Guidance in works on treatment of borderline.

Clinicians should not use drugs to specifically treat borderline personality disorder and should not use brief pharmaceutical interventions to treat the symptoms of the condition, under a draft guideline published by the health effectiveness agency for England and Wales.

The draft document from the National Institute for Health and Clinical Excellence also called on mental health trusts to establish multidisciplinary teams to assess and treat borderline personality disorder and diagnose cases when psychiatrists are in doubt.

The document also said community mental health services should be responsible for routine diagnosis, treatment, and management of patients with borderline personality disorder.

NICE said the guideline is expected to be published in January 2009, Borderline personality disorder is present in just under 1% of the population, with greater frequency in women and in patients in early adulthood, according to the document.

Physicians can consider use of sedative medications in a crisis for no more than a week, with consent of the patient, according to the document. Symptoms associated with the disorder, such as repeated self-harm, marked emotional instability, risk-taking behavior and transient psychotic symptoms, should not trigger drug treatment, it said.

Other recommendations included that when offering psychological treatment, clinicians should offer both group and individual therapy.

Further, it said, health care professionals should discuss withdrawal and transition of treatment carefully with patients, phase it in over time, and work in collaboration with other professionals and services, including crisis services.

They should also give patients written material about the treatment model they are recommending when referring the patient. Drug treatment can be considered for comorbid conditions, the draft said.

BY JONATHAN GARDNER

London Bureau