Medication prescribed to people with personality disorder: the influence of patient factors and treatment setting

Crawford, Mike; Kakad, S.; Rendel, C.; Mansour, Nazar; Crugel, Monica; Liu, K. W.; Paton, Carol; Barnes, Thomas R. E.

doi:10.1111/j.1600-0447.2011.01728.x

Cited by 28 publications

(38 citation statements)

References 25 publications

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“…1 In our subgroup of patients with EUPD alone, threequarters were prescribed an antidepressant; three-fifths, an antipsychotic drug; one-third, a benzodiazepine; and onefifth, a z-hypnotic or mood stabilizer. The high prevalence of antidepressant use is consistent with other surveys of prescribing practice [8][9][10] but in contrast with the findings from clinical studies that these drugs are not effective in treating affective symptoms in patients with EUPD 17 and are relatively less effective in treating depression in people with comorbid personality disorder than in those without. 19,20 A higher proportion of our patients with EUPD were prescribed an antipsychotic than the 40% reported by Pascual et al 8 in a naturalistic study of 226 consecutive patients with BPD admitted to an outpatient program, although these investigators noted an increasing prevalence of antipsychotic prescribing over time.…”

Section: High Prevalence Of Psychotropic Drug Prescribing For Eupdsupporting

confidence: 86%

“…1,8,9,16 Many of the symptoms of EUPD overlap with those of mental illness but may not reach the qualitative or quantitative criteria required for a comorbid diagnosis in that they are not severe enough or do not last long enough. In routine practice, clinicians are likely to differ in their individual thresholds for a diagnosis of a comorbid condition, with, for example, some considering even severe mood lability to be consistent with a diagnosis of EUPD, while others would diagnose comorbid bipolar disorder.…”

Section: Most Eupd Patients Had Comorbid Mental Illnessmentioning

confidence: 99%

“…5,[7][8][9] Polypharmacy was also common with two-thirds of patients with EUPD alone prescribed psychotropic drugs from at least 2 different classes and almost a fifth from at least 4. This is consistent with Zanarini et al, 6 who reported that 11% of those with EUPD were taking 5 or more psychotropic drugs, although these investigators included patients with comorbid mental illness.…”

Section: High Prevalence Of Psychotropic Drug Prescribing For Eupdmentioning

confidence: 99%

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The Use of Psychotropic Medication in Patients With Emotionally Unstable Personality Disorder Under the Care of UK Mental Health Services

Paton¹,

Crawford²,

Bhatti³

et al. 2015

J. Clin. Psychiatry

118

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Background:Guideline recommendations for the pharmacologic treatment of personality disorder lack consensus, particularly for emotionally unstable personality disorder (EUPD), and there is limited information on current prescribing practice in the United Kingdom.Objective: To characterize the nature and quality of current prescribing practice for personality disorder across the United Kingdom, as part of a quality improvement program.

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Section: High Prevalence Of Psychotropic Drug Prescribing For Eupdsupporting

confidence: 86%

Section: Most Eupd Patients Had Comorbid Mental Illnessmentioning

confidence: 99%

Section: High Prevalence Of Psychotropic Drug Prescribing For Eupdmentioning

confidence: 99%

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The Use of Psychotropic Medication in Patients With Emotionally Unstable Personality Disorder Under the Care of UK Mental Health Services

Paton¹,

Crawford²,

Bhatti³

et al. 2015

J. Clin. Psychiatry

118

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“…Despite this, people with this condition are often prescribed large amounts of psychotropic medication. 18 Antidepressants are widely used, despite evidence that they do not improve the mental health or social functioning of people with BPD. 19 The results of randomised trials of antipsychotic medications are equivocal.…”

