22 Additional, recently published systematic reviews add consensus data in the psychopharmacologic Dactolisib treatment of BPD.23-29 The primary aim of this review is to present the most up-to-date, evidence-based clinical approach to psychopharmacologic management of BPD. Secondary aims include detailing current difficulties and future directions in research on BPD psychopharmacology. General considerations The evidence base Inhibitors,research,lifescience,medical for psychopharmacological treatment of BPD is limited by relatively small sample sizes, high rates of placebo response, and brief trial durations. Most trials in the past have lasted 3 months or
less, or else suffered from high dropout rates.30-31 Because of high comorbidity of BPD with Axis I disorders, subjects often report other disorders whose presence may complicate response to the study medication. Without this comorbidity, however, results would not be generalizable to clinical practice. BPD trials are also prone to high placebo response rates,12,22,32 meaning that open-label trial data should be interpreted with caution. Nevertheless, clinicians can provide optimal Inhibitors,research,lifescience,medical evidence-based treatment by implementing the specific Inhibitors,research,lifescience,medical medications studied in randomized placebo-controlled trials, along with evidencebased psychotherapy. An older literature characterized BPD subjects with a distinct diagnostic nosology,33 or included
subjects with highly comorbid or other personality disorder diagnoses.34-40 Findings may therefore be difficult to apply to current practice. Clinicians should exercise caution in attempting to apply Inhibitors,research,lifescience,medical research findings to severely ill BPD patients, as many medication trials recruited only outpatients, who further were excluded if they expressed acute suicidality30,41-43 or had made a recent suicide attempt.44 Impulsive aggression has been targeted more effectively with medications Inhibitors,research,lifescience,medical relative to other symptoms, as evident in the conclusions of recent systematic reviews.22-29 This suggests that these symptoms, though acutely dangerous, may be more amenable to treatment than identity and interpersonal dysfunction, whose functional neurobiology is less well understood.
As noted 3-mercaptopyruvate sulfurtransferase above, impulsive aggression is more apt to resolve spontaneously, compared with interpersonal affective symptoms.18-21 There are no medications approved by the US Food and Drug Administration (FDA) for the treatment of BPD, and very limited data exist for any single medication improving overall BPD severity. This has led to symptom-based approaches to psychopharmacologic management, often resulting in unnecessary polypharmacy, despite little benefit from this in the main trial studying such a practice.43 Instead, practicality dictates targeting patients’ most distressing symptoms with the most efficacious and tolerable medications, and repeated evaluation of risks versus benefits of continued pharmacotherapy. Others interpret limitations in the evidence base to advocate use of medication only during crises.
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