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9 - Pharmacotherapy of severe personality disorders: a critical review

Published online by Cambridge University Press:  14 August 2009

By
Thomas Rinne  and
Theo Ingenhoven
Edited by
Bert van Luyn ,
Salman Akhtar  and
W. John Livesley
Thomas Rinne
Affiliation:
Scientific Director Dutch Institute of Forensic Psychiatry and Psychology, Member of the Board, Medical Director Pieter Baan Centrum, Forensic Psychiatric Observation Clinic, Utrecht, The Netherlands
Theo Ingenhoven
Affiliation:
Clinical Head De Zwaluw and De Enk, Centers for Psychotherapy for Personality Disorders Symfora groep, Centers for Mental Health, Amersfoort, The Netherlands
Bert van Luyn
Affiliation:
Symfora Group, The Netherlands
Salman Akhtar
Affiliation:
Thomas Jefferson University, Philadelphia
W. John Livesley
Affiliation:
University of British Columbia, Vancouver
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Summary

Since the late 1970s, there has been remarkable growing optimism about the efficacy of drug therapy in the treatment of patients with personality disorders. But is this optimism justified? Once in a while pharmacotherapists meet personality-disordered patients who respond dramatically to a new drug after years of struggling in therapy without progress. Open-label, uncontrolled studies are fuelled by these spectacular cures. Scientific journals accept these case histories and open studies as preliminary evidence of the efficacy of a given agent and the effects that might be expected from pharmacological interventions. Subsequent reviews on the efficacy of pharmacological treatment then provide misleading overviews by suggesting that, even in the absence of placebo-controlled randomized clinical trials, these “best” results can shape an evidence-based approach.

In spite of the poor evidence for the efficacy of most drugs, official “Guidelines” mimic these reviews and their conclusions and recommendations. For example, the recommendations of the American Psychiatric Association's practical guideline for the treatment of patients with borderline personality disorder (American Psychiatric Association, 2001) seem to encourage pharmacotherapy to treat symptoms during acute decompensations as well as trait vulnerability. In clinical practice, these recommendations may lead to polypharmacy that is justified by all kinds of speculative assumptions about disbalances of neurotransmitter systems (American Psychiatric Association, 2001). Unfortunately this can lead to iatrogenic neurobiological dysregulations, behavioral dyscontrol, immense side-effects, new disappointments for all parties concerned (therapists, patients, and their families) and low cost-effectiveness.

Type
Chapter
Information
Severe Personality Disorders , pp. 137 - 163
Publisher: Cambridge University Press
Print publication year: 2007

