Hostname: page-component-848d4c4894-nmvwc Total loading time: 0 Render date: 2024-07-04T04:13:04.817Z Has data issue: false hasContentIssue false
  • English
  • Français

Pharmacological treatment of borderline personality disorder

Published online by Cambridge University Press:  09 June 2006

Carol Paton  and
Chike Okocha
Carol Paton
Affiliation:
Oxleas NHS Trust and Honorary Research Fellow, Imperial College of Psychological Medicine
Chike Okocha
Affiliation:
Oxleas NHS Trust
Get access

Abstract

Background: Borderline personality disorder (BPD) is a distressing disorder that is associated with significant morbidity and mortality. Patients with BPD are often admitted to PICUs where psychotropic drugs are usually prescribed to treat trait or state dependant symptoms.

Aims: To review the evidence base for the efficacy of psychotropic drugs in borderline personality disorder.

Method: Medline and Cochrane search covering the period 1966 to March 2003.

Results: Nineteen RCTs and a large number of case reports, case series and open studies were retrieved. Numerous different treatments have been used, each in a small number of patients. Open studies often report remarkable efficacy that is not reproduced in randomised controlled trials.

Conclusions: The initial placebo response to any drug treatment is high but symptoms invariably return leading to the addition of further psychotropic drugs. Long term gains from drug treatment are likely to be small in the majority of patients. Large pragmatic trials of drug treatments could be co-ordinated through the PICU network.

Declarations of Interest: None.

Keywords

BPDPICUsRCTsSSRIs
Type
Review Article
Information
Journal of Psychiatric Intensive Care , Volume 1 , Issue 2 , December 2005 , pp. 105 - 116
Copyright
© 2006 NAPICU

