Pharmacologic management of borderline personality disorder: a case study.
Mental Health Service, St. Michael's Hospital, University of Toronto, Toronto, Canada.Essential psychopharmacology 02/2005; 6(6):319-30.
General principles of the "outcome-focused" model of psychopharmacologic management of patients with BPD are illustrated using the case of Ms. A, a patient with borderline personality disorder (BPD) experiencing impulsivity such as suicidal behavior, chronic insomnia and concurrent substance abuse. The model includes (1) measurement of specific behavioral outcomes related to functioning; (2) assessment of the role of substance use/abuse in patients with BPD; (3) consideration of interventions to clarify and strengthen the boundaries of the therapeutic relationship-including short lengths of time between prescription refills, medication contracts outlining consequences if substances are obtained outside of the relationship, and urine testing to ascertain compliance; (4) an understanding of the psychodynamic meanings attributed to medication while positive and negative medication effects are monitored with treatment response or transference issues, and; (5) use of the N-of-1 approach to test the new medication vs previous medications using patient specific outcomes that are anticipated to change with the pharmacologic management.
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ABSTRACT: The question of hospitalization in patients who suffer from a borderline personality disorder is very contentious. Through a case-based approach, this review article highlights the issues that surround this controversy. It then reviews the current practice guidelines and examines the evidence for various forms of hospitalization. A synthesis of this information leads to practical recommendations for the management of this challenging population.Current Psychiatry Reports 03/2007; 9(1):63-7. DOI:10.1007/s11920-007-0011-0 · 3.24 Impact Factor
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