Neuroleptic treatment in the borderline patient: advantages and techniques

A low-dose neuroleptic strategy is indicated in borderline personality disorder as an acute treatment for symptoms of anger, hostility and suspiciousness, referential thinking and paranoid ideation, anxiety and dissociation, depressed mood, and related behavioral dyscontrol. Medication effects are clinically significant although modest in magnitude. Recommended duration of treatment is generally brief (3-12 weeks), although continued pharmacotherapy may be warranted in selected cases. The risks of treatment include the well-recognized side effects of neuroleptics (minimized by low doses) and the possibility of abuse, overdose, or interaction with alcohol or street drugs. Pharmacotherapy is seen as an adjunct to supportive psychosocial intervention.