Schulkens Julie, Bergs Nina, Ingenhoven Theo, Rosowsky Erlene, Alphen Sebastiaan van, Sobczak Sjacko
Clinical Center of Excellence for Personality Disorders in Older Adults, Mondriaan Hospital, Heerlen, The Netherlands.
School for Mental Health and Neuroscience (MHeNs), Department of Psychiatry and Neuropsychology, Maastricht University Medical Centre＋, Maastricht, The Netherlands.
Clin Psychopharmacol Neurosci. 2021 Feb 28;19(1):53-62. doi: 10.9758/cpn.2021.19.1.53.
International guidelines on symptom-based treatment of borderline personality disorders (BPD) in older adults are lacking. The number of older adults (≥ 65 years) with borderline personality disorder is rising. Effectiveness of Selective Serotonin Reuptake Inhibitors (SSRIs) on symptoms of BPD has only been investigated in younger adults and results are ambiguous. During life, serotonergic function changes, which can influence the indication and effectiveness of SSRIs in older adults with BPD. Aim of this study is to reach consensus on the suitability of SSRIs for the treatment of older adults with BPD.
A Delphi study was conducted among eighteen international experts. In three successive rounds, a total of 16 statements addressing the treatment with SSRI's in older adults with BPD were assessed. Consensus on specific statements was reached if at least two-third of these experts agreed.
Consensus was reached on 11 statements related to the indication and effectiveness of SSRIs in the treatment of older adults with BPD.
The results of this study suggest a valuable role for SSRIs in the treatment of affective instability, and to a lesser extent impulsive behavior, in older adults with BPD. Sertraline or citalopram are suggested to be the first-choice medication but should be prescribed with some caution. Treatment recommendations have been suggested (presented in a flowchart), but still have to be investigated in clinical practice.
目前缺乏针对老年边缘型人格障碍（BPD）基于症状治疗的国际指南。患有边缘型人格障碍的老年人（≥65岁）数量正在上升。选择性5-羟色胺再摄取抑制剂（SSRIs）对BPD症状的有效性仅在年轻人中进行过研究，结果并不明确。在生命过程中，血清素能功能会发生变化，这可能会影响SSRIs在患有BPD的老年人中的适应证和有效性。本研究的目的是就SSRIs用于治疗老年BPD患者的适用性达成共识。
对18位国际专家进行了一项德尔菲研究。在连续三轮中，共评估了16条关于用SSRIs治疗老年BPD患者的陈述。如果至少三分之二的专家同意，则就具体陈述达成共识。
就11条与SSRIs治疗老年BPD患者的适应证和有效性相关的陈述达成了共识。
本研究结果表明，SSRIs在治疗老年BPD患者的情感不稳定方面具有重要作用，在治疗冲动行为方面作用较小。建议舍曲林或西酞普兰作为首选药物，但应谨慎处方。已提出治疗建议（以流程图形式呈现），但仍需在临床实践中进行研究。
