The State of Overmedication in Borderline Personality Disorder: Interpersonal and Structural Factors

Shapiro-Thompson, Rosa; Fineberg, Sarah K.

doi:10.1007/s40501-021-00255-x

Cited by 5 publications

(1 citation statement)

References 60 publications

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“…4 Uncomfortable countertransference and limited access to evidence-based psychotherapy have been cited as reasons for clinicians' deviation from treatment guidelines. 5 Historically, sodium valproate was indicated to treat two comorbidities in borderline personality disorder; mania in bipolar disorder and to prevent seizures in epilepsy. However, in 2015 the International League Against Epilepsy recommended that sodium valproate be avoided in the treatment of epilepsy in woman of childbearing age due to the high risk of teratogenicity.…”

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confidence: 99%

Changes in sodium valproate dispensing in women of childbearing age with a diagnosis of borderline personality disorder in Aotearoa New Zealand

Tennant,

Frampton,

Mulder

et al. 2024

NZMJ

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aims: To compare sodium valproate dispensing in women of childbearing age diagnosed with borderline personality disorder in 2014 and 2019 to discover if prescribing practices in Aotearoa New Zealand have changed in response to international recommendations. methods: National dispensing data from the Pharmaceutical Collection were linked with diagnostic data from PRIMHD (the national mental health and addiction database) to identify people diagnosed with borderline personality disorder in Aotearoa New Zealand who were dispensed psychotropic medication. Dispensing of sodium valproate for women of childbearing age was compared between 2014 and 2019. Rates of dispensing were compared between ethnicities. results: In 2014, 10% of women of childbearing age diagnosed with borderline personality disorder were dispensed sodium valproate. This reduced to 6% of women in 2019 (p<0.001). In 2014, there was substantial ethnic disparity with 18.1% of Māori women and 15.8% of Pacific women dispensed sodium valproate compared with 7.4% of New Zealand Europeans. This disparity reduced in 2019, with 6.4% of Māori women and 12.5% of Pacific women dispensed sodium valproate compared with 5.6% of New Zealand Europeans. conclusions: These findings suggest that international recommendations and guidelines have been effective in changing clinical practice and reducing ethnic inequities. Given the significant risk to offspring exposed to sodium valproate, we echo warnings against off-label prescribing of sodium valproate in borderline personality disorder.

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confidence: 99%

Changes in sodium valproate dispensing in women of childbearing age with a diagnosis of borderline personality disorder in Aotearoa New Zealand

Tennant,

Frampton,

Mulder

et al. 2024

NZMJ

View full text Add to dashboard Cite

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Special Population: LGBTQ Community

Austen

Lahlou

Moore

2023

Chronic Illness Care

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Why do patients want medication free treatment for psychosis? An explorative study on reasons for applying to medication free programs

Reitan,

Iversen,

Riley

et al. 2024

BMC Psychiatry

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Background A focus on patient’s and service user’s perspectives regarding long-term antipsychotic treatment led to a declaration from the Norwegian Ministry of Health in 2015 to offer treatment without psychotropic medication in mental health as a voluntary option in all four health care regions. In the northernmost region, a 6-bed inpatient ward unit was established, uniquely designed to give people with severe mental illness the possibility to choose such treatment. Only voluntary admissions were accepted. The aim of the present study was to explore the motivation for applying for medication free treatment among patients with several years of treatment history due to psychosis. Method We performed nineteen semi-structured, in-depth interviews with persons having at least one admission at the medication free treatment ward during the period 01.01.17 – 17.10.2021. The interviews were recorded, transcribed and analysed using computer-assisted qualitative data analysis software (NVivo). Systematic Text Condensation was applied, with analysis of data from the first interview. Exploration of connections, similarities and nuances was performed through axial coding with continuous comparison of data and memo writing, followed by focused coding identifying core concepts. Results All participants had a diagnosis of severe mental illness and a history of use of antipsychotics throughout many years. The motivation to apply for medication free treatment was complex. Negative experiences with medication were described, but also positive. Many had tried to taper off before, but described this as a lonely and difficult process. Five core concepts were formed and developed from the participants’ narratives: 1) Medication experiences, 2) Developing illness, 3) Treatment in general, 4) Social life and 4) Growing up. Conclusion The concept of medication free treatment represents a salutogenetic hope for change, closely linked to self-efficacy and an experience of mastery. Potential conflicts concerning guidelines or evidence on medication does not come forward as important. Support from family and professionals is crucial, in contrast to the feeling of being alone when hoping for change. Motivational factors are closely linked to the concept of recovery, where interaction happens on both an individual and a structural level.

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The State of Overmedication in Borderline Personality Disorder: Interpersonal and Structural Factors

Cited by 5 publications

References 60 publications

Changes in sodium valproate dispensing in women of childbearing age with a diagnosis of borderline personality disorder in Aotearoa New Zealand

Changes in sodium valproate dispensing in women of childbearing age with a diagnosis of borderline personality disorder in Aotearoa New Zealand

Special Population: LGBTQ Community

Why do patients want medication free treatment for psychosis? An explorative study on reasons for applying to medication free programs

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