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References

Akiskal, H. S. (1994). The temperamental borders of affective disorders. Acta Psychiatr Scand Suppl 379: 32–37.Google Scholar
Akiskal, H. S., Hantouche, E. G. and Allilaire, J. F. (2003). Bipolar II with and without cyclothymic temperament: “dark” and “sunny” expressions of soft bipolarity. J Affect Disord 73: 49–57.Google Scholar
American Psychiatric Association (2001). Practice guideline for the treatment of patients with borderline personality disorder. American Psychiatric Association. Am J Psychiatry 158: 1–52.
Bogenschütz, M. P. and George, N. H. (2004). Olanzapine versus placebo in the treatment of borderline personality disorder. J Clin Psychiatry 65: 104–109.Google Scholar
Cloninger, C. R. (1987). A systematic method for clinical description and classification of personality variants. A proposal. Arch Gen Psychiatry 44(6): 573–588.Google Scholar
Cloninger, C. R., Svarkic, D. M. and Przybeck, T. R. (1993). A psychobiological model of temperament and character. Arch Gen Psychiatry 50(12): 975–990.Google Scholar
Coccaro, E. F. and Kavoussi, R. J. (1997). Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Arch Gen Psychiatry 54: 1081–1088.Google Scholar
Cornelius, J. R., Soloff, P. H., George, A., Ulrich, R. F. and Perel, J. M. (1993a). Haloperidol vs. phenelzine in continuation therapy of borderline disorder. Psychopharmacol Bull 29: 333–337.Google Scholar
Cornelius, J. R., Soloff, P. H., Perel, J. M. and Ulrich, R. F. (1993b). Continuation pharmacotherapy of borderline personality disorder with haloperidol and phenelzine. Am J Psychiatry 150: 1843–1848.Google Scholar
Cowdry, R. W. and Gardner, D. L. (1988). Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine. Arch Gen Psychiatry 45: 111–119.Google Scholar
Fuente, J. M. and Lotstra, F. (1994). A trial of carbamazepine in borderline personality disorder. Eur Neuropsychopharmacol 4: 479–486.Google Scholar
Farwell, W. R., Stump, T. E., Wang, J., Tafesse, E., L'Italien, G. and Tierney, W. M. (2004). Weight gain and new onset diabetes associated with olanzapine and risperidone. J Gen Intern Med 19: 1200–1205.Google Scholar
Gardner, D. L. and Cowdry, R. W. (1985). Alprazolam-induced dyscontrol in borderline personality disorder. Am J Psychiatry 142: 98–100.Google Scholar
Gitlin, M. J. (1993). Pharmacotherapy of personality disorders: conceptual framework and clinical strategies. J Clin Psychopharmacol 13: 343–353.Google Scholar
Goldberg, S. C., Schulz, S. C., Schulz, P. M., Resnick, R. J., Hamer, R. M. and Friedel, R. O. (1986). Borderline and schizotypal personality disorders treated with low-dose thiothixene vs placebo. Arch Gen Psychiatry 43: 680–686.Google Scholar
Hollander, E., Allen, A., Lopez, R. P.et. al. (2001). A preliminary double-blind, placebo-controlled trial of divalproex sodium in borderline personality disorder. J Clin Psychiatry 62: 199–203.Google Scholar
Hollander, E., Tracy, K. A., Swann, A. C.et al. (2003). Divalproex in the treatment of impulsive aggression: efficacy in cluster B personality disorders. Neuropsychopharmacology 28: 1186–1197.Google Scholar
Hollander, E., Swann, A. C., Coccaro, E. F., Jiang, P. and Smith, T. B. (2005). Impact of trait impulsivity and state aggression on divalproex versus placebo response in borderline personality disorder. Am J Psychiatry 162: 621–624.Google Scholar
Knutson, B., Wolkowitz, O. M., Cole, S. W.et al. (1998). Selective alteration of personality and social behavior by serotonergic intervention. Am J Psychiatry 155: 373–379.Google Scholar
Koenigsberg, H. W., Reynolds, D., Goodman, M.et al. (2003). Risperidone in the treatment of schizotypal personality disorder. J Clin Psychiatry 64: 628–634.Google Scholar
Links, S., Steiner, M., Boiago, I. and Irwing, D. (1990). Lithium therapy for borderline patients: preliminary findings. J Pers Disord 4: 173–181.Google Scholar
Loewe, T. H., Nickel, M. K., Meuhlbacher, M.et al. (2006). Topiramate treatment for women with borderline personality disorder. J Clin Psychopharmacol 26: 61–66.Google Scholar
Montgomery, S. A. and Montgomery, D. (1982). Pharmacological prevention of suicidal behaviour. J Affect Disord 4: 291–298.Google Scholar
Montgomery, S. A., Roy, D. and Montgomery, D. B. (1983). The prevention of recurrent suicidal acts. Br J Clin Pharmacol 15(Suppl 2): 183S–188S.Google Scholar
Nickel, M. K., Nickel, C., Mitterlehner, F. O.et al. (2004). Topiramate treatment of aggression in female borderline personality disorder patients: a double-blind, placebo-controlled study. J Clin Psychiatry 65: 1515–1519.Google Scholar
Nickel, M. K., Nickel, C., Kaplan, P.et al. (2005). Treatment of aggression with topiramate in male borderline patients: a double-blind, placebo-controlled study. Biol Psychiatry 57: 495–499.Google Scholar
Nickel, M. K., Loewe, T. H., Meuhlbacher, M.et al. (2006). Aripiprasole in the treatment of patients with borderline personality disorder; a double-controlled study. Am J Psychiatry 163: 833–838.Google Scholar
Parsons, B., Quitkin, F. M., McGrath, P. J.et al. (1989). Phenelzine, imipramine, and placebo in borderline patients meeting criteria for atypical depression. Psychopharmacol Bull 25: 524–534.Google Scholar
Philipsen, A., Schmahl, C. and Lieb, K. (2004). Naloxone in the treatment of acute dissociative states in female patients with borderline personality disorder. Pharmacopsychiatry 37: 196–199.Google Scholar
Rinne, T., , B. W., Wouters, L. and Dyck, R. (2002). SSRI treatment of borderline personality disorder: a randomized, placebo-controlled clinical trial for female patients with borderline personality disorder. Am J Psychiatry 159: 2048–2054.Google Scholar
Salzman, C., Wolfson, A. N., Schatzberg, A.et al. (1995). Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. J Clin Psychopharmacol 15: 23–29.Google Scholar
Siever, L. J. and Davis, K. L. (1991). A psychobiological perspective on the personality disorders. Am J Psychiatry 148: 1647–1658.Google Scholar
Simpson, E. B.Yen, S., Costello, E.et al. (2004). Combined dialectical behavior therapy and fluoxetine in the treatment of borderline personality disorder. J Clin Psychiatry 65: 379–385.Google Scholar
Soler, J., Pascual, J. C., Campins, M. J.et al. (2005). Double-blind, placebo-controlled study of dialectical behavior therapy plus olanzapine for borderline personality disorder. Am J Psychiatry 162: 1221–1224.Google Scholar
Soloff, P. H. (1998). Symptom-specific treatments for cognitive-perceptual, affective, and impulsive-behavioral dysregulation. Bull Menninger Clin 62: 195–214.Google Scholar
Soloff, P. H. (2000). Psychopharmacology of borderline personality disorder. Psychiatr Clin North Am 23: 169–92, ix.Google Scholar
Soloff, P. H., George, A., Nathan, R. S., Schulz, P. M. and Perel, J. M. (1986a). Paradoxical effects of amitriptyline on borderline patients. Am J Psychiatry 143: 1603–1605.Google Scholar
Soloff, P. H., George, A., Nathan, R. S.et al. (1986b). Progress in pharmacotherapy of borderline disorders. A double-blind study of amitriptyline, haloperidol, and placebo. Arch Gen Psychiatry 43: 691–697.Google Scholar
Soloff, P. H., George, A., Nathan, S.et al. (1989). Amitriptyline versus haloperidol in borderlines: final outcomes and predictors of response. J Clin Psychopharmacol 9: 238–246.Google Scholar
Soloff, P. H., Cornelius, J., George, A., Nathan, S., Perel, J. M. and Ulrich, R. F. (1993). Efficacy of phenelzine and haloperidol in borderline personality disorder. Arch Gen Psychiatry 50: 377–385.Google Scholar
Trestman, R. L., Keefe, R. S., Mitropoulou, V.et al. (1995). Cognitive function and biological correlates of cognitive performance in schizotypal personality disorder. Psychiatry Res 59: 127–136.Google Scholar
Tritt, K., Nickel, C., Lahmann, C.et al. (2005). Lamotrigine treatment of aggression in female borderline-patients: a randomized, double blind, placebo-controlled study. J Psychopharmacol 19: 287–291.Google Scholar
Zanarini, M. C. and Frankenburg, F. R. (2001). Olanzapine treatment of female borderline personality disorder patients: a double-blind, placebo-controlled pilot study. J Clin Psychiatry 62: 849–854.Google Scholar
Zanarini, M. C. and Frankenburg, F. R. (2003). Omega-3 fatty acid treatment of women with borderline personality disorder: a double-blind, placebo-controlled pilot study. Am J Psychiatry 160: 167–169.Google Scholar
Zanarini, M. C., Frankenburg, F. R. and Parachini, E. A. (2004). A preliminary, randomized trial of fluoxetine, olanzapine, and the olanzapine-fluoxetine combination in women with borderline personality disorder. J Clin Psychiatry 65: 903–907.Google Scholar

