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

Paton, Carol; Crawford, Mike; Bhatti, Sumera; Patel, Maxine X.; Barnes, Thomas R. E.

doi:10.4088/jcp.14m09228

Cited by 117 publications

(72 citation statements)

References 21 publications

(26 reference statements)

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“…Data from a national audit of prescribing practice suggest that one-quarter of people who are in contact with mental health services are being prescribed a mood stabiliser. 72 Some patients report that prescribing medication during a crisis can help bring about short-term reductions in emotional distress. The results of the LABILE study support the clinical impression that prescribing lamotrigine can lead to improvements in mental health but suggest that this benefit is no greater than would be found if a placebo were to be prescribed.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

“…77 Despite this, a recent national audit showed that 11% of women with BPD who are in contact with DISCUSSION NIHR Journals Library www.journalslibrary.nihr.ac.uk secondary care mental health services are currently being prescribed this drug. 72 The data from the LABILE study showing the high level of unplanned pregnancies among women with BPD emphasise the importance of avoiding the use of unlicensed medications, such as sodium valproate, that are potentially teratogenic.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

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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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Section: Implications For Clinical Practicementioning

confidence: 99%

Section: Implications For Clinical Practicementioning

confidence: 99%

Lamotrigine for people with borderline personality disorder: a RCT

Crawford

Sanatinia

Barrett

et al. 2018

Health Technol Assess

Self Cite

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“…What is important in the current study is that among those who had only the diagnosis of EUPD (n = 786), 28% were taking medications from 2 different medication classes, 23% from 3 classes, and 16% from 4 or more classes. 1 Unfortunately, this is not dissimilar to the 16-year data recently reported from the McLean Study of Adult Development. 9 After 16 years of prospective follow-up, 71% were still taking psychotropic medication, with 35.5% taking 3 or more concurrent medications, 18.6% taking 4 or more, and 6.9% taking 5 or more psychotropic medications.…”

Section: Current Knowledge On Effectiveness Of Medication In Bpdmentioning

confidence: 52%

“…he article by Paton and colleagues 1 on the use of psychotropic medication in patients with emotionally unstable personality disorder (EUPD) in the current issue of JCP is an important article. Making the assumption that EUPD as defined by ICD-10 (F60.3) is reasonably equivalent to borderline personality disorder (BPD) as defined in the United States by DSM, we are provided some insight into how practitioners think about prescribing medications to people with EUPD/BPD.…”

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confidence: 99%

Management and Effectiveness of Psychopharmacology in Emotionally Unstable and Borderline Personality Disorder

Silk¹

2015

J. Clin. Psychiatry

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“…7 The survey obtained data from clinics where the personality disorder is recognized (often as the primary diagnosis), but it did not examine clinical settings where personality disorder is either ignored or misdiagnosed. In contemporary practice, many personality disorder patients are given the diagnosis of bipolar disorder 8 and treated accordingly.…”

mentioning

confidence: 99%

Why Patients With Severe Personality Disorders Are Overmedicated

Paris¹

2015

J. Clin. Psychiatry

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

Cited by 117 publications

References 21 publications

Lamotrigine for people with borderline personality disorder: a RCT

Lamotrigine for people with borderline personality disorder: a RCT

Management and Effectiveness of Psychopharmacology in Emotionally Unstable and Borderline Personality Disorder

Why Patients With Severe Personality Disorders Are Overmedicated

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