Riffer, Manuel Sprung, Lore Streibl & Elmar Kaiser Psychosomatisches Zentrum Waldviertel (Austria) Aims
Results
Naturalistic study of pharmacotherapy for patients with borderline personality disorder (BPD) in routine clinical practice in comparison with recommended guidelines. • APA, WFSBP and DGPPN guidelines recommend pharmacotherapy for symptoms of BPD with antidepressants (SSRI), antipsychotics and mood stabilizers. • N I C E a n d N H M R C g u i d e l i n e s recommend to avoid pharmacotherapy, if there are no comorbid diagnoses. Cochrane Review of RCTs: evidence for effectiveness of mood stabilizers and SGA European Drug Safety project: 70% antipsychotics, 33% mood stabilizers, 30% tranquilizers (benzodiazepine)
96,4% of patients in the present sample were prescribed at least 1 psychotropic medication. 33,6% were prescribed 1-2, 36,4% 3-4 and 26,4% 5 or more medications. Table 2. Psychotropic medications Categories / Types First generation antipsychotics (FGA) Second generation antipsychotics (SGA)
Mood stabilizers
Methods Retrospective analysis of data from a sample of BPD patients in an in-patient psychiatric-psychosomatic clinic in Austria. Data on pharmacotherapy, primary and secondary diagnoses and from routine outcome assessment (SCL-90, Global Severity Index) were analyzed.
Sample (N=110) 90% females, mean age = 29,4 (SD=8,4) 84,5% with comorbid diagnoses Table 1. Primary and secondary diagnoses Primary and secondary diagnoses
Number (%)
Tricyclic antidepressants (TCA)
Serotonin-norepinephrine reuptake inhibitors (SNRI)/ norepinephrinedopamine reuptake inhibitors (NDRI) (antidepressants) Selective serotonin reuptake inhibitors (SSRI) (antidepressants)
Other psychotropic medication
Primary Diagnosis F60.31 (emotionally unstable personality disorder–
95 (86%)
borderline type) F60.30 (emotionally unstable personality disorder–
12 (11%)
impulsive type) F60.3 (emotionally unstable personality disorder)
3 (3%)
Active Substances N % Levomepromazine 5 4,5 Chlorprothixene 20 18,2 Total FGA 25 22,7 Risperidone 3 2,7 Aripiprazole 15 13,6 Olanzapine 5 4,5 Quetiapine 32 29,1 Ziprasidone 2 1,8 Paliperidone 1 0,9 Risperiodone+ Aripiprazole 1 0,9 Aripiprazole + Quetiapine 10 9,1 Aripiprazole + Olanzapin 6 5,5 Aripiprazole+ Amisulpride 1 0,9 Amisulpride+ Quetiapine 1 0,9 Total SGA 77 70 Lamotrigine 35 31,8 Topiramate 4 3,6 Oxcarbazepine 1 0,9 Levetiracetam 1 0,9 Valproate 5 4,5 Total mood stabilizers 46 41,8 Trazodone 32 29,1 Amitriptyline 1 0,9 Trazodone+ Amitriptyline 1 0,9 Colomipramine 1 0,9 Total TCA 35 31,8 Venlaflaxine 14 12,7 Duloxetine 4 3,6 Bupropion 4 3,6 Mirtazapine 2 1,8 Venlaflaxine+ Mirtazapine 1 0,9 Total SNRI / NDRI 25 22,7 Setraline 37 33,6 Escitalopram 3 2,7 Fluoxetine 11 10,0 Paroxetine 2 1,8 Citalopram 1 0,9 Total SSRI 54 49,1 Methylphenydate, Pregabalin, Prothipendyl, Zolpidem, Naltrexon, Hydromorphon, Alprazolam, Hydroxyzine, Morphine, Lithium, Gabapentin, Valerian, Tetrazepam, Pramipexole Total other 62 56,4
Figure 1. Mean number of medications of patients with vs. without comorbid diagnoses
Secondary (Comorbid) Diagnoses Eating disorders (Bulimia Nervosa, Anorexia Nervosa or
39 (35,5%)
33 (30%)
Recurrent depressive disorder
23 (21%)
Posttraumatic stress disorder (PTSD)
23 (21%)
Obesity
22 (20%)
Bipolar disorder
11 (10%)
Obsessive compulsive disorder (OCD)
8 (7%)
Panic disorder or generalized anxiety disorder (GAD)
8 (7%)
Social anxiety disorder
2 (2%)
At least 1 comorbid diagnosis
93 (84,5%)
2 or more comorbid diagnoses
50 (45,5%)
3 or more comorbid diagnoses
17 (15,5%)
Sources can be obtained from the authors (please contact
[email protected])
à S i g n i fi c a n t t r e a t m e n t e f f e c t [F(1,72)=8,15,p
