Pharmacotherapy and Personality Disorder Flashcards

Summarise current evidence on pharmacotherapy for personality disorder Describe current practice in treatment of personality disorder Understand the challenges in treatment of personality disorder

1
Q

Define personality

A

The pattern of thoughts, feelings, and behaviours which makes every individual the person that they are. This pattern is flexible, with behaviour differing according to social situation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define personality disorder

A

An enduring maladaptive pattern of perceiving, relating to, and thinking about the environment and oneself - this pattern is inflexible, deviates from cultural expectations, and impairs function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Give some reasons for treating personality disorder

A

Ease the distress it causes, ease suffering, reduce the impact of stigma, reduce service use, reduce associated morbidity and mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the main cause of death in individuals with personality disorder? (Fok et al, 2012)

A

Cardiovascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the primary treatment for personality disorder?

A

Psychotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

State the ICD-10 definition of emotionally unstable personality disorder

A

A marked tendency to act impulsively with affective instability and minimal ability to plan ahead

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Name the 2 variants of emotionally unstable personality disorder defined in ICD-10

A

Impulsive type and borderline type

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which classes of drugs could be useful for borderline personality disorder based on its symptoms?

A

Antidepressants (chronic feelings of emptiness), mood stabilisers (affective instability), antipsychotics (transient paranoid ideation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the evidence around antidepressants for personality disorder

A

Out of the 7 trials, 6 found no beneficial effects. The last found amitriptyline caused a reduction in depressive symptoms - but these individuals could have had comorbid depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the evidence around antipsychotics for personality disorder

A

Antipsychotics reduce hostility, anger, and impulsivity, but also have significant side effects such as weight gain and many patients do not adhere

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the impact of clozapine on personality disorder (Frankenburg & Zanarini, 1993; Chengappa et al, 1999; Frogley et al, 2013)

A

Clozapine reduces impulsive behaviour, affect-related symptoms, aggresion, and self-harming behaviour, It effects appear greatest in the first 6 months, and are associated with a significant increase in weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe the evidence around mood stabilisers for personality disorder

A

Mood stabilisers reduce anger, depression, and impulsivity - although all trials have been small and of poor quality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What do the 2009 NICE guidelines state about pharmacological treatment and borderline personality disorder?

A

Drug treatment should not be used specifically for borderline personality disorder or behaviour associated with it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does Lieb et al’s 2010 Cochrane review state about pharmacological treatment and borderline personality disorder?

A

Mood stabilisers and 2nd generation antipsychotics may be effective in treating symptoms associated with borderline personality disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What percentage of borderline personality disorder patients have a comorbid mental health condition?

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

State the 2 most common comorbidities of borderline personalty disorder

A

Depression and substance misuse

17
Q

Why is the level of medication prescription high in personality disorder?

A

Patient’s fear of abandonment, lack of trust (no drugs = no care), clinician counter-transference, clinician guilt over not doing enough

18
Q

Describe the results of Evans’ 2014 study on the clinician-patient relationship in personality disorder

A

It is punctuated by feelings of helplessness and discontinuity. Patients feel there is a lack of knowledge and understanding, and clinicians rely on medication due to a lack of involvement. Patients also believe they should help to decide if medication is appropriate

19
Q

What is lamotrigine?

A

A sodium channel blocker used in treatment of epilepsy and as a mood stabiliser in bipolar disorder

20
Q

State some side effects of lamotrigine

A

Nausea, insomnia, fatigue, rhinitis, rash, neck stiffness. 1 in 1,000 develop a severe rash that is fatal if not treated

21
Q

Describe the results of the LABILE study on lamotrigine for borderline personality disorder

A

Lamotrigine had no benefit over placebo on any outcome - including BDI score, alcohol use, substance misuse, or self-harm