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For our next Quick Take, let’s look at a randomized trial of lamotrigine in borderline personality disorder.
First, a little context: You might think, “Well, I’ll just refer everyone with borderline personality disorder for a dialectic behavior therapy.” Right? Or you might think one of the other borderline-specific therapies, like mentalization from Anthony Bateman and Peter Fonagy or the STEPPS Program from the University of Iowa. All of these have randomized trial evidence for efficacy. But John Gunderson of Harvard’s McLean Hospital, a well-known figure in borderline research, has advocated that we in psychiatry not simply refer everyone that we think has borderlinity. For one thing, there aren’t enough specialists to handle them all. Moreover, his group has data that suggest that what they call “good psychiatric management” by any experienced psychiatric clinician gets positive outcomes. Meaning, in his view, we ought to all take on some of these folks
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