• Acutely, may need to explore suicidality and assess risk.

• Aim to establish a stable, supportive relationship with patient.

• Psychotherapy and other psychosocial interventions can help patients
with relationship issues, to confront fears, cope with trauma, deal with
dysfunctional thoughts, e.g. CBT, mindfulness, dynamic psychotherapy,
dialectical behaviour therapy, mentalisation-based therapy, transferencefocused psychotherapy.
Some of these may be available in primary care
but often require specialist referral.
• Psychotropic medication treatment is not generally recommended.
However, depression and anxiety when co-morbid is treated with SSRI
antidepressants. Off licence low dose antipsychotic treatment with
olanzapine (2.5–5 mg) or quetiapine (25–50 mg) is sometimes used as a
short-term prescription to help emotional regulation in crises although a
safer alternative would be low dose promethazine (25–50 mg).
Quasi-psychotic symptoms may sometimes require treatment with
low dose antipsychotics.
• Patient communication and relationship management strategies.
• Substance abuse, particularly alcohol abuse, is often co-morbid and
requires treatment.