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Psychiatry Other
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my personal edition > psychiatry other > news
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DGDispatch
Selective Serotonin Reuptake Inhibitors and Antipsychotic Drugs Aid Borderline Personality Disorder: Presented at PRI-MED WEST
By Roberta Friedman
ANAHEIM, CA -- May 17, 2004 -- Selective serotonin reuptake inhibitor (SSRI) drugs used can help patients with borderline personality disorder, and some of these difficult to treat patients may actually achieve remission, according to Christopher M. Palmer, MD, an instructor at Harvard Medical School and a researcher at McLean Hospital, Boston, Massachusetts.
In a presentation here May 13th at the Annual Pri-Med West Conference and Exhibition, Dr. Palmer noted, "we don't want anything to do with these patients, we just want to refer them," but he said, "they do come to your office and pose a lot of problems."
Primary care physicians can avoid pitfalls and even achieve success in this personality problem marked by wide mood swings and some psychotic-like symptoms, that straddles the boundary between neurosis and frank psychosis. The patients may say, "finally I've found a physician who understands me," but by a few visits, said Dr. Palmer, "you may become one of those evil quacks" that the patient had been talking about.
While they are nearly as commonly seen as people with anxiety disorders, Dr. Palmer said that only half of borderline personalities are recognized as such by a primary care physician, and that only half had received mental health treatment in the year prior, according to a recently published survey.
About half also report childhood abuse.
Even when referred to a psychiatrist, patients with borderline personality disorder will return to primary care to manage their frequently occurring comorbidities. These include a laundry list of problems such as migraine, irritable bowel, back pain, and hypertension and diabetes--often patients are obese.
Substance abuse is not uncommon, so avoid benzodiazepines for these patients despite their symptoms of anxiety, and refer for use of MAO inhibitors which are difficult to use, but can be helpful. SSRIs are a good choice, at standard doses. Antipsychotics are very useful in BPD, even though primary care doctors "have reservations about using these powerful medicines in people who don't seem so ill," much of the time, Dr. Palmer said. Yet antipsychotic drugs address all of the symptoms of BPD.
Dr. Palmer also warned primary care practitioners to avoid countertransference, guard boundaries, and to set limits--and to be prepared for adverse reactions to this, including suicide threats. "Acknowledge the suffering, and watch excessive medication." Dr. Palmer said. He added that telling patients straight out that they have a definite disorder that is difficult, but that they are not the only ones with it, is truly helpful. Advise patients to do their own research into the condition.
"You can say, 'I'm in over my head, but I'm concerned about you, please go see a mental health provider.'" Dr. Palmer shared new evidence that 10 years out, patients are being found to have remitted.
[Presentation Title: Borderline Personality Disorder]
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