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
Define personality
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
Define personality disorder
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
Give some reasons for treating personality disorder
Ease the distress it causes, ease suffering, reduce the impact of stigma, reduce service use, reduce associated morbidity and mortality
What is the main cause of death in individuals with personality disorder? (Fok et al, 2012)
Cardiovascular disease
What is the primary treatment for personality disorder?
Psychotherapy
State the ICD-10 definition of emotionally unstable personality disorder
A marked tendency to act impulsively with affective instability and minimal ability to plan ahead
Name the 2 variants of emotionally unstable personality disorder defined in ICD-10
Impulsive type and borderline type
Which classes of drugs could be useful for borderline personality disorder based on its symptoms?
Antidepressants (chronic feelings of emptiness), mood stabilisers (affective instability), antipsychotics (transient paranoid ideation)
Describe the evidence around antidepressants for personality disorder
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
Describe the evidence around antipsychotics for personality disorder
Antipsychotics reduce hostility, anger, and impulsivity, but also have significant side effects such as weight gain and many patients do not adhere
Describe the impact of clozapine on personality disorder (Frankenburg & Zanarini, 1993; Chengappa et al, 1999; Frogley et al, 2013)
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
Describe the evidence around mood stabilisers for personality disorder
Mood stabilisers reduce anger, depression, and impulsivity - although all trials have been small and of poor quality
What do the 2009 NICE guidelines state about pharmacological treatment and borderline personality disorder?
Drug treatment should not be used specifically for borderline personality disorder or behaviour associated with it
What does Lieb et al’s 2010 Cochrane review state about pharmacological treatment and borderline personality disorder?
Mood stabilisers and 2nd generation antipsychotics may be effective in treating symptoms associated with borderline personality disorder
What percentage of borderline personality disorder patients have a comorbid mental health condition?
75%