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will need extended psychotherapy to attain and maintain lasting
improvement in their personality, interpersonal problems, and overall
Pharmacotherapy often has an important adjunctive
role, especially for diminution of symptoms such as affective instability,
impulsivity, psychotic-like symptoms, and self-destructive behavior.
Many patients will benefit most from a combination
of psychotherapy and pharmacotherapy.
should address borderline personality disorder as well as comorbid
axis I and axis II disorders, with priority established according
to risk or predominant symptomatology.
The treatment plan must be flexible, adapted
to the needs of the individual patient.
The plan also must respond to the changing
characteristics of the patient over time.
range of treatments available for the patient's condition
and what the psychiatrist recommends.
Elicit the patient's views and
modify the plan to the extent feasible to take these views and preferences
Both are viable
Treatment by multiple clinicians has potential
advantages but may become fragmented.
Good collaboration of the treatment team
and clarity about roles and responsibility are essential.
The effectiveness of single versus multiple
clinicians should be monitored over time and changed if the patient
is not improving.