Practice Guideline for the Treatment of Patients With Borderline Personality Disorder

Practice Guideline for the Treatment
of Patients With
Borderline Personality Disorder

APPENDIXES:
PSYCHOPHARMACOLOGICAL TREATMENT ALGORITHMS

APPENDIX 1.
Psychopharmacological Treatment
of Affective Dysregulation Symptoms
in Patients With Borderline Personality Disorder

^aAlgorithm based on clinical judgment that uses evidence currently in the literature, following the format of the International Psychopharmacology Algorithm Project (2). The first step in the algorithm is generally supported by the best empirical evidence. Recommendations may not be applicable to all patients or take individual needs into account. The empirical research studies on which these recommendations are based may be "first trials" involving previously untreated patients and may not take into account previous patient nonresponse to one, two, or even three levels of the algorithm (i.e., patients who, by definition, have more refractory disorders). There are no empirical trials of the complete algorithm.

APPENDIX 2.
Psychopharmacological Treatment of Impulsive-Behavioral Dyscontrol Symptoms in Patients With Borderline Personality Disorder^a

^aAlgorithm based on clinical judgment that uses evidence currently in the literature, following the format of the International Psychopharmacology Algorithm Project (2). The first step in the algorithm is generally supported by the best empirical evidence. Recommendations may not be applicable to all patients or take individual needs into account. The empirical research studies on which these recommendations are based may be "first trials" involving previously untreated patients and may not take into account previous patient nonresponse to one, two, or even three levels of the algorithm (i.e., patients who, by definition, have more refractory disorders). There are no empirical trials of the complete algorithm.
^bSSRI treatment must be discontinued and followed with an adequate washout period before initiating treatment with an MAOI.

APPENDIX 3.
Psychopharmacological Treatment of Cognitive-Perceptual Symptoms in Patients With Borderline Personality Disorder^a

^aAlgorithm based on clinical judgment that uses evidence currently in the literature, following the format of the International Psychopharmacology Algorithm Project (2). The first step in the algorithm is generally supported by the best empirical evidence. Recommendations may not be applicable to all patients or take individual needs into account. The empirical research studies on which these recommendations are based may be "first trials" involving previously untreated patients and may not take into account previous patient nonresponse to one, two, or even three levels of the algorithm (i.e., patients who, by definition, have more refractory disorders). There are no empirical trials of the complete algorithm.

^bThe generally favorable side effect profiles of the newer atypical neuroleptic medications compared with those of conventional neuroleptics underscore the need for careful empirical trials of these newer medications in the treatment of patients with borderline personality disorder.