Quality statement 4: Pharmacological interventions

Quality statement

People with borderline or antisocial personality disorders are prescribed antipsychotic or sedative medication only for short‑term crisis management or treatment of comorbid conditions.

Rationale

No drugs have established efficacy in treating or managing borderline or antisocial personality disorder. However, antipsychotic and sedative medication can sometimes be helpful in short‑term management of crisis (the duration of treatment should be no longer than 1 week) or treatment of comorbid conditions.

Quality measures

Structure

a) Evidence of local arrangements to ensure that people with borderline or antisocial personality disorder are prescribed antipsychotic or sedative medication only for short‑term crisis management or treatment of comorbid conditions.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that when people with borderline or antisocial personality disorder are prescribed antipsychotic or sedative medication, there is a record of the reason for prescribing the medication and the duration of the treatment.

Data source: Local data collection.

Process

a) Proportion of people with borderline or antisocial personality disorder prescribed antipsychotic or sedative medication in a crisis or to treat comorbid conditions.

Numerator – the number in the denominator who were prescribed the antipsychotic or sedative medication in a crisis or to treat comorbid conditions.

Denominator – the number of people with borderline or antisocial personality disorder prescribed antipsychotic or sedative medication.

Data source: Local data collection.

b) Proportion of people with borderline or antisocial personality disorder prescribed antipsychotic or sedative medication in a crisis and who had it prescribed for no longer than a week.

Numerator – the number in the denominator prescribed antipsychotic or sedative medication for no longer than a week.

Denominator – the number of people with borderline or antisocial personality disorder prescribed antipsychotic or sedative medication in a crisis.

Data source: Local data collection.

Outcome measure

Antipsychotic and sedative medication prescribing rates.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals, and commissioners

Service providers (GPs and mental health trusts) ensure that staff only prescribe antipsychotic or sedative medication for people with borderline or antisocial personality disorder for short‑term crisis management or treatment of comorbid conditions.

Healthcare professionals only prescribe antipsychotic or sedative medication for people with borderline or antisocial personality disorder for short‑term crisis management or treatment of comorbid conditions.

Commissioners (clinical commissioning groups, NHS England local area teams) commission services that only prescribe antipsychotic or sedative medication for people with borderline or antisocial personality disorder for short‑term crisis management or treatment of comorbid conditions.

What the quality statement means for service users and carers

People with borderline or antisocial personality disorder are only prescribed antipsychotic or sedative medication for a short time if they have a crisis or if they have another condition that needs that medication.

Source guidance

Definitions of terms used in this quality statement

Short‑term crisis management

Using sedative or antipsychotic medication for short‑term crisis management means using it cautiously in a crisis as part of the overall treatment plan for people with borderline or antisocial personality disorder. The duration of treatment should be agreed with the person, but should be no longer than 1 week.

[NICE guideline CG78]

Crisis may be suicidal behaviour or intention, panic attacks or extreme anxiety, psychotic episodes, or behaviour that seems out of control, or irrational and likely to endanger the person or others.

[Mental health crisis care concordat, Department of Health (2014) and expert opinion]