Pautas para el tratamiento psicofarmacológico del trastorno límite de la personalidad (guías prácticas APA)
Dr. Diego
Dr. Diego Cohen CUADRO 5 Conclusiones - Si fuera posible evitar la polifarmacia. - El uso de NLP típicos o atípicos parece tener una aceptación más amplia y mayor espectro de aplicación. Serían útiles frente a una gran variedad de síntomas a pesar de la alta tasa de discontinuación de NLP típicos (87,22%) a 22 semanas. - Los ATD IRSS resultan drogas de primera elección frente a varios síntomas de las dimensiones conductuales en TLP. - Los estudios actuales consideran que la terapéutica con ATD puede ser particularmente efectiva (Cochrane Database Syst Rev, 2006). - Las BZD parecen tener un rol cada vez más limitado en especial alprazolam. - Limitado sustento empírico para el uso de anticonvulsivantes (CBZ y Valproico). aumento de peso. La pregunta 7 remite al apartado correspondiente. Respecto de la pregunta 8, la impresión clínica es que estamos muy lejos de la recomendación general de limitar el uso de BZD a 4 semanas (76) de tratamiento. Se deberían controlar en mayor medida en los pacientes con trastorno por abuso de sustancias concomitante. Resta aclarar con mayor profundidad la información contradictoria respecto del uso del alprazolam. El riesgo de la adherencia estricta a las guías puede radicar en que, orientándonos en estudios de nivel A de comprobación y en el agrupamiento de datos de estudios rigurosos, nos conduzcan al ocultamiento de aquello que ocurre en el paciente individual y que hacen de la psicofarmacología una ciencia y en cierta medida un arte. Debido al polimorfismo del cuadro clínico del TLP y la variabilidad de respuesta y de neurocircuitos involucrados principalmente en el procesamiento de emociones, resta todavía evaluar cierto grupo de ATD como el bupropion, la mirtazapina y drogas promisorias para el tratamiento de la ansiedad y ciertas enfermedades comórbidas como la fibromialgia, por ejemplo pregabalina (Cuadro 5). Referencias bibliográficas 1. American Psychiatric Association. 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