Search

This chapter provides guidelines on how to integrate pharmacological treatment for service users diagnosed with borderline personality disorder (BPD) in structured clinical management (SCM) treatment. It examines current international and national guidelines on pharmacological treatment, discusses the importance of service user–practitioner alliance, distinguishes between crisis-driven symptoms and co-occurring disorders, setting goals, and evaluating any pharmacological interventions. Finally, it integrates clinical decision-making about drug treatment into the SCM team model. Drug treatments are often used despite the lack of research evidence underpinning this approach. Further complications for effective prescribing often arise over the course of treatment itself with high rates of non-attendance and complications arising from co-occurring substance misuse and ruptures in the therapeutic alliance between service user and practitioner.

Nail-patella syndrome (NPS) is an autosomal-dominant pleiotropic disorder characterized by dyplasia of finger nails, skeletal anomalies and frequently renal disease. In the reported case, genetic analysis revealed a new missense mutation in the homeodomain of LMX1B, presumed to abolish DNA binding (c.725T>C, p.Val242Ala). A missense mutation at codon 725 was identified, where thymine was replaced by cytosine which led to the replacement of valine by alanine at position 242. It was not detected in both parents. A 2005 study by Bongers et al. described a significant association between the presence of clinically relevant renal involvement in an NPS patient and a positive family history of nephropathy, which was lacking in our case.