Behandlung von dissoziativen Symptomen bei Borderline-Persönlichkeitsstörungen mit Naltrexon

Schmahl, Christian; Stiglmayr, Christian; Böhme, Richard; Bohus, Martin

doi:10.1007/s001150050431

Cited by 9 publications

(4 citation statements)

References 7 publications

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“…They were given 50 mg of naltrexone daily for several weeks, which eventually resulted in a reduction of dissociative symptoms in all subjects. This study, due to the small number of patients, was not reliable, but it created the basis for further research [29]. In the early 2000s, Joel R. Saper of the Michigan Head Pain & Neurological Institute, while treating chronic headaches with opioids, noticed that patients with the disorder became less withdrawn and more aggressive than they had been before the use of drugs in this group.…”

Section: Naltrexone Treatment In Borderline Personality Disordermentioning

confidence: 94%

The meaning of lithium and naltrexone pharmacotherapy in the treatment of borderline personality disorder – a narrative review

Wingralek,

Marczak,

Tomasik

et al. 2023

Curr Probl Psychiatry

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Introduction: Borderline personality disorder (BPD) affects approximately 1%-3% of the population. As the most common personality disorder, BPD features behavioural, emotional and social dysfunctions. It often co-occurs with self-harm, suicidal tendencies and substance abuse. To date, pharmacological treatment does not provide sufficient therapeutic effects. The aim of our study is to analyse the neurobiological, genetic and environmental components in the aetiopathogenesis of BPD and to collect data on the innovative use of lithium and naltrexone in the therapy of BPD. Methods: Basing on PubMed and Google Scholar databases using the following keywords: borderline, lithium, naltrexone for papers published from 1979 to 2022. Results: Difficult childhood, and emotional, sexual and physical abuse are the strongest predictors of BPD development. The core symptoms of BPD may be related to dysfunction of the serotonin, dopaminergic, endogenous system and opioid systems. Variation in 5-HTT, COMT, FKBP5 and oxytocin receptor genes may influence the course of BPD. Imaging studies have shown structural and functional abnormalities in the prefrontal cortex, amygdala and hippocampus. Lithium reduces impulsivity, aggression, suicidal tendencies and self-harm in BPD. Naltrexone may effectively reduce self-harm without suicidal tendencies, impulsivity, substance abuse and suicidality. Conclusions: No unified model has been developed to account for environmental, genetic and neurobiological components in the pathogenesis of BPD. Understanding the mechanisms is a crucial step towards personalising treatment. The use of lithium and naltrexone may have positive therapeutic effects. Randomised clinical trials are required to establish the efficacy and safety of both drugs in long-term treatment. Keywords: borderline, lithium, naltrexone

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Section: Naltrexone Treatment In Borderline Personality Disordermentioning

confidence: 94%

The meaning of lithium and naltrexone pharmacotherapy in the treatment of borderline personality disorder – a narrative review

Wingralek,

Marczak,

Tomasik

et al. 2023

Curr Probl Psychiatry

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“…Es gibt mehrere Fallberichte über den erfolgreichen