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Table 4 European recommendations on medication for Personality disorders

From: European guidelines for personality disorders: past, present and future

Guideline Pop. Recommendations
Swiss (2018) BPD Medication should be restricted to critical situations and administered for a short timespan
In case of need, symptom-focused hierarchical organization
 - Lamotrigin and Topiramat is administered for anger, aggression and impulsivity
 - Quetiapin and Aripiprazol is administered for irritability and cognitive-perceptive symptoms
Generally, dosage is kept in the lower range. Benzodiazepines should be completely avoided
Treatment of comorbidities should be evaluated systematically and thoroughly
No Polypharmacy.
Swedish (2017) PD Medication should not be offered as a primary treatment for personality syndromes but may be applied treating co-occurring symptom disorders.
Danish (2016) BPD Antidepressants should only be used for the treatment of patients with borderline personality disorder upon due consideration.
Mood stabilizers should only be used for the treatment of patients with borderline personality disorder upon due consideration.
Antipsychotics should only be used for the treatment of patients with borderline personality disorder upon due consideration
Finnish (2015) BPD Antipsychotic medication might relieve symptoms in multiple dimensions.
Mood stabilizers may be useful in reducing impulsivity and aggression. Serotonin reuptake inhibitors may be useful especially in treatment of comorbidity.
There is a risk of polypharmacy in pharmacological treatment.
Mood stabilizers and 2nd generation antipsychotics are preferred in pharmacotherapy.
Catalonia (2011) BPD There is no evidence for any pharmacological treatment. It is recommended to avoid the use of benzodiazepines due to the risk of abuse and dependence.
The pharmacological treatment should be considered as a coadjuvant of the psychotherapeutic or the psychosocial intervention to globally improve or to improve one of its characteristic symptoms.
The pharmacological treatment in patients with BPD must be periodically reviewed, with the aim of eliminating unnecessary or ineffective medications as well as avoiding polypharmacy.
German (2009) PD Pharmacological treatment can be considered for crisis-like aggravation and comorbid disorders. There is no evidence for pharmacological treatment of PD only, it should always be combined with psychotherapy.
British (BPD) (2009) BPD Do not use:
Drug treatment specifically for borderline personality disorder or for the individual symptoms or behaviour associated with the disorder.
Antipsychotic drugs for the medium- and long-term treatment of borderline personality disorder.
Consider drug treatment in the overall treatment of comorbid conditions.
Consider cautiously short-term use of sedative medication as part of the overall treatment plan for people with borderline personality disorder in a crisis. Agree the duration of treatment with them, but it should be no longer than 1 week.
Review the treatment of those who do not have a diagnosed comorbid mental or physical illness and who are currently being prescribed drugs. Aim to reduce and stop unnecessary drug treatment.
British (2009) ASPD Pharmacological interventions should not be routinely used for the treatment of antisocial personality disorder or associated behaviours of aggression, anger and impulsivity.
Dutch (2008) PD There is evidence that antipsychotics, SSRI’s and mood stabilizers may improve targeted symptoms of a personality disorder and the global functioning.