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Update on pharmacotherapy of borderline personality disorder

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Abstract

Pharmacotherapy is a very common form of treatment for borderline personality disorder or its concomitant disorders. This paper reviews all the open-label and placebo-controlled trials of second generation medications studied in samples of well-defined borderline patients. Most of the medications studied in double-blind, placebo-controlled trials were efficacious. Most of these medications were also useful in treating symptoms of affective dysregulation and impulsive aggression, which have been suggested to be the core dimensions of psychopathology of underlying borderline personality disorder. Taken together, the results of these studies suggest that the choice of medication can be guided as much by tolerability and safety as by symptom presentation. It also suggests that the common practice of polypharmacy, which has no empiric support, may be unnecessary for most patients with borderline personality disorder.

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References and Recommended Reading

  1. Bender DS, Dolan RT, Skodol AE, et al.: Treatment utilization by patients with personality disorders. Am J Psychiatry 2001, 158:295–302.

    Article  PubMed  CAS  Google Scholar 

  2. Zanarini MC, Frankenburg FR, Khera GS, Bleichmar J: Treatment histories of borderline inpatients. Compr Psychiatry 2001, 42:144–150.

    Article  PubMed  CAS  Google Scholar 

  3. Zanarini MC, Frankenburg FR, Hennen J, Silk KR: Mental health service utilization of borderline patients and axis II comparison subjects followed prospectively for six years. J Clin Psychiatry 2003, in press.

  4. Norden MJ: Fluoxetine in borderline personality disorder. Prog Neuorpsychopharmacol Biol Psychiatr 1989, 13:885–893.

    Article  CAS  Google Scholar 

  5. Cornelius JR, Soloff PH, Perel JM, Ulrich RF: Fluoxetine trial in borderline personality disorder. Psychopharmacol Bull 1990, 26:151–154.

    PubMed  CAS  Google Scholar 

  6. Gunderson JG, Kolb JE, Austin V: Diagnosing borderline patients with a semistructured interview. Arch Gen Psychiatry 1981, 138:896–903.

    CAS  Google Scholar 

  7. Markowitz PJ, Calabrese, Schulz SC, Meltzer HY: Fluoxetine in the treatment of borderline and schizotypal personality disorders. Am J Psychiatry 1991, 148:1064–1067.

    Google Scholar 

  8. Derogatis LR, Lipman RS, Covi L: SCL-90: an outpatient psychiatric rating scale. Preliminary report. Psychopharmacol Bull 1997, 9:13–28.

    Google Scholar 

  9. Markowitz P: Pharmacotherapy of impulsivity, aggression and related disorders. In Impulsivity and Aggression. Edited by Hollander E, Stein D. West Sussex, UK: John Wiley & Son: 1995:263–287.

    Google Scholar 

  10. Beck AT, Ward DH, Mendelson M, et al.: An inventory for measuring depression. Arch Gen Psychiatry 1961, 5:561–571.

    Google Scholar 

  11. Markowitz PJ, Wagner SC: Venlafaxine in the treatment of borderline personality disorder. Psychopharmacol Bull 1995, 31:773–777.

    Google Scholar 

  12. Salzman C, Wolfson AN, Schatzberg A, et al.: Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. J Clin Psychopharmacol 1995, 15:23–29.

    Article  PubMed  CAS  Google Scholar 

  13. Rinne T, van den Brink W, Wouters L, van Dyck R: SSRI treatment of borderline personality disorder: a randomized, placebo-controlled clinical trial for female patients with borderline personality disorder. Am J Psychiatry 2002, 159:2048–2054. The results of this study suggest that selective serotonin reuptake inhibitors may have a targeted efficacy in the treatment of borderline patients, being particularly effective in reducing their mood lability.

    Article  PubMed  Google Scholar 

  14. Frankenburg FR, Zanarini MC: Clozapine treatment in borderline patients: a preliminary study. Compr Psychiatry 1993, 34:402–405.

    Article  PubMed  CAS  Google Scholar 

  15. Zanarini MC, Gunderson JG, Frankenburg FR, et al.: The revised diagnostic interview for borderlines: discriminating BPD from other axis II disorders. J Personal Disord 1989, 3:10–18.

    Google Scholar 

  16. Overall JE, Gorham DR: The brief psychiatric rating scale. Psychol Rep 1962, 10:799–812.

    Article  Google Scholar 

  17. Benedetti F, Sforzini L, Colombo C, et al.: Low-dose clozapine in acute and continuation treatment of severe borderline personality disorder. J Clin Psychiatry 1998, 59:103–107.

