Pharmacotherapy for personality disorder

Question 1

What is personailty disorder?

Answer 1

Ensuring maladaptive pattern of perceiving, relating to and thinking about the environment an oneself.

Deviates from cultural expectations

Question 2

What % of mental health inpatient units are borderline personality disorder?

Answer 2

20%

Question 3

What are the 4 classes in the DSM-IV criteria, and what do they involve?

Answer 3

Affective:

• Inappropriate intense anger
• Chronic feelings of emptiness
• Affective instability.

Congitive:

• Transient paranoid ideation or severe dissociative symptoms
• Identity disturbance

Behavioural:
-Suicidal behaviour, threats, self mutilating.

Interperesonal:
–Frantically avoids abandonment
UnStable and intense relationships

Question 4

Why is it ‘borderline’ PD?

Answer 4

It is the borderline between psychosis and neurosis, borderline between mental illness and normal.

Question 5

What are the 2 ICD types of PD?

Answer 5

Impulsive type

Borderline type

Question 6

Which medication can be used for the 4 domains?

Answer 6

Affective- antidepressants?
Affective instabilty- mood stablisers

Cognitive- Antipsychotics?

Be

Question 7

Antidepressants

Answer 7

6 trials no beneficial evidence, 1 trial reported reduction (Amitriptyline)

But, 30% of people in contact with services meet criteria for depression.

Question 8

Antipsychotics

Answer 8

Some evidence of reductions in hostility, anger and impulsivity.

There is no trial to see if clozapine works.

But, short term, and many side effects.

Question 9

Mood stablisers?

Answer 9

9 trials, lead to reductions in anger, depression and impulsivity. But, sample size small.

Question 10

How does Lamotrigine work?

Answer 10

It is used extensively in epilepsy & Bipolar disorder.

It is a sodium channel blocker. Reduces instability of mood and prevents episodes of depression.

Minority experience nausea, insomnia, fatigue, rhinitis.