Pro Re Nata (As Needed) Psychotropic Medication Use in Patients With Borderline Personality Disorder and Subjects With Other Personality Disorders Over 14 Years of Prospective Follow-Up

Abstract

The use of PRN (as-needed) psychotropic medication in borderline patients has not been well characterized. This study had three purposes: (i) to describe the prevalence of PRN psychotropic medication use among borderline patients and other personality-disordered comparison subjects over 14 years of prospective follow-up; (ii) to examine the rates reported by ever-recovered and never-recovered borderline patients; and (iii) to examine the reasons for taking PRN medication reported by these patients. Overall, the prevalence of PRN psychotropic medication use was initially approximately 3 times higher among borderline patients than other personality-disordered comparison subjects, with a significant one- third decline in the use of PRN medication reported by borderline patients over time. In analyses restricted to borderline patients, never-recovered borderline patients were about twice as likely to use PRN medication than ever-recovered borderline patients over time. In terms of reasons for use, the rates of PRN medication use to decrease agitation for both diagnostic groups declined significantly over time, although they remained significantly higher among borderline patients. Likewise, never-recovered borderline patients reported higher use of PRN medication to decrease agitation than ever-recovered borderline patients over time. The results of this study indicate that PRN psychotropic medication is widely used for the treatment of borderline patients, particularly those who have not achieved a recovery in both the symptomatic and psychosocial realms. They also suggest that borderline patients use proportionally more PRN medication to decrease agitation than other personality comparison subjects, with lower proportional use to reduce agitation found among recovered borderline patients.

What Works in the Treatment of Borderline Personality Disorder

“…After 16 years of prospective follow-up, 18.6 and 6.9% of BPD patients report taking four or more and five or more psychotropic medications, respectively [ 59 ]. In the same cohort over 14 years of follow-up, nearly one-third consistently used PRN medication despite the absence of any evidence-based protocols for prescribing PRNs for BPD [ 60 ]. The wish to be helpful and perceived “pressure to do something” for patients presenting in acute distress reporting unrelenting agitation, anxiety, and insomnia may account for the tendency to prescribe outside of evidence-based parameters.…”

Psychotropic medication use pre and post-diagnosis of cluster B personality disorder: a Quebec’s health services register cohort

“…Indeed, some studies have reported high consumption of psychotropics in individuals with cluster B PDs (20-31). Nevertheless, most of these studies were cross-sectional (21,22,26,28,30), focused on borderline individuals (21-23, 25,26,28,31), were conducted in small samples (26,31), or considered only hospitalized patients (25,26,31), those participating in mental health programs (20, 22, 23, 29), or those followed by a psychiatrist (21).…”

Interventions to improve the sleep quality of adults with personality disorder: A systematic review

“…Furthermore, the presence of sleep disturbance (Plante et al, 2013a) and dysfunctional cognitions about sleep appear to be associated with poor improvement over time in the symptoms of borderline PD (Plante et al, 2013b). Unsurprisingly, poor sleep is therefore a common contributor to the decision to prescribe psychotropic medication for people with CEN (Martinho et al, 2014; Paton et al, 2015; Plante et al, 2009).…”