    PubMed  CAS  Google Scholar 

  18. Schulz SC, Camlin KL, Berry SA, Jesberger JA: Olanzapine safety and efficacy in patients with borderline personality disorder and comorbid dysthymia. Biol Psychiatry 1999, 46:1429–1435.

    Article  PubMed  CAS  Google Scholar 

  19. Zanarini MC, Frankenburg FR: Olanzapine treatment of female borderline personality disorder patients: a doubleblind, placebo-controlled pilot study. J Clin Psychiatry 2001, 62:849–854. The results of this study suggest that olanzapine is an effective agent in treating all four of the main domains of borderline psychopathology.

    Article  PubMed  CAS  Google Scholar 

  20. Rocca P, Marchiaro L, Cocuzza E, Bogetto F: Treatment of borderline personality disorder with risperidone. J Clin Psychiatry 2002, 63:241–244.

    PubMed  CAS  Google Scholar 

  21. Stein DJ, Simeon D, Frenkel M, et al.: An open trial of valproate in borderline personality disorder. J Clin Psychiatry 1995, 56:506–510.

    PubMed  CAS  Google Scholar 

  22. Coccaro EF, Harvey PH, Kupshaw-Lawrence E, et al.: Development of neuropharmacologically based assessments of impulsive aggressive behavior. J Neuropsychiatry 1991, 3(suppl):44–51.

    Google Scholar 

  23. Wilcox JA: Divalproex sodium as a treatment for borderline personality disorder. Ann Clin Psychiatry 1995, 7:33–37.

    PubMed  CAS  Google Scholar 

  24. Hollander E, Allen A, Lopez RP, et al.: A preliminary doubleblind, placebo-controlled trial of divalproex sodium in borderline personality disorder. J Clin Psychiatry 2001, 62:199–203.

    Article  PubMed  CAS  Google Scholar 

  25. Frankenburg FR, Zanarini MC: Divalproex sodium treatment of women with borderline personality disorder and bipolar II disorder: a double-blind placebo-controlled pilot study. J Clin Psychiatry 2002, 63:442–446.

    PubMed  CAS  Google Scholar 

  26. Pinto OC, Akiskal HS: Lamotrigine as a promising approach to borderline personality: an open case series without concurrent DSM-IV major mood disorder. J Affect Disord 1998, 51:333–343.

    Article  PubMed  CAS  Google Scholar 

  27. Zanarini MC, Frankenburg FR: Omega-3 Fatty acid treatment of women with borderline personality disorder: a doubleblind, placebo-controlled pilot study. Am J Psychiatry 2003, 160:167–169. The results of this study suggest that a naturally occurring substance is about as effective a mood stabilizer for moderately disturbed borderline patients without a concurrent mood disorder as pharmaceutical compounds.

    Article  PubMed  Google Scholar 

  28. Montgomery SA, Asberg M: A new depression scale designed to be sensitive to change. Br J Psychiatry 1979, 134:382–389.

    Article  PubMed  CAS  Google Scholar 

  29. Zanarini MC, Vujanovic AA, Parachini EA, et al.: Zanarini Rating Scale for borderline personality disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology. J Personal Disord 2003, 17:233–242.

    Article  PubMed  Google Scholar 

  30. Hamilton M: A rating scale for depression. J Neurol Neurosurg Psychiatry 1960, 23:56–62.

    Article  PubMed  CAS  Google Scholar 

  31. Young RC, Biggs JT, Ziegler VE, Meyer DA: A rating scale for mania: reliability, validity and sensitivity. Br J Psychiatry 1978, 133:429–435.

    PubMed  CAS  Google Scholar 

  32. Zanarini MC, Frankenburg FR, Dubo ED, et al.: Axis I comorbidity of borderline personality disorder. Am J Psychiatry 1998, 155:1733–1739.

    PubMed  CAS  Google Scholar 

  33. Siever LJ, Davis KL: A psychobiological perspective on the personality disorders. Am J Psychiatry 1991, 148:1647–1658.

    PubMed  CAS  Google Scholar 

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Zanarini, M.C. Update on pharmacotherapy of borderline personality disorder. Curr Psychiatry Rep 6, 66–70 (2004). https://doi.org/10.1007/s11920-004-0041-9

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