Management
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There is great variation in the presentation of personality disorders, but there are a few common principles for all when it comes to management. Inevitably progress will be slow since ingrained behaviour is being dealt with. It should never be forgotten that people who have personality disorders also get conventional psychiatric illnesses, particularly depression, and those should be treated. Often the main aim of therapy is to help the individual change their situation to one that is less discordant with their personality. Finally, it should be borne in mind that these patients do badly being passed from one doctor to another every few months.
Personality Restructuring.
Individuals with milder forms of personality disorder may benefit from a long term psychotherapy (psychodynamic or cognitive). Such a therapy would enable him/her to understand the effects his/her behaviour has on others, to understand their feelings and to make changes. Often there is benefit from conducting this in a group setting.
Support and Problem Solving
Most patients with personality disorders will not be suitable for restructuring psychotherapy. They will need support, particularly through times of crisis. A long-term consistent relationship with a concerned clinician (GP, psychiatrist etc.) is often of fundamental importance. Such a relationship will emphasise the importance of the patient taking responsibility for themselves and will seek to limit the damage caused by the patient's unhelpful behaviours. Some will benefit from problem focused therapies to ameliorate specific difficulties, e.g. assertiveness training for anxious (avoidant) personality disorder.
Medication
Drug treatments are of limited benefit in most personality disorders. Particularly care should be taken with the prescription of any drug with potential for dependence formation, e.g. benzodiazepines and attention should be paid to the risk of deliberate over-dosage. Occasionally patients who are prone to suspiciousness and patients who have poor impulse control benefit from low doses of major tranquillisers. In addition patients with impulsive, borderline and dissocial may gain benefit from SSRIs, which can ameliorate impulsive behaviours.
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