Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Av. Sant Antoni Mª Claret 167, 08025, Barcelona, Spain.
Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
CNS Drugs. 2021 Sep;35(9):1023-1032. doi: 10.1007/s40263-021-00852-7. Epub 2021 Aug 9.
Although no psychotropic drugs have been officially approved for the treatment of borderline personality disorder (BPD), medications are routinely prescribed for these patients. The primary aim of this study was to evaluate changes in the pharmacological management of patients with BPD treated in an outpatient specific unit in Spain over the past 20 years, while a secondary aim was to identify the factors associated with the prescription.
Observational and cross-sectional study of all patients with a primary diagnosis of BPD (n = 620) consecutively admitted to a BPD outpatient program in Barcelona, Spain, from 2001 through 2020. We examined trends in the prescription of antidepressants, benzodiazepines, mood stabilizers, and antipsychotics. For the analysis, prescription data were grouped into four 5-year periods (2001-2005, 2006-2010, 2011-2015, and 2016-2020). Logistic regression models were performed to identify sociodemographic and clinical variables associated with pharmacological prescription and polypharmacy.
The percentage of patients receiving pharmacotherapy decreased over time. Antidepressant prescription rates remained high and stable over time (74% of patients), while benzodiazepine use decreased significantly during the study period (from 77 to 36%) and second-generation antipsychotic (SGA) use increased from 15 to 32%. Psychiatric comorbidity was the main factor associated with pharmacological treatment (odds ratio 2.5, 95% confidence interval 1.5-4.2) and polypharmacy, although a high percentage of patients without comorbidity were also taking medications.
Over the past 20 years, the pharmacological treatment of BPD outpatients has undergone important changes, most notably the decrease in benzodiazepines and increase in SGAs. The findings of this study demonstrate that pharmacotherapy is much more prevalent in patients with BPD than recommended in most clinical guidelines.
尽管没有精神药物被正式批准用于治疗边缘型人格障碍（BPD），但这些患者经常会被开这些药物。本研究的主要目的是评估过去 20 年来在西班牙一家专门的门诊单位中治疗 BPD 患者的药物治疗管理的变化，次要目的是确定与处方相关的因素。
对 2001 年至 2020 年期间连续入住西班牙巴塞罗那 BPD 门诊项目的所有 BPD 患者（n=620）进行了观察性和横断面研究。我们检查了抗抑郁药、苯二氮䓬类、心境稳定剂和抗精神病药处方的趋势。在分析中，将处方数据分为四个 5 年期（2001-2005 年、2006-2010 年、2011-2015 年和 2016-2020 年）。使用逻辑回归模型来识别与药物治疗和多药治疗相关的社会人口统计学和临床变量。
接受药物治疗的患者比例随时间的推移而降低。抗抑郁药的处方率在整个研究期间保持较高且稳定（74%的患者），而苯二氮䓬类药物的使用在研究期间显著下降（从 77%降至 36%），第二代抗精神病药（SGA）的使用从 15%增至 32%。精神共病是药物治疗的主要相关因素（比值比 2.5，95%置信区间 1.5-4.2）和多药治疗，尽管高比例无共病的患者也在服用药物。
过去 20 年来，BPD 门诊患者的药物治疗发生了重要变化，最显著的是苯二氮䓬类药物的减少和 SGA 的增加。本研究的结果表明，药物治疗在 BPD 患者中的流行程度远高于大多数临床指南所推荐的。
