The State of Overmedication in Borderline Personality Disorder: Interpersonal and Structural Factors.
The State of Overmedication in Borderline Personality Disorder: Interpersonal and Structural Factors.
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DOI：
10.1007/s40501-021-00255-x
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发表时间：
2022-03
影响因子：
--
通讯作者：
Fineberg, Sarah K
中科院分区：
文献类型：
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作者：
Shapiro-Thompson, Rosa;Fineberg, Sarah K
这篇综述文章描述了边缘型人格障碍（BPD）的处方实践状况，其中药物的处方远远超过证据或实践指南的建议。首先，我们描述了BPD患者的药物使用频率和多药治疗。在随后的章节中，我们详细阐述了导致BPD患者过度用药的两大类因素：人际介导的因素和结构性因素。我们认为人际介导的因素产生于痛苦的患者的沟通和他们的处方医生善意的努力，以提供某些压倒性的情感状态救济。我们特别关注处方中与BPD病理学特定方面直接相关的反移情模式。我们认为结构性因素产生的复杂性的医疗和法医学系统和融资的医疗保健的当代模式，我们假设，这些复杂性往往迫使处方开始用药，随着时间的推移减少或停止这些药物的相关抑制因素。需要更多的研究来了解如何在BPD中最好地使用药物，例如与心理治疗和心理社会干预相结合。然而，目前的做法往往明显偏离证据。我们建议在门诊和住院实践中推广可获得的、全科的BPD治疗模式;增加BPD的早期发现;增加诊断信息的披露。我们还建议个人提供者和系统实施从BPD特定的心理社会模型中得出的前瞻性治疗计划。这种方法可以采用干预措施的层次，以尽量减少反应性处方的预期高影响，并提供BPD患者稳定的移情证据支持的护理。
This review paper describes the state of prescribing practice in Borderline Personality Disorder (BPD), wherein medications are prescribed far more than either evidence or practice guideline would recommend. First, we describe the frequencies of medication use and polypharmacy in people with BPD. In subsequent sections, we elaborate two main categories of factors that lead to overmedication of people with BPD: the interpersonally mediated and the structural. We consider interpersonally mediated factors to arise from communications of patients in distress and the well-meaning efforts of their prescribers to provide relief for certain overwhelming affective states. We are particularly focused on patterns of countertransference in prescribing that are directly linked to specific aspects of BPD pathology. We consider structural factors to arise from the complexities of medical and medicolegal systems and the contemporary patterns of financing medical care; we postulate that these complexities often compel prescribers to start medications, with associated disincentives for decreasing or discontinuing those medications over time. More research is needed to understand how to best use medications in BPD, for example in targeted combination with psychotherapeutic and psychosocial interventions. However, current practice often departs markedly from the evidence. We recommend the dissemination of accessible, generalist BPD-treatment models in outpatient and inpatient practice; increased early detection of BPD; and increased diagnostic disclosure. We also recommend for individual providers and systems to implement prospective treatment plans that draw from BPD-specific psychosocial models. This approach can employ tiers of interventions to minimize reactive prescribing by anticipating high affect and offering BPD patients steadily empathic evidence-supported care.