Pharmacotherapy and Personality Disorder Flashcards Preview

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Flashcards in Pharmacotherapy and Personality Disorder Deck (21)
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1

Define personality

The pattern of thoughts, feelings, and behaviours which makes every individual the person that they are. This pattern is flexible, with behaviour differing according to social situation

2

Define personality disorder

An enduring maladaptive pattern of perceiving, relating to, and thinking about the environment and oneself - this pattern is inflexible, deviates from cultural expectations, and impairs function

3

Give some reasons for treating personality disorder

Ease the distress it causes, ease suffering, reduce the impact of stigma, reduce service use, reduce associated morbidity and mortality

4

What is the main cause of death in individuals with personality disorder? (Fok et al, 2012)

Cardiovascular disease

5

What is the primary treatment for personality disorder?

Psychotherapy

6

State the ICD-10 definition of emotionally unstable personality disorder

A marked tendency to act impulsively with affective instability and minimal ability to plan ahead

7

Name the 2 variants of emotionally unstable personality disorder defined in ICD-10

Impulsive type and borderline type

8

Which classes of drugs could be useful for borderline personality disorder based on its symptoms?

Antidepressants (chronic feelings of emptiness), mood stabilisers (affective instability), antipsychotics (transient paranoid ideation)

9

Describe the evidence around antidepressants for personality disorder

Out of the 7 trials, 6 found no beneficial effects. The last found amitriptyline caused a reduction in depressive symptoms - but these individuals could have had comorbid depression

10

Describe the evidence around antipsychotics for personality disorder

Antipsychotics reduce hostility, anger, and impulsivity, but also have significant side effects such as weight gain and many patients do not adhere

11

Describe the impact of clozapine on personality disorder (Frankenburg & Zanarini, 1993; Chengappa et al, 1999; Frogley et al, 2013)

Clozapine reduces impulsive behaviour, affect-related symptoms, aggresion, and self-harming behaviour, It effects appear greatest in the first 6 months, and are associated with a significant increase in weight

12

Describe the evidence around mood stabilisers for personality disorder

Mood stabilisers reduce anger, depression, and impulsivity - although all trials have been small and of poor quality

13

What do the 2009 NICE guidelines state about pharmacological treatment and borderline personality disorder?

Drug treatment should not be used specifically for borderline personality disorder or behaviour associated with it

14

What does Lieb et al's 2010 Cochrane review state about pharmacological treatment and borderline personality disorder?

Mood stabilisers and 2nd generation antipsychotics may be effective in treating symptoms associated with borderline personality disorder

15

What percentage of borderline personality disorder patients have a comorbid mental health condition?

75%

16

State the 2 most common comorbidities of borderline personalty disorder

Depression and substance misuse

17

Why is the level of medication prescription high in personality disorder?

Patient's fear of abandonment, lack of trust (no drugs = no care), clinician counter-transference, clinician guilt over not doing enough

18

Describe the results of Evans' 2014 study on the clinician-patient relationship in personality disorder

It is punctuated by feelings of helplessness and discontinuity. Patients feel there is a lack of knowledge and understanding, and clinicians rely on medication due to a lack of involvement. Patients also believe they should help to decide if medication is appropriate

19

What is lamotrigine?

A sodium channel blocker used in treatment of epilepsy and as a mood stabiliser in bipolar disorder

20

State some side effects of lamotrigine

Nausea, insomnia, fatigue, rhinitis, rash, neck stiffness. 1 in 1,000 develop a severe rash that is fatal if not treated

21

Describe the results of the LABILE study on lamotrigine for borderline personality disorder

Lamotrigine had no benefit over placebo on any outcome - including BDI score, alcohol use, substance misuse, or self-harm