[Pharmacotherapy of a 67-year old female with borderline personality disorder]

Pharmacotherapy in older adults with personality disorders is very complicated. On the one hand, this is caused by interference of the personality disorder in the therapeutic relationship. On the other hand, age specific factors, such as polypharmacy and changing pharmacokinetics and -dynamics play an important complicating role. In this article the difficulties of pharmacotherapy in older adults with personality disorders are illustrated by the description of a case of a 67-year old female with a borderline personality disorder. She has an extensive history of many therapies, which have not been effective in treating a variety of symptoms. This case description emphasizes the importance of making the correct diagnosis and focusing pharmacotherapy on the personality disorder. Also, decreasing polypharmacy, often a consequence of an extensive history of many - both psychiatric and somatic - treatments, plays an important role. There is a lack of evidence on pharmacotherapy in older adults with personality disorders to rely on and therefore there is a need for more research on this subject.

[Pharmacotherapy in older adults with personality disorders: a new area of attention]

BACKGROUND

Pharmacotherapy in older adults with personality disorders (PD) is a new and important area of attention. Nowadays, symptom based pharmacotherapy in older adults with PD is based on multidisciplinary guidelines, which are constructed on research performed in patients up to 50 years of age. There is no specific guideline for older adults with PD.

GOAL

Providing a description of patient characteristics: number of comorbid psychiatric disorders, use of medication, including polypharmacy, in older adults (≥ 65 years) with personality disorders.

METHOD

A retrospective cross-sectional patient file study (n = 50) in a clinical center of excellence for older adults with personality disorders (outpatient setting).

RESULTS

. From the file study, it appears that 1) the unspecified/other specified personality disorder and the borderline personality disorder (BPD) occur most frequently, 2) there is a trend (no significant difference) that older adults with BPS use most medication (somatic medication and psychotropics) and 3) there is a trend (no significant difference) that polypharmacy is the most prevalent amongst older adults with BPD.

CONCLUSION

The use of medication in certain subgroups of older adults with PD tends to be high. Further research is necessary to optimize pharmacotherapy in older adults with PD.