Pharmakologische Behandlung von stationären Patienten mit einer emotional instabilen Persönlichkeitsstörung

Pharmacotherapy of hospitalized patients with borderline personality disorder

by Margarita Nuss
Doctoral thesis
Date of Examination:2016-04-05
Date of issue:2016-03-08
Advisor:PD Dr. Dirk Wedekind
Referee:Prof. Dr. Carsten Spitzer
Referee:Prof. Dr. Rainer Mausberg
Persistent Address: http://dx.doi.org/10.53846/goediss-5549

 

 

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Abstract

English

Disease-related deficits in the everyday social interaction are responsible for socially inadequate integration of patients with borderline personality disorder (BPS). The supply resources due to the extensive psychosocial impairment of affected patients are strongly encouraged. Nevertheless the BPS gets less attention in aspects of structural analysis for quality of care compared to other mental disorders. Although the psychotropic drugs benefit compared to the psychotherapy in treatment of BPS, it is extensively applied in practice. In the present study, 87 borderline patients with a total of 140 hospital stays were analyzed in the period of 2008-2012. The retrospective analysis of medical record showed that 94% of patients in the in-patient treatment history were given psychotropic drugs. In the period 1998-2004, there were 87%. During this period there were no significant differences in the frequency of the psychotropic drug treatment compared to the psychotherapy for crisis- intervention. Different psychotropic substance classes were used, most commonly, like in the first observation period, antidepressants. In the first group there were 73.2%, in the present study 64% of patients, who had already experience with antidepressants while being admitted or during the hospitalization. Remarkable in our study slightly less neuroleptic drugs were prescribed compared to other studies In the period of 2008-2012, there were 46.5% of the patients. Comparing both periods regarding hypnotics and sedatives, the first observation period dominated with 45.1%. In contrast, only 29% of patients received these drugs in the second time interval.Noteworthy, the substances, which are not recommended or even proved to be detrimental (e.g. benzodiazepine) in treatment of BPS. The treatment of the BPS is syndrome-oriented, therefore the administration of the various substance classes was broken down by syndromes - for example patients with affective symptoms got antidepressants and self-harming patients often got Neuroleptics. The number of medicines prescribed increased by an average of 27% during an inpatient stay, which means that the patients left hospital with significantly more drugs than they came in. Compared to the observation period (1996-2004), there was a general increase in the variety of medications administered per inpatient stay as well as a significant increase in the frequency of a psychotropic drug treatment even at shortened length of inpatient stay. High percentages of comorbidities and the socio-demographic data highlighted the severity of the disease, which obviously often requires a targeted psychotropic drug treatment. High rates of psychotropic drug treatment and intensive polypharmacy were found for borderline patients- a psychotropic drug treatment was as high as for other psychiatric syndromes. Therefore there is a need for future research for effective medication at the borderline personality disorder.
Keywords: borderline; personality; disorder; antidepressants; neuroleptics; mood; stabilizer
Schlagwörter: Borderline; Persönlichkeitsstörung; Antidepressiva; Neuroleptika
 
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