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Yıl:2013; Cilt: 26; Sayı: 1>> Özet
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Düşünen Adam: Psikiyatri ve Nörolojik Bilimler Dergisi; 2013;26(1):72-79
“Borderline” Kişilik Bozukluğu: Duygudurum Dengeleyicilerinin Tedavideki Yeri
H Belli, C Ural, M Akbudak
Bağcılar Eğitim ve Araştırma Hastanesi, Psikiyatri Kliniği, İstanbul
Bu yazıda, bipolar bozuklukla ortak olarak, “borderline” kişilik bozukluğunun (BKB) psikofarmakolojik tedavisinde kullanılan duygudurum dengeleyicilerin etkinliğini gözden geçirmek amaçlanmıştır. Bu çerçevede, BKB ile bipolar bozukluğun örtüşen fenomenolojisi ve ayırıcı klinik tanının özellikleri de literatür eşliğinde gözden geçirilecektir. Her iki bozukluk da tanı açısından ortak özellikler gösterebilir ve fenomenolojik açıdan örtüşebilirler, birlikte var olma sıklıkları da oldukça yüksektir. Her iki bozukluğun birbirinden ayrıştırılması için duygudurum kaymalarının niteliği, impulsivitenin tipleri ve bozuklukların uzunlamasına gidişine dikkat edilmelidir. BKB tedavisinde lityum, karbamazepin, okskarbazepin, sodyum valproat ve lamotrijin gibi duygudurum dengeleyicilerin etkinliğine dair çeşitli araştırmalar mevcuttur. BKB’nin bipolar bozukluklardan ayrıştırılması kolay değildir. Çok dikkatli bir değerlendirme gereklidir. Bu ayrıştırmanın yapılabilmesi tedavi açısından da yararlı olabilir. BKB tedavisinde valproat ve lamotrijinin etkinliği ile ilgili çok sayıda araştırma sonucu mevcuttur. Diğer duygudurum dengeleyiciler ile ilgili bulgular ise yetersizdir. BKB tedavisinde herhangi bir ilacın kullanımı resmi otoriteler tarafından onaylanmamıştır. BKB tedavisinde psikoterapötik yaklaşımlar önemli yerlerini korumaktadırlar. Bununla birlikte, duygudurum dengeleyicilerin kullanımında semptom temelli yaklaşım önerilmiştir. Anahtar kelimeler: Borderline kişilik bozukluğu, bipolar bozukluk, duygudurum dengeleyiciler
Borderline personality disorder: the place of mood stabilizers in the treatment
This article aims to review the effectiveness of mood stabilizers used in the psychopharmacologic treatment of both bipolar disorder and borderline personality disorder. In this context, the overlapping phenomenology of borderline personality disorder and bipolar disorder and the differential diagnosis of clinical features will be also reviewed with the literature. Both disorders can show common features in terms of diagnosis and overlap in phenomenological perspective. Coexistence of both disorders is quite frequent. The nature of mood shifts, types of impulsivity and the longitudinal course of the disorders should be considered to differenciate them. There are findings on the effectiveness of mood stabilizers such as lithium, carbamazepine, oxcarbazepine, sodium valproate or lamotrigine in the treatment of the borderline personality disorder. The differentiation of borderline personality disorder from bipolar disorder is not easy. A very careful evaluation is required. This differentiation may also be useful in terms of treatment. A greater number of research results are available on the effectiveness of valproate and lamotrigine in the treatment of borderline personality disorder. Findings related to other mood stabilizers are insufficient. In the treatment of borderline personality disorder, there is not any drug approved by the official authorities. Psychotherapeutic approaches still retain their important place in the treatment. However, symptom-based approach is proposed in the use of mood stabilizers. Keywords : Borderline personality disorder, bipolar disorder, mood stabilizers

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