Personality disorders

In order to develop and maintain an effective treatment relationship, advise patients to select one primary care physician, who will be identified as their "PCP" in a facility that is considered a "medical home." The parameters of the medical practice, such as hours of operation of the clinic site, contact information, and after-hours availability of their physician or his/her designated substitute, and protocol with regard to use of e-mail communication should be specified at the onset of the relationship. Regarding their health care, patients should be encouraged to be involved as active participants in establishing and achieving treatment goals, including those related to lifestyle modification and chronic disease management. Patients and families should be assisted to locate support organizations within their communities. National Alliance on Mental Illness Opens in new window Poor social functioning is a complication of personality disorder, and the establishment of positive social supports is a desirable goal, particularly for patients with children and those who have chronic medical conditions.

The possibility of teratogenicity should be considered for any of the drugs used in the treatment of personality disorders, and the risks and benefits discussed with the patient. Of particular note, valproic acid and its derivatives may cause major congenital malformations, including neurodevelopmental disorders and neural tube defects, after in utero exposure.

• These agents must not be used in female patients of childbearing potential unless other options are unsuitable, there is a pregnancy prevention program in place, and certain conditions are met

• Precautionary measures may also be required in male patients owing to a potential risk that use in the 3 months leading up to conception may increase the likelihood of neurodevelopmental disorders in their children

• Regulations and precautionary measures for female and male patients may vary between countries, with some countries taking a more heightened precautionary stance, and you should consult your local guidance for more information.

In some countries, it is also recommended that topiramate should only be used in women of childbearing potential if there is a pregnancy prevention program in place.