02-17-2015, 03:07 PM
Clinical uncertainty associated with alternative opportunities for managing border personality disorder
It's really useful to see the important and complex issue with border personality disorder (PRL) is solved by Crawford and others . The authors present a compelling argument for why the mood stabilizers, and indeed even psychotropic, should be avoided as much as possible . It is interesting to note that the authors are also very relevant to note that such patients can be "demanding" and "doctors may feel under pressure to prescribe medication ';"In addition, patients with borderline personality disorder have higher rates of deliberate self-harm and suicide rate, which is 20 times greater than in the general population ".
I have been working as a consultant for 15 years, and after having spent almost half of that time in the NHS, as a psychiatrist and consultant General adult administering such patients in community and inpatient, I am of the opinion that non-medical recommendation provided sponsored as an alternative to the use of psychotropic (specifically the mood stabilizers) easier said than done.
Beneficial for both integrated psychotherapy and psychotherapeutic intervention for patients without a border personality disorder recognized in accordance with the latest Unblinded . However, this should be seen in perspective, the availability and delivery of psychological therapy in the UK first reality. While mental health services, are exempt from the 18-week maximum waiting time for access to the services under the NHS Constitution, there is some evidence that approximately 1 in 5 people waiting for more than a year, and 1 in 2 will have to wait at least 3 months . In addition, improving access to psychological therapies (IAPT) survey also shows that among people that were using the talk therapies, 58% were offered a choice of type of therapy, and 75% were not given a choice of where they get it . If you extrapolate these data on patients with BPD, it would not be in accordance with the General principles of care for the management of these patients in line with NICE Guidance .
In addition, the authors stressed the excessively high level of use of psychotropic for management of patients with borderline personality disorder from various NHS trusts . a similar conclusion was reported from other countries, such as Germany , where pharmacotherapy generally played an important role in the management of borderline personality disorder; One of the main reasons postulated is that prescribing psychiatrists are not sure the range of psychological assistance for medications . Although not clearly documented, but a similar reason could work in the UK too.
It is well known that patients with borderline personality disorder tend to be prone to failure and have a hereditary tendency to fragmentation and/or "sabotage" its own treatment with a high level of disengagement [1, 4, 6]. In addition, most professionals (most commonly psychiatric nurses) of these patients tend to have negative feelings and attitudes about self (uncomfortable, unsettling challenge to manipulate) and (dangerous, powerful, hard to take care of, ruthless, time, etc.) with the behavioral reactions of social distancing, being less useful and expressed less sympathetic, and expressing anger .
Having in mind the interplay of these factors, the reality of managing patients with borderline personality disorder (especially those who threaten or demonstrate a harm, and are considered to be at high potential risk for suicide) is extremely difficult and demanding, and it's not just demonstrate their full fidelity in translating the theoretical reasoning (or lack of it in the case of BPD) in direct medical care.
Thus, the pragmatic management of patients with borderline personality disorder is likely to continue to show the use of psychotropic (including mood stabilizers) on an empirical basis, and as a stop-gap arrangement till the necessary pragmatic and/or controlled trial evidence becomes available. More importantly, the implementation of NICE guidance on psychotherapy BPD , as well as dealing with ground realities, referred to above, can be equally, if not more important way forward for physicians in the treatment of patients with borderline personality disorder.