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  • Pharmacotherapy of severe personality disorders: a critical review
    • By Thomas Rinne, Scientific Director Dutch Institute of Forensic Psychiatry and Psychology, Member of the Board, Medical Director Pieter Baan Centrum, Forensic Psychiatric Observation Clinic, Utrecht, The Netherlands, Theo Ingenhoven, Clinical Head De Zwaluw and De Enk, Centers for Psychotherapy for Personality Disorders Symfora groep, Centers for Mental Health, Amersfoort, The Netherlands
  • Edited by Bert van Luyn, Salman Akhtar, Thomas Jefferson University, Philadelphia, W. John Livesley, University of British Columbia, Vancouver
  • Book: Severe Personality Disorders
  • Online publication: 14 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544439.010
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Pharmacotherapy of severe personality disorders: a critical review
    • By Thomas Rinne, Scientific Director Dutch Institute of Forensic Psychiatry and Psychology, Member of the Board, Medical Director Pieter Baan Centrum, Forensic Psychiatric Observation Clinic, Utrecht, The Netherlands, Theo Ingenhoven, Clinical Head De Zwaluw and De Enk, Centers for Psychotherapy for Personality Disorders Symfora groep, Centers for Mental Health, Amersfoort, The Netherlands
  • Edited by Bert van Luyn, Salman Akhtar, Thomas Jefferson University, Philadelphia, W. John Livesley, University of British Columbia, Vancouver
  • Book: Severe Personality Disorders
  • Online publication: 14 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544439.010
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Pharmacotherapy of severe personality disorders: a critical review
    • By Thomas Rinne, Scientific Director Dutch Institute of Forensic Psychiatry and Psychology, Member of the Board, Medical Director Pieter Baan Centrum, Forensic Psychiatric Observation Clinic, Utrecht, The Netherlands, Theo Ingenhoven, Clinical Head De Zwaluw and De Enk, Centers for Psychotherapy for Personality Disorders Symfora groep, Centers for Mental Health, Amersfoort, The Netherlands
  • Edited by Bert van Luyn, Salman Akhtar, Thomas Jefferson University, Philadelphia, W. John Livesley, University of British Columbia, Vancouver
  • Book: Severe Personality Disorders
  • Online publication: 14 August 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544439.010
Available formats
×