Pharmacotherapy of a 67-year old female with borderline personality disorder

Pharmacotherapy in older adults with personality disorders is very complicated. On the one hand, this is caused by interference of the personality disorder in the therapeutic relationship. On the other hand, age specific factors, such as polypharmacy and changing pharmacokinetics and -dynamics play an important complicating role. In this article the difficulties of pharmacotherapy in older adults with personality disorders are illustrated by the description of a case of a 67-year old female with a borderline personality disorder. She has an extensive history of many therapies, which have not been effective in treating a variety of symptoms. This case description emphasizes the importance of making the correct diagnosis and focusing pharmacotherapy on the personality disorder. Also, decreasing polypharmacy, often a consequence of an extensive history of many - both psychiatric and somatic - treatments, plays an important role. There is a lack of evidence on pharmacotherapy in older adults with personality disorders to rely on and therefore there is a need for more research on this subject.</p

Features of Polypharmacy in Dutch Older Outpatients with Personality Disorders: A Cross-Sectional Study

Introduction: Pharmacotherapy in older adults with personality disorders (PDs) can be even more complicated compared to younger adults, because older adults stand at risk for polypharmacy and its negative consequences due to somatic comorbidities and biological age-related changes. Aims: This study’s primary objective serves to describe the point prevalence of polypharmacy in older adults with PDs. Next, we described 1) the number of psychotropics employed, 2) classes of psychotropics, 3) the number of somatic medication, and 4) the anticholinergic burden of the total medication. Methods: This cross sectional study was performed at a clinical center of excellence for older adults with PDs in the Netherlands. Fifty outpatients aged 65 years and older with a primary diagnosis of a PD were selected from an alphabetically ordered list. Data from the files on polypharmacy (use of five medications or more daily), use of medication and the anticholinergic burden (ARS score) was collected. Results: Polypharmacy was present in 72% of older adults with PDs. The mean number of psychotropics was 2.0 (SD = 1.4) psychotropics per person, for somatic medication the mean was 6.2 (SD = 3.6). Antidepressants were the most frequently prescribed (used by 62%), followed by anxiolytics (used by 40%). The mean ARS score was 1.1 points (SD = 1.7). Conclusions: The prevalence of polypharmacy in older adults with PDs stands high, due to the high use of both psychotropics and somatic medication. Although this study provides important and new information on the use of medication in older adults, its representation of the population may be limited due to the tertiary care setting and small sample size excluding certain PDs (e.g., schizoid or obsessive-compulsive PD). Also, we did not register or measure the consequences of polypharmacy

Pharmacotherapy in older adults with personality disorders:a new area of attention

Achtergrond: Farmacotherapie bij ouderen met persoonlijkheidsstoornissen (PS) vormt een nieuw en belangrijk aandachtsgebied. Vooralsnog wordt de symptoomgerichte farmacotherapeutische behandeling van ouderen met PS vormgegeven aan de hand van de multidisciplinaire richtlijn Persoonlijkheidsstoornissen, die gebaseerd is op onderzoeken bij patiënten met PS tot circa 50 jaar oud. Het ontbreekt aan een richtlijn specifiek voor ouderen.Doel: Het leveren van een beschrijving van patiëntkenmerken: aantal comorbide psychiatrische stoornissen, medicatiegebruik, inclusief polyfarmacie, bij ouderen (≥ 65 jaar) met persoonlijkheidsstoornissen.Methode: Een retrospectieve cross-sectionele dossierstudie (n = 50) binnen een topklinisch centrum voor ouderen met persoonlijkheidsstoornissen (ambulante setting).Resultaten: Uit de dossierstudie blijkt 1) de ongespecificeerde/andere gespecificeerde persoonlijkheidsstoornis en de borderline persoonlijkheidsstoornis (BPS) het meest voor te komen, 2) er een trend (geen statistisch significant verschil) te zijn dat patiënten met BPS meer somatische medicatie en psychofarmaca gebruiken en 3) er een trend (geen statistisch significant verschil) te zijn dat polyfarmacie het meest voorkomt bij oudere patiënten met BPS.Conclusie: Het medicatiegebruik in bepaalde subgroepen van ouderen met PS lijkt hoog te zijn. Vervolgonderzoek is essentieel om farmacotherapie bij ouderen met PS te verbeteren

A life span perspective on borderline personality disorder

Purpose of review To provide an update of a life span perspective on borderline personality disorder (BPD). We address the life span course of BPD, and discuss possible implications for assessment, treatment, and research. Recent findings BPD first manifests itself in adolescence and can be distinguished reliably from normal adolescent development. The course of BPD from adolescence to late life is characterized by a symptomatic switch from affective dysregulation, impulsivity, and suicidality to maladaptive interpersonal functioning and enduring functional impairments, with subsequent remission and relapse. Dimensional models of BPD appear more age neutral and more useful across the entire life span. There is a need for age-specific interventions across the life span. Summary BPD symptoms and impairments tend to wax and wane from adolescence up to old age, and presentation depends on contextual factors. Our understanding of the onset and early course of BPD is growing, but knowledge of BPD in late life is limited. Although the categorical criteria of DSM allow for reliable diagnosis of BPD in adolescence, dimensional models appear both more age neutral, and useful up to late life. To account for the fluctuating expression of BPD, and to guide development and selection of treatment across the life span, a clinical staging model for BPD holds promise