Borderline personality disorders treatment

NICE (2009) CG78 Borderline personality disorder Treatment and management. 

Psychoses, when they occur, appear to be due to drug effect interacting with a vulnerable personality organization (Luisada 1978). Our experience has been that some adolescents with borderline personality disorders, as well as adolescents at risk of schizophrenic decompensation, may have this vulnerability. Although we do not have hard data to support the hypothesis that patients with PCP psychoses that are most resistant to treatment have the poorest long-term prognosis (Erard et al. 1980), our observations have been that persistence of symptoms of psychosis after the first 2 to 3 weeks of treatment often correlates with extended periods of impai rment. 

Linehan, M. M. (1993). Cognitive-behavioral treatment of Borderline Personality Disorder. New York Guilford Press. 

Borderline Personality Disorder (BPD). In selecting a treatment for BPD, there are two key considerations. First, one should choose the treatment that will... 

I Unlabeled Uses Treatment of anorexia, apathy borderline personality disorder, Huntington s disease maintenanceof long-term treatment response in schizophrenic patients nausea vomiting... 

American Psychiatric Association Practice Guideline for the Treatment of Patients With Borderline Personality Disorder. Washington, DC, American Psychiatric Association, 2001... 

ATOS). Addiction, 98, 1129-35 Darke S, Ross J, Williamson A, Mills KL, Harvard A Teesson M (2007). Borderline personality disorder and persistently elevated levels of risk in 36 month outcomes for the treatment of heroin dependence. Addiction, 102, 1140-6... 

Teicher MH, Glod CA, Aaronson ST, et al. Open assessment of the safety and efficacy of thioridazine in the treatment of patients with borderline personality disorder. Psychopharmacol Bull 1989 25 535-549. 

Gardner DL, Cowdry RW. Development of melancholia during carbamazepine treatment in borderline personality disorder. J Clin Psychopharmacol 1986 6 236-239. 

Benedetti F, Sforzini L, Colombo C, et al. Low-dose clozapine in acute and continuation treatment of severe borderline personality disorder. J Clin Psychiatry 1998 59 103-107. 

In an 8-week, double-blind, placebo-controlled study of topiramate 250 mg/day in the treatment of aggression in 42 men with borderline personality disorder there was significant weight loss of 5.0 kg (95% Cl = 3.4, 6.5) (1129). There were no psychotic symptoms or other... 

Zanarini M. C. and Frankenburg F. R. (2003). Omega-3 fatty acid treatment of women with borderline personality disorder A double-blind, placebo-controlled pilot study. Am. J. Psychiat. 160 167-169. 

Perrella C, Carrus D, Costa E and Schifano F (2007) Quetiapine for the treatment of borderline personality disorder an open label study. Progress in Neuropsychopharmacology and Biological Psychiatry 31 158-163. 

Of 12 in-patients with borderline personality disorder treated with clozapine for 16 weeks, 10 developed sedation, which disappeared during the first month of treatment 9 had hypersialorrhea, and 6 had falls in white blood cell counts, which never reached unsafe values. 

Crisis meets limit setting without abandonment —this is the treatment sequence for those with borderline personality disorder who are in crisis, and it will be repeated in crises large and small, many hundreds of times, over the years of therapy. When the patient is not in crisis, other... 

The following case illustrates many of the considerations, pharmacological and otherwise, that need to be considered in the treatment of the patient with borderline personality disorder. 

The request for medications (explicit or implicit) by dependent patients, often conveys a need to be fed. Aside from direct medication effects, the gratification experienced by the patient when given drugs may account for symptomatic improvement. It is also important to note that once the therapist prescribes medications (however appropriate this may be) in some way he or she has strayed from a position of neutrality, and this may have consequences for the therapeutic relationship. Conversely, the choice not to prescribe or recommend medications may be seen as "withholding." The symbolic-dynamic issues discussed here are also important concerns in the treatment of clients with borderline personality disorders. 

In addition to these subtypes, it is important to keep in mind that many, if not most, borderline personalities have comorbid Axis I disorders—especially common are major depression and substance abuse. These coexisting disorders always complicate the picture and must be dealt with in any approach to treatment. In particular, longitudinal studies following the course and outcome of borderline personality disorders over the life span suggest very clearly that those patients who continue to do poorly are those who continue to abuse alcohol and other substances. Thus treatment of chemical dependency problems must be addressed. 

Norden, M. J. 1989. Is there an effective drug treatment for borderline personality disorder Harvard Mental Health Letter 6 8. 

Preston, J. D. 1997. Shorter Term Treatments for Borderline Personality Disorders. Oakland, Calif. New Harbinger Publications. 

SHORTER TERM TREATMENTS FOR BORDERLINE PERSONALITY DISORDERS... 

This much-needed professional guide offers treatment approaches aimed toward realistic short-term goals helping clients with borderline personality disorder to stabilize emotions, decrease vulnerability, and work toward more adaptive day-to-day functioning. The author covers diagnostic issues, reviews the treatment implications of the disorder s core characteristics, and details specific treatment strategies drawn from a variety of different models and approaches. By John D. Preston, Psy.D. Hardcover, 39.95... 

Thioxanthenes are used in the treatment of psychosis, including schizophrenia, senile psychosis, pathological jealousy, and borderline personality disorder. Other uses include the treatment of pain, postoperative neuralgia, sedation, anxiety neurosis, childhood behavior problems, and depression. The maximum therapeutic daily oral dose for chlorprothixene, flupenthixol, and thiothixene is 600, 224, and 60 mg respectively the maximum intramuscular dose of each is 200 mg day 100 mg weekly, and 30 mg dayrespectively. Some thioxanthenes and thioxanthenones have shown signs in mice and in vitro assays of possible human therapeutic potential against tumors, and some thioxanthenes have been shown to have cytotoxic and antimicrobial activities. 

Practice guidelines for the treatment of patients with borderline personality disorder. Am J Psychiatry 2001 ... 

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