Shaikh Untara, Qamar Iqra, Jafry Farhana, Hassan Mudasar, Shagufta Shanila, Odhejo Yassar Islamail, Ahmed Saeed
Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan.
Nassau University Medical Center, East Meadow, NY, United States.
Front Psychiatry. 2017 Aug 4;8:136. doi: 10.3389/fpsyt.2017.00136. eCollection 2017.
Borderline personality disorder (BPD) patients, when in crisis, are frequent visitors of emergency departments (EDs). When these patients exhibit symptoms such as aggressiveness, impulsivity, intense anxiety, severe depression, self-harm, and suicidal attempts or gestures, diagnosis, and treatment of the BPD becomes challenging for ED doctors. This review will, therefore, outline advice to physicians and health-care providers who face this challenging patient population in the EDs. Crisis intervention should be the first objective of clinicians when dealing with BPD in the emergency. For the patients with agitation, symptom-specific pharmacotherapy is usually recommended, while for non-agitated patients, short but intensive psychotherapy especially dialectical behavior therapy (DBT) has a positive effect. Although various psychotherapies, either alone or integrated, are preferred modes of treatment for this group of patients, the effects of psychotherapies on BPD outcomes are small to medium. Proper risk management along with developing a positive attitude and empathy toward these patients will help them in normalizing in an emergency setting after which treatment course can be decided.
边缘型人格障碍（BPD）患者在危机时刻经常前往急诊科就诊。当这些患者表现出攻击性、冲动性、强烈焦虑、严重抑郁、自我伤害以及自杀企图或行为等症状时，急诊科医生对BPD的诊断和治疗就会变得具有挑战性。因此，本综述将为在急诊科面对这一具有挑战性患者群体的医生和医疗服务提供者概述相关建议。在急诊科处理BPD患者时，危机干预应是临床医生的首要目标。对于有激越症状的患者，通常建议采用针对症状的药物治疗，而对于无激越症状的患者，短期但强化的心理治疗尤其是辩证行为疗法（DBT）具有积极效果。尽管各种心理治疗单独使用或综合使用都是这组患者首选的治疗方式，但心理治疗对BPD治疗效果的影响为中到小。适当的风险管理以及对这些患者培养积极的态度和同理心，将有助于他们在急诊科环境中恢复正常，之后再决定治疗方案。
