Prescribing for emotionally unstable personality disorder: clinicians’ views

Abstract

Emotionally unstable personality disorder (EUPD) has become a public health challenge due to its prevalence, cost to health care services and comorbidities. Prescribers are faced with a clinical conundrum when offering medication to patients with EUPD due to the risk of deliberate overdose. Here, the authors analyse clinicians’ views and experiences pertaining to prescribing medications for EUPD within the context of the NICE guidelines, with resulting messages to enable positive change in future clinical guidelines and policies.

Gulf between research evidence and clinical reality in relation to prescribing in EUPD

“…The recommendations are for developers of guidance to design effective interventions to guide practice; and develop future recommendations on the role of pharmacological interventions in the treatment of EUPD. 1 Given the stance by NICE and other relevant guiding bodies across the continents that there is limited evidence for prescribing of psychotropic medications in EUPD, I am cautious about your attempts to influence changes in future clinical guidelines and policies. And the gulf between research findings (that there is limited evidence for prescribing psychotropic medications in EUPD) and clinical practice (where drug prescription and polypharmacy are commonly seen in the management of borderline personality disorder [BPD] and the 'placebo effect of medications' in BPD patients is considerable) will probably remain.…”

“…The article highlighted that the relational aspect of prescribing is not considered in clinical guidelines. The recommendations are for developers of guidance to design effective interventions to guide practice; and develop future recommendations on the role of pharmacological interventions in the treatment of EUPD 1 …”