Objective

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.

Methods

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.

Results

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.

Conclusions

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.

中文翻译：

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边缘性人格障碍门诊患者心理药理学治疗的 20 年趋势：西班牙的一项横断面自然主义研究

客观的

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)，但通常会为这些患者开具药物处方。本研究的主要目的是评估过去 20 年在西班牙门诊特定病房治疗的 BPD 患者的药理学管理变化，而次要目的是确定与处方相关的因素。

方法

从 2001 年到 2020 年，对所有初步诊断为 BPD 的患者（ n = 620）进行了观察性和横断面研究，这些患者 在西班牙巴塞罗那连续接受 BPD 门诊项目。我们检查了抗抑郁药、苯二氮卓类药物、情绪稳定剂处方的趋势, 和抗精神病药。为了进行分析，处方数据分为四个 5 年期（2001-2005、2006-2010、2011-2015 和 2016-2020）。进行逻辑回归模型以确定与药理学处方和多种药物相关的社会人口统计学和临床​​变量。

结果

接受药物治疗的患者百分比随着时间的推移而下降。随着时间的推移，抗抑郁药处方率保持较高且稳定（74% 的患者），而苯二氮卓类药物的使用在研究期间显着下降（从 77% 降至 36%），第二代抗精神病药 (SGA) 的使用率从 15% 增加到 32%。精神病合并症是与药物治疗（优势比 2.5，95% 置信区间 1.5-4.2）和多种药物治疗相关的主要因素，尽管大部分没有合并症的患者也在服用药物。

结论

在过去的 20 年中，BPD 门诊患者的药物治疗发生了重要变化，其中最明显的是苯二氮卓类药物的减少和 SGA 的增加。这项研究的结果表明，药物治疗在 BPD 患者中比大多数临床指南中推荐的更为普遍。