Objective:

Polypharmacy is common and especially challenging in the context of borderline personality disorder in light of impulsivity and self-harm associated with the disorder, risk of adverse drug-drug interactions, and financial burden. Reduction in polypharmacy could be conceptualized as a high priority in the treatment of borderline personality disorder. This case aims to demonstrate that potential.

Method:

This case report presents outcomes data for an individual with borderline personality disorder during the course of an extended psychiatric hospitalization. Symptomatic change is based on the Patient Health Questionnaire Somatic, Anxiety, and Depression Symptoms scales and World Health Organization 5-Item Well-Being Index. Change in polypharmacy is presented both in terms of absolute number and complexity of the medication regimen. Clinical outcomes data are provided at 2, 12, and 24 weeks postdischarge.

Results:

During a 56-day hospitalization, the patient demonstrated clinical improvement across clinical domains—all occurred within the context of reduced number (43%) and complexity (40%) of her medication regimen. Symptomatic improvement was sustained up to 6 months postdischarge.

Conclusions:

Despite good intentions, polypharmacy can be associated with iatrogenic harm and contribute to functional impairment, especially in the context of borderline personality disorder, in which symptomatic fluctuations are part of the illness itself. A reduction in the patient’s high-risk polypharmacy during treatment represents a noteworthy treatment outcome in and of itself. Additional measures of medication risk and liability have the potential to become markers of clinical effectiveness.

Clinical Points

Despite good intentions, polypharmacy is common and especially challenging in the context of borderline personality disorder in light of impulsivity and self-harm associated with the disorder, risk of adverse drug-drug interactions, and financial burden.
A reduction in patients’ high-risk polypharmacy during treatment represents a noteworthy treatment outcome in and of itself and might be conceptualized as a marker of clinical effectiveness.

Table 1.

Ms A’s Medications at Admission and Discharge

Admission	Indication	Discharge	Indication
Venlafaxine 75 mg: 3 by mouth in the morning and 2 by mouth at bedtime	Antidepressant
Lamotrigine 200 mg by mouth in the morning	Mood stabilizer	Lamotrigine 200 mg at bedtime	Mood stabilizer
Mirtazapine 30 mg by mouth at bedtime	Antidepressant	Mirtazapine 30 mg at bedtime	Antidepressant
Clonazepam 1 mg by mouth in the morning and at bedtime	Antianxiety	Hydroxyzine 25 mg every 8 h as needed	Antianxiety
Ziprasidone 80 mg by mouth in the morning and at bedtime	Antipsychotic	Ziprasidone 80 mg twice daily	Antipsychotic
Zolpidem 10 mg by mouth daily as needed for anxiety	Hypnotic
Metformin hydrochloride 1,000 mg by mouth twice daily	Diabetes	Metformin hydrochloride 1,000 mg in the morning and 500 mg at bedtime	Diabetes
Atorvastatin 40 mg by mouth at bedtime	High cholesterol
Esomeprazole 40 mg by mouth at bedtime	Gastroesophageal reflux disease	Esomeprazole 40 mg daily	Gastroesophageal reflux disease
Lithium carbonate 600 mg by mouth twice daily	Mood stabilizer	Lithium carbonate 600 mg twice daily	Mood stabilizer
Buspirone 7.5 mg by mouth twice daily	Antianxiety	Buspirone 7.5 mg twice daily	Antianxiety
Levothyroxine 50 mcg by mouth in the morning	Hypothyroid	Levothyroxine 100 mcg daily	Hypothyroid
Amphetamine/dextroamphetamine 25 mg by mouth in the morning and 20 mg at noon	Stimulant
Multivitamin: 1 by mouth daily	General health
Baby aspirin: 1 by mouth daily	Cardiovasular
Quinine sulfate: 2 tablets by mouth at bedtime	Leg cramps
Cetirizine 10 mg by mouth in the morning	Antihistamine
Atropine/diphenoxylate: 1 by mouth twice daily	Irritable bowel syndrome
Bismuth subsalicylate over-the-counter by mouth twice daily	Irritable bowel syndrome
Insulin glargine 45 IU subcutaneous twice daily	Diabetes	Insulin glargine 47 units subcutaneous in the morning and at bedtime	Diabetes
Insulin lispro sliding scale	Diabetes	Insulin lispro sliding scale	Diabetes
		Ferrous sulfate 324 mg daily	Anemia
		Pregabalin 50 mg twice daily	Paresthesia