Personality disorder medical therapy: Difference between revisions
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==Overview== | ==Overview== | ||
PD affects all aspects of individual life and causes interference with [[psychological]] and behavioral growth. It causes emotional distress and social impairment. It affects the quality of life grimly and has dire consequences on life years. Early recognition is crucial to start appropriate management and prevent complications from this debilitating condition. | |||
Management of PDs lacks [[evidence-based]] guidelines, and health authorities across the world have formulated their independent guidelines. [[American Society of Psychiatry]] guidelines exists only for BPD, while European guidelines are present for BPD, ASPD, and PD general. It includes [[acute]] treatment by hospitalization if there is a risk of self or other people harm and [[chronic]] management of the disorder. Indications for [[inpatient management]] include; suicidal intent and plan, impulse control loss, imminent danger to self and others, and severe symptoms impairing functioning and unresponsive to outpatient treatment. An initial assessment should be performed. | |||
The second step is designing a treatment plan and discussing it with the patient. Family support and patient education play a vital role in effective management. | |||
Prior to starting the therapy, it is essential to rule out [[PTSD]], [[depression]], and [[anxiety]] and manage them if these conditions co-exist. [[Substance use disorder]] needs to be recognized and treated as well. | |||
==Medical Therapy== | ==Medical Therapy== | ||
Revision as of 17:39, 30 June 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Ayesha Anwar, M.B.B.S[2]
Overview
PD affects all aspects of individual life and causes interference with psychological and behavioral growth. It causes emotional distress and social impairment. It affects the quality of life grimly and has dire consequences on life years. Early recognition is crucial to start appropriate management and prevent complications from this debilitating condition.
Management of PDs lacks evidence-based guidelines, and health authorities across the world have formulated their independent guidelines. American Society of Psychiatry guidelines exists only for BPD, while European guidelines are present for BPD, ASPD, and PD general. It includes acute treatment by hospitalization if there is a risk of self or other people harm and chronic management of the disorder. Indications for inpatient management include; suicidal intent and plan, impulse control loss, imminent danger to self and others, and severe symptoms impairing functioning and unresponsive to outpatient treatment. An initial assessment should be performed. The second step is designing a treatment plan and discussing it with the patient. Family support and patient education play a vital role in effective management. Prior to starting the therapy, it is essential to rule out PTSD, depression, and anxiety and manage them if these conditions co-exist. Substance use disorder needs to be recognized and treated as well.
Medical Therapy
No medical therapy is approved by Food and Drug administration, FDA for treatment of personality disorders. Pharmacotherapy is utilised to manage symptoms during acute decompensation and trait vulnerabilities.
Mood dysregulatory symptoms like emotional lability, anger outbursts, depressive crashes, and other affective dysregulation symptoms are managed with (selective serotonin reuptake inhibitors) SSRIs or selective norepinephrine reuptake inhibitors (SNRIs) like venlafaxine. Mood stabilizers like lithium, valproate, carbamazepine, lamotrigine or topiramate are used as second line. Impulse control dyscontrol symptoms are self-mutilation, aggression, eroticism, reckless sex, extravagant spending and uncontrolled substance use. They are managed with SSRIs as first line and monoamine oxidase inhibitors (MAOIs) as second line [1]. British guidelines recommend against the use of medications for these symptoms [2]. Cognitive perceptual symptoms incorporate paranoia, delusions, hallucination, derealisation, depersonalization and suspiciousness. Low dose neuroleptics or antipsychotic medications are used. They help with psychotic symptoms as well as mood issues.