Prescribing of psychotropic medication for personality disordered patients in secure forensic settings

Little is known about effective interventions for personality disorders but psychological treatment is generally favoured over psychotropic medication. However, rates of prescribing are high in personality disorders, in particular in borderline personality disorder (BPD). We surveyed prescribing for ASPD and BPD in a high and medium secure setting. We found that nearly 80% of the 161 personality disordered patients surveyed received some form of psychotropic medication, nearly two-thirds were prescribed two or more drugs. Sixty-five percent of patients were prescribed medication specifically for the management of their personality disorder. Second generation antipsychotics and mood stabilisers were the most commonly prescribed drugs. Symptoms most frequently reported as targets for psychotropic medication included emotional instability, paranoia, aggression and hostility. Psychotropic interventions were seen as effective by prescribers. We discuss the implications of our findings in the light of recent NICE guidance on ASPD and BPD.