Section: Treatment Of Borderline Personality Disordermentioning

confidence: 99%

Lamotrigine for people with borderline personality disorder: a RCT

Crawford

Sanatinia

Barrett

et al. 2018

Health Technol Assess

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BackgroundNo drug treatments are currently licensed for the treatment of borderline personality disorder (BPD). Despite this, people with this condition are frequently prescribed psychotropic medications and often with considerable polypharmacy. Preliminary studies have indicated that mood stabilisers may be of benefit to people with BPD.ObjectiveTo examine the clinical effectiveness and cost-effectiveness of lamotrigine for people with BPD.DesignA two-arm, double-blind, placebo-controlled individually randomised trial of lamotrigine versus placebo. Participants were randomised via an independent and remote web-based service using permuted blocks and stratified by study centre, the severity of personality disorder and the extent of hypomanic symptoms.SettingSecondary care NHS mental health services in six centres in England.ParticipantsPotential participants had to be aged ≥ 18 years, meet diagnostic criteria for BPD and provide written informed consent. We excluded people with coexisting psychosis or bipolar affective disorder, those already taking a mood stabiliser, those who spoke insufficient English to complete the baseline assessment and women who were pregnant or contemplating becoming pregnant.InterventionsUp to 200 mg of lamotrigine per day or an inert placebo. Women taking combined oral contraceptives were prescribed up to 400 mg of trial medication per day.Main outcome measuresOutcomes were assessed at 12, 24 and 52 weeks after randomisation. The primary outcome was the total score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. The secondary outcomes were depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment and adverse events. Higher scores on all measures indicate poorer outcomes.ResultsBetween July 2013 and October 2015 we randomised 276 participants, of whom 195 (70.6%) were followed up 52 weeks later. At 52 weeks, 49 (36%) of those participants prescribed lamotrigine and 58 (42%) of those prescribed placebo were taking it. At 52 weeks, the mean total ZAN-BPD score was 11.3 [standard deviation (SD) 6.6] among those participants randomised to lamotrigine and 11.5 (SD 7.7) among those participants randomised to placebo (adjusted mean difference 0.1, 95% CI –1.8 to 2.0;p = 0.91). No statistically significant differences in secondary outcomes were seen at any time. Adjusted costs of direct care for those prescribed lamotrigine were similar to those prescribed placebo.LimitationsLevels of adherence in this pragmatic trial were low, but greater adherence was not associated with better mental health.ConclusionsThe addition of lamotrigine to the usual care of people with BPD was not found to be clinically effective or provide a cost-effective use of resources.Future workFuture research into the treatment of BPD should focus on improving the evidence base for the clinical effectiveness and cost-effectiveness of non-pharmacological treatments to help policy-makers make better decisions about investing in specialist treatment services.Trial registrationCurrent Controlled Trials ISRCTN90916365.FundingFunding for this trial was provided by the Health Technology Assessment programme of the National Institute for Health Research (NIHR) and will be published in full inHealth Technology Assessment; Vol. 22, No. 17. See the NIHR Journals Library website for further project information. The Imperial Biomedical Research Centre Facility, which is funded by NIHR, also provided support that has contributed to the research results reported within this paper. Part of Richard Morriss’ salary during the project was paid by NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands.

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“…Substance use disorders are a major cause of death and disability [1,9] and frequently co-occur with PD, particularly in young people with Cluster B PD [28], and the particularly high SMR for Cluster B PD may reflect unhealthy lifestyles characterised by heavy substance use and smoking. Patients with PD are often prescribed excessive doses of psychotropic and non-psychotropic medications [29] which themselves may potentially lead to unwanted physical consequences. Finally, people with PD often struggle to obtain adequate health care and have greater unmet treatment needs [30].…”

Section: Possible Mechanismsmentioning

confidence: 99%

Life expectancy at birth and all-cause mortality among people with personality disorder

Fok

Hayes

Chang

et al. 2012

Journal of Psychosomatic Research

208

150

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Publisher's copyright statement: NOTICE: this is the author's version of a work that was accepted for publication in the Journal of Psychosomatic Research. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be re ected in this document. Changes may have been made to this work since it was submitted for publication. Use policyThe full-text may be used and/or reproduced, and given to third parties in any format or medium, without prior permission or charge, for personal research or study, educational, or not-for-pro t purposes provided that:• a full bibliographic reference is made to the original source • a link is made to the metadata record in DRO • the full-text is not changed in any way The full-text must not be sold in any format or medium without the formal permission of the copyright holders.Please consult the full DRO policy for further details. ABSTRACT ObjectiveIt is well established that serious mental illness is associated with raised mortality, yet few studies have looked at the life expectancy of people with personality disorder (PD). This study aims to examine the life expectancy and relative mortality in people with PD within secondary mental health care. MethodsWe set out to examine this using a large psychiatric case register in southeast London, UK.Mortality was obtained through national mortality tracing procedures. In a cohort of patients with a primary diagnosis of PD (n=1836), standardized mortality ratios (SMRs) and life expectancies at birth were calculated, using general population mortality statistics as the comparator. ResultsLife expectancy at birth was 63.3 years for women and 59.1 years for men with PD -18.7 years and 17.7 years shorter than females and males respectively in the general population in England and Wales. The SMR was 4.2 (95% CI: 3.03 -5.64) overall; 5.0 (95% CI: 3.15 -7.45) for females and 3.5 (95% CI: 2.17 -5.47) for males. The highest SMRs were found in the younger age groups for both genders. ConclusionPeople with PD using mental health services have a substantially reduced life expectancy, highlighting the significant public health burden of the disorder.

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Medication prescribed to people with personality disorder: the influence of patient factors and treatment setting

Abstract: Drug treatments are widely used for people with PD despite the relatively weak evidence base. Both the type of personality problem and the context in which treatment is delivered appear to have an impact on whether drug treatments are prescribed.

Cited by 28 publications

References 25 publications

The Use of Psychotropic Medication in Patients With Emotionally Unstable Personality Disorder Under the Care of UK Mental Health Services

The Use of Psychotropic Medication in Patients With Emotionally Unstable Personality Disorder Under the Care of UK Mental Health Services

Lamotrigine for people with borderline personality disorder: a RCT

Life expectancy at birth and all-cause mortality among people with personality disorder

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