Abstract
Borderline personality disorder (BPD) is a common, serious, and life-threatening psychiatric illness. The view of its treatment has undergone a significant change in recent years, not only in psychotherapy, which is the main effective intervention, but also in pharmacotherapy.
Despite the fact that the recommendations of professional societies do not agree and the clinical practice is very heterogeneous, we can find facts that support us in the treatment of this group of patients. It is important to take into account the fact that no drug has been shown to be sufficiently effective in improving the prognosis of the disease as a whole.
Currently, the use of drugs is recommended only to correct specific symptoms, such as affective instability, impulsive aggression and cognitive-behavioral disturbances, where we find some clues in the issue of influencing non-suicidal self-aggressive behavior. However, there are also drugs that are not generally recommended, such as benzodiazepines or have been shown to have no effect in the treatment of BPD, such as lamotrigine.
In the management of therapy, we must also take into account psychiatric comorbidities. In patients with BPD, we encounter concomitant diseases that respond to targeted treatment of the associated disease, but also pathologies for which the introduction of specific pharmacotherapy is not recommended.
The main reason for this practice is the finding that given comorbidities (e.g. depressive disorder, panic disorder) respond very well to complex BPD therapy, which is considered solid psychotherapy, preferably in one of the directions directly aimed at this psychopathology (for example dialectic-behavioral therapy, schematherapy and others). The article also discusses the situation in the Czech Republic, the problem of polypharmacy and possible reasons for incorrect practice in the treatment of BPD.