Prescribing and borderline personality disorder

In a challenging therapeutic area, where evidence to guide practice is scarce, Andrew Chanen and Katherine Thompson provide an insightful, pragmatic review on prescribing for patients with borderline personality disorder.1

The authors’ reference to the high rate of comorbid conditions complicating accurate diagnosis and potentially overwhelming the clinical picture was of particular interest to us. Our interdisciplinary team of care coordinators assists complex patients to navigate the healthcare system, promoting self-management and facilitating communication between healthcare providers. These patients are typically high users of hospital or emergency services and at the higher end of functional decline with multiple comorbidities. Patients with borderline personality disorder – both diagnosed and undiagnosed – are highly represented in our patient cohort.

Comorbid mood disorders, chronic pain, anxiety or substance use disorders present significant challenges for treating clinicians. Fragmented care and delayed communication regarding medication management from hospital admissions or specialist outpatient clinics only serve to magnify problems. Embedding a clinical pharmacist within our care coordination team has enhanced timely, collaborative medication management across the care continuum particularly for this patient group. Having an agreed prescribing framework between specialists (knowing who is responsible for prescribing certain drugs), a dedicated GP and dispensing community pharmacist provides reassurance and role certainty among all members of the team. The combination of care coordination with medication management is a useful adjunct in caring for patients with borderline personality disorder.