Antipsychotics Appear Effective For Borderline Personality Disorder
Mood stabilizers and antipsychotics may be effective in treating patients with borderline personality disorder.
Psychiatrists presented the results of several studies at a conference last month organized by the Treatment Advancements and Research Association for Personality Disorder.
Atypical antipsychotics were originally developed to treat schizophrenia and schizotypical disorder, said Schulz. But in the last five years, atypical antipsychotics have also been used to treat mania in bipolar disorder, cognitive distortions, and behavioral disturbances in autistic children, said Schulz.
Schulz mentioned brief open-label studies involving the atypical drugs risperidone (Risperdal), olanzapine (Zyprexa), and quetiapine (Seroquel). “The results showed that the medications improved overall psychiatric symptoms and global functioning in patients with borderline personality disorder,” said Schulz.
Risperidone also improved the core trait of impulsive-aggression in an Italian open-label study published in the March 2002 Journal of Clinical Psychiatry, according to Schulz.
His open-label pilot study of olanzapine in patients with borderline personality disorder and dysthymia was published in the November 15, 1999, Biological Psychiatry. The findings showed significant reduction in the symptoms of depression, interpersonal sensitivity, anger, phobic anxiety, and psychotic behaviors.
“Emerging randomized controlled studies of atypical antipsychotic medications indicate they are potentially effective in borderline personality disorder patients,” said Schulz.
He referred to a 26-week study of 28 women patients with borderline personality disorder who were given olanzapine. The study was published in the November 2001 Journal of Clinical Psychiatry. The findings indicated the medication was safe and significantly improved the subjects’ four core domains of affect, cognition, impulsivity, and interpersonal relationships, said Schulz. The subjects experienced only a slight weight gain and no serious movement disorders, he added.
Limitations of these studies include small sample sizes and short duration, with the exception of the 26-week study of olanzapine, said Schulz.
In my recent double-blind, randomized, controlled trial of risperidone in borderline patients, the placebo was state-of-the-art dialectical behavioral therapy. The findings did not indicate any significant difference between placebo and risperidone on several measures and need to be investigated further,” said Schulz.
Eric Hollander, M.D., a professor of psychiatry and director of clinical psychopharmacology at Mount Sinai School of Medicine in New York City, described his research on divalproex sodium in patients with borderline personality disorder at the conference last month.
A study published in the March 2001 Journal of Clinical Psychiatry involved 16 patients receiving placebo or divalproex sodium during a 10-week, double-blind trial. “The preliminary results showed that the medication may be effective in improving global symptoms, level of functioning, aggression, and depression,” said Hollander.
Specific treatment findings were limited by a high dropout rate of 58 percent, which is not uncommon in this population, he noted.
Hollander summarized the results of a double-blind randomized controlled trial involving divalproex sodium in patients with several types of personality disorders (cluster B) including borderline, narcissistic, and not otherwise specified (NOS). About 40 percent of the predominantly male patients had a history of arrest, and about 20 percent had been incarcerated. The study was presented at APA’s 2002 annual meeting.
There was a significant improvement on measures of aggression, irritability, and verbal assaults and in global clinical symptoms in the subjects, said Hollander. Side effects included nausea and weight gain, he added.
“This suggests that mood stabilizers may influence multiple symptom domains in cluster B disorders involving impulsive aggression, affective instability, and arousal/rejection,” said Hollander. ▪
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Published online: 17 January 2003
Published in print: January 17, 2003
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Several recent studies involving mood stabilizers in patients with borderline personality disorder suggest that the medications improve a broad range of symptoms.
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