Sweeney D R
J Clin Psychiatry. 1987 Aug;48 Suppl:32-7.
Outpatient treatment of patients with borderline personality disorder is sometimes more difficult and more challenging than inpatient treatment. Because symptoms are frequently less florid and more variable in the outpatient, diagnostic evaluation must proceed at a slower pace. Diagnostic distinctions among patients with borderline personality disorder are based on whether the predominant symptoms displayed are "affective," "schizotypal," or "impulse-disordered." Outpatient evaluation requires a keen sensitivity to the presenting problems and the ability to assign priorities to treatment issues. Pharmacotherapy can be of advantage in treating outpatients with borderline personality disorder, but care must be taken in selecting appropriate drugs and dosage and in communicating to the patient what can be expected during therapy. Borderline patients with impulse-control disorders, especially substance abuse, cannot be treated effectively with individual psychotherapy alone. Although many creative and articulate psychodynamic formulations of borderline personality disorder have been proposed, an initial "cognitive" approach to psychotherapy combined with pharmacotherapy can be effective in alleviating acute symptoms, and more psychodynamic approaches can be employed when the patient is better equipped to use them.
边缘型人格障碍患者的门诊治疗有时比住院治疗更困难、更具挑战性。因为在门诊患者中症状往往不那么明显且更具变异性，所以诊断评估必须以较慢的速度进行。边缘型人格障碍患者之间的诊断区分基于所表现出的主要症状是“情感性的”、“分裂样的”还是“冲动性紊乱的”。门诊评估需要对呈现的问题有敏锐的敏感性，以及对治疗问题进行优先级排序的能力。药物治疗对边缘型人格障碍门诊患者可能有益，但在选择合适的药物和剂量以及向患者说明治疗期间的预期效果时必须谨慎。患有冲动控制障碍（尤其是物质滥用）的边缘型患者仅靠个体心理治疗无法得到有效治疗。尽管已经提出了许多关于边缘型人格障碍的富有创造性且清晰明了的心理动力学理论，但心理治疗结合药物治疗的初始“认知”方法可有效缓解急性症状，当患者更有能力运用时，可采用更多的心理动力学方法。
