Psychopharmacological treatment of patients with borderline personality disorder: comparing data from routine clinical care with recommended guidelines

Abstract

Objectives: Borderline personality disorder (BPD) is a life-threatening mental disorder. Guideline recommendations for pharmacological treatment of patients with BPD vary widely. The objective of the present study was to investigate pharmacotherapy of BPD patients in a routine clinical care setting.

Methods: Data on the pharmacological treatment of 110 patients (90% female) with BPD (F- 60.3), treated in an inpatient psychiatric-psychosomatic clinic in Austria were assessed.

Results: Results show that clinicians frequently prescribe psychotropic medications to patients with BPD, in many cases multiple medications. The most commonly prescribed substance groups were antipsychotics, mood stabilisers and antidepressants. The most commonly prescribed individual drugs were Quetiapine, Lamotrigine and Setraline. There was no significant difference in the different types or overall number of medications prescribed to BPD patients with vs. without comorbid diagnoses. Pharmacotherapy was not related to comorbidity.

Conclusions: The present study shows that in routine clinical care settings psychotropic medications are frequently prescribed to patients with BPD, very often resulting in polypharmacy. A positive association between the number of medications and the effectiveness of the inpatient treatment program, as well as the absence of a relationship between number of medications and comorbidity contradicts the often suggested iatrogenic effect of polypharmacy.

Key points

• Guidelines for pharmacotherapy of borderline personality disorders lack consensus

• Yet, clinicians frequently prescribe psychotropic medications to BPD patients

• Types/number of medications prescribed to patients with vs. without comorbidities are similar

• Larger treatment effects are observed for patients with greater numbers of medications

• Further knowledge is needed about how and why clinicians prescribe medications

Keywords:

• Borderline personality disorder
• Pharmacotherapy
• pharmacological treatment
• comorbidity

Notes

Acknowledgements

We would like to thank two anonymous reviewers for their very helpful comments and suggestions.

We would like to thank Christoph Scheichl (IT specialist) for his help with extracting relevant data from the electronic routine outcome assessment system (‘Hogrefe Testsystem’) and from the hospital information system (‘KIS’).

The findings presented in this article have in part been presented during a poster session at the WPA XVII World Congress of Psychiatry Berlin 2017, e-Poster 008, ‘Pharmacological treatment for borderline personality disorder: comparing data from routine clinical care with recommended guidelines’.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 η_G² = generalized eta-squared, recommended for mixed factor ANOVAS (Lakens, 2013; Olejnik & Algina, 2003), cut-offs: .0099  =  small, .0588  =  medium, .1379  =  large (Cohen, 1988; Richardson, 2011).