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders (4th edition). APA, Washington DC.
American Psychiatric Association (2001) Practice guideline for the treatment of patients with borderline personality disorder. American Journal of Psychiatry. 158: 1–52.
Baer, L., Jenike, M.A., Black, D.W., et al. (1992) Effect of axis 11 diagnoses on treatment outcome with clomipramine in 55 patients with obsessive-compulsive disorder. Archives of General Psychiatry. 49: 862–866.Google Scholar
Benedetti, F., Sforzini, L., Colombo, C., et al. (1998) Low dose clozapine in acute and continuation treatment of severe borderline personality disorder. Journal of Clinical Psychiatry. 59: 103–107.Google Scholar
Bolton, S. and Gunderson, J.G. (1996) Distinguishing borderline personality disorder from bipolar disorder: differential diagnosis and implications. American Journal of Psychiatry. 153: 1202–1207.Google Scholar
Bonnet, K.A. and Redford, H.R. (1982) Levodopa in borderline doisorders. Archives of General Psychiatry. 39: 826.Google Scholar
Cheng, A.T.A., Mann, A.H. and Chan, K.A. (1997) Personality disorder and suicide: a case control study. British Journal of Psychiatry. 170: 441–446.Google Scholar
Chengappa, K.N.R., Ebeling, T., Kang, J.S., et al. (1999) Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder. Journal of Clinical Psychiatry. 60: 477–484.Google Scholar
Coccaro, E.F. and Kavoussi, R.J. (1997) Fluoxetine and impulsive aggressive behaviour in personality disordered subjects. Archives of General Psychiatry. 54: 1081–1088.Google Scholar
Cornelius, J.R., Soloff, P.H., Perel, J.M., et al. (1990) Fluoxetine trial in borderline personality disorder. Psychopharmacology Bulletin. 26: 151–154.Google Scholar
Cornelius, J.R., Soloff, P.H., Perel, J., et al. (1993) Continuation pharmacotherapy of borderline personality disorder with haloperidol and phenelzine. American Journal of Psychiatry. 150: 1843–1848.Google Scholar
Cowdry, R.W. and Gardner, D.L. (1988) Pharmacotherapy of borderline personality disorder: alprazolam, carba-mazepine, trifluoperazine and tranylcypromine. Archives of General Psychiatry. 45: 111–119.Google Scholar
DeBattista, C. and Mueller, K. (2001) Is electroconvulsive therapy effective for the depressed patient with comorbid borderline personality disorder. The Journal of ECT. 17: 91–98.Google Scholar
De la Fuente, J.M. and Blotstra, F. (1994) A trial of carba-mazepine in borderline personality disorder. European Neuropsychopharmacology. 4: 479–486.Google Scholar
Deltito, J., Martin, L., Riefkohl, B., et al. (2001) Do patients with borderline personality disorder belong to the bipolar spectrum? Journal of Affective Disorders. 67: 221–228.Google Scholar
Faltus, F.J. (1984) The positive effect of alprazolam in the treatment of three patients with borderline personality disorder. American Journal of Psychiatry. 141: 802–803.Google Scholar
Frankenburg, F.R. and Zanarini, M.C. (1993) Clozapine treatment of borderline patients: a preliminary study. Comprehensive Psychiatry. 34: 402–405.Google Scholar
Frankenburg, F.R. and Zanarini, M.C. (2002) Divalproex sodium treatment of women with borderline personality disorder and bipolar 11 disorder: a double blind, placebo controlled pilot study. Journal of Clinical Psychiatry. 63: 442–446.Google Scholar
Gardner, D.L. and Cowdry, R.W. (1986) Development of melancholia during carbamazepine treatment in borderline personality disorder. Journal of Clinical Psychopharmacology. 6: 236–239.Google Scholar
Gardner, D.L. and Cowdry, R.W. (1986) Positive effects of carbamazepine on behavioural dyscontrol in borderline personality disorder. American Journal of Psychiatry. 143: 519–522.Google Scholar
Gardner, D.L. and Cowdry, R.W. (1985) Alprazolam-induced dyscontrol in borderline personality disorder. American Journal of Psychiatry. 142: 98–100.Google Scholar
Goldberg, S.C., Schulz, C., Schulz, P., et al. (1986) Borderline and schizotypal personality disorders treated with low dose thiothixene vs placebo. Archives of General Psychiatry. 43: 680–686.Google Scholar
Goldberg, S.C. (1989) Prediction of change in borderline personality disorder. Psychopharmacology Bulletin. 25: 550–555.Google Scholar
Gunderson, J.G., Carpenter, W.T. and Strauss, J.S. (1975) Borderline and schizotypal patients: a comparative study. American Journal of Psychiatry. 132: 1257–1264.Google Scholar
Hedberg, D.L., Houck, J.H. and Glueck, B.C. (1971) Tranylcypromine – Trifluoperazine combination in the treatment of schizophrenia. American Journal of Psychiatry. 127: 1141–1146.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. Journal of Clinical Psychiatry. 62: 199–203.Google Scholar
Kavoussi, R.J., Liu, J. and Coccaro, E.F. (1994) An open trial of sertraline in personality disordered patients with impulsive aggression. Journal of Clinical Psychiatry. 55: 137–141.Google Scholar
Kavoussi, R.J. and Coccaro, E.F. (1998) Divalproex sodium for impulsive aggressive behaviour in patients with personality disorder. Journal of Clinical Psychiatry. 59: 676–680.Google Scholar
Kendell, R.E. (2002) The distinction between personality disorder and mental illness. British Journal of Psychiatry. 180: 110–115.Google Scholar
Klein, D.F. and Oaks, G. (1967) Importance of Psychiatric Diagnosis in prediction of clinical drug effects. Archives General Psychiatry. 16: 118–126.Google Scholar
Koenigsberg, H.W., Harvey, P.D., Mitropoulou, V., et al. (2002) Characterising affective instability in borderline personality disorder. American Journal of Psychiatry. 159: 784–788.Google Scholar
Leone, N.F. (1982) Response of borderline patients to loxapine and chlorpromazine. Journal of Clinical Psychiatry. 43: 148–150.Google Scholar
Lewis, G. and Appleby, L. (1988) Personality disorder: the patients psychiatrists dislike. British Journal of Psychiatry. 153: 44–49.Google Scholar
Links, P.S., Steiner, M., Boiago, I., et al. (1990) Lithium therapy for borderline patients: preliminary findings. Journal of Personality Disorders. 4: 173–181.Google Scholar
Links, P.S., Heslegrave, R. and van Reekum, R. (1998) Prospective follow-up study of borderline personality disorder: prognosis, prediction of outcome and Axis II comor-bidity. Canadian Journal of Psychiatry. 43: 265–270.Google Scholar
Markovitz, P.J., Calabrese, J.R., Schulz, S.C., et al. (1991) Fluoxetine in the treatment of borderline and schizotypal personality disorders. American Journal of Psychiatry. 148: 1064–1067.Google Scholar
Markovitz, P.J. and Wagner, S.C. (1995) Venlafaxine in the treatment of borderline personality disorder. Psychopharmacology Bulletin. 31: 773–777.Google Scholar
Miller, S.G. (1994) Borderline personality disorder from the patients perspective. Hospital & Community Psychiatry. 45: 1215–1219.Google Scholar
Montgomery, S.A. and Montgomery, D. (1982) Pharmacological prevention of suicidal behaviour. Journal of Affective Disorders. 4: 291–298.Google Scholar
Paris, J. (2002) Chronic suicidality among patients with borderline personality disorder. Psychiatric Services. 53: 738–742.Google Scholar
Paris, J. (2002) Commentary on the American Psychiatric Association guidelines for the treatment of borderline personality disorder: evidence based psychiatry and the quality of evidence. Journal of Personality Disorders. 16: 130–134.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. Psychopharmacology Bulletin. 25: 524–534.Google Scholar
Pinto, O.C. and Akiskal, H.S. (1998) Lamotrigine as a promising approach to borderline personality: an open case series without concurrent DSM-IV major mood disorder. Journal of Affective Disorders. 51: 333–343.Google Scholar
Rifkin, A., Quitkin, F., Carrillo, C., et al. (1972) Lithium carbonate in emotionally unstable character disorder. Archives of General Psychiatry. 27: 519–523.Google Scholar
Rinne, T., van der Brink, W., Wooters, L., et al. (2002) SSRI treatment of borderline personality disorder: a randomised, placebo controlled clinical trial for female patients with borderline personality disorder. American Journal of Psychiatry. 159: 2048–2054.Google Scholar
Rocca, P., Marchiavo, L., Cocuzza, E., et al. (2002) Treatment of borderline personality disorder with risperi-done. Journal of Clinical Psychiatry. 63: 241–244.Google Scholar
Salzman, C., Wolfson, A.N., Schatzberg, A., et al. (1995) Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. Journal of Clinical Psychopharmacology. 15: 23–29.Google Scholar
Sanderson, C., Swenson, C. and Botus, M. (2002) A critique of the American Psychiatric Association practice guideline for the treatment of patients with borderline personality disorder. Journal of Personality Disorders. 16: 122–129.Google Scholar
Schulz, S.C., Camlin, K.L., Berry, S.A., et al. (1999) Olanzapine safety & efficacy in patients with borderline personality disorder and comorbid dysthymia. Biological Psychiatry. 46: 1429–1435.Google Scholar
Schwartz, M., Blazer, D., George, L., et al. (1990) Estimating the prevalence of borderline personality disorder in the community. Journal of Personality Disorder. 4: 257–272.Google Scholar
Schulz, S.C., Cornelius, J., Schulz, P.M., et al. (1988) The amphetamine challenge test in patients with borderline personality disorder. American Journal of Psychiatry. 147: 809–814.Google Scholar
Serban, G. and Siegel, S. (1984) Response of borderline and schizotypal patients to small doses of thiothixene and haloperidol. American Journal of Psychiatry. 141: 1455–1458.Google Scholar
Shawcross, C.R. and Tyrer, P. (1985) Influence of personality on response to monoamine oxidase inhibitors and tri-cyclic antidepressants. Journal of Psychiatry Research. 19: 557–562.Google Scholar
Shea, M.T., Pilkonis, P.A., Beckham, E., et al. (1990) Personality disorders and treatment outcome in the NIMH treatment of depression collaborative research program. American Journal of Psychiatry. 147: 711–718.Google Scholar
Soloff, P.H., Anselm, G., Nathan, R.S., et al. (1986) Progress in pharmacotherapy of borderline disorders: a double-blind study of amitriptyline, haloperidol and placebo. Archives of General Psychiatry. 43: 691–697.Google Scholar
Soloff, P.H., George, A., Nathan, S., et al. (1986) Paradoxical effects of amitriptyline in borderline patients. American Journal of Psychiatry. 143: 1603–1605.Google Scholar
Soloff, P.H., George, P.H., Nathan, R.S., et al. (1989) Amitriptyline versus haloperidol in borderlines: final outcomes and predictors of response. Journal of Clinical Psychopharmacology. 9: 238–246.Google Scholar
Soloff, P.H., Cornelius, J., George, A., et al. (1993) Efficacy of phenelzine and haloperidol in borderline personality disorder. Archives of General Psychiatry. 50: 377–385.Google Scholar
Stein, D.J., Simeon, D., Frenkel, M., et al. (1995) An open trial of valproate in borderline personality disorder. Journal of Clinical Psychiatry. 56: 506–510.Google Scholar
Stevenson, J., Meares, R. and Comerford, A. (2003) Diminished impulsivity in older patients with borderline personality disorder. American Journal of Psychiatry. 160: 165–166.Google Scholar
Teicher, M.H., Glod, C.A., Aaronson, S.T., et al. (1989) Open assessment of the safety and efficacy of thioridazine in the treatment of patients with borderline personality disorder. Psychopharmacology Bulletin. 25: 535–549.Google Scholar
Tyrer, P. (2002) Practice guideline for the treatment of borderline personality disorder: a bridge too far. Journal of Personality Disorders. 16: 113–118.Google Scholar
Verhoeven, W. and Tuinier, S. (1997) Biological and psy-chopharmacological aspects of impulse-control disorders. Acta Neuropsychiatrica. 9: 89–93.Google Scholar
Vilkin, M.I. (1964) Comparative chemotherapeutic trial in treatment of chronic borderline patients. American Journal of Psychiatry. 120: 1004.Google Scholar
Winston, A.P. (2000) Recent developments in borderline personality disorder. Advances in Psychiatric Treatment. 6: 211–218.Google Scholar
World Health Organisation (1992) The ICD 10 classification of mental and behavioural disorders – clinical descriptions and diagnostic guidelines. WHO, Geneva.
Zanarini, M.C. and Frankenburg, F.R. (1997) Pathways to the development of borderline personality disorder. Journal of Personality Disorders. 11: 93–104.Google Scholar
Zanarini, M.C., Frankenburg, F.R., Dubo, E.D., et al. (1998) Axis 1 comorbidity of borderline personality disorder. American Journal of Psychiatry. 155: 1733–1739.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. Journal of Clinical Psychiatry. 62: 849–854.Google Scholar
Zanarini, M.C., Frankenburg, F.R., Khera, J.S., et al. (2001) Treatment histories of borderline patients. Comprehensive Psychiatry. 42: 144–150.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. American Journal of Psychiatry. 160: 167–169.Google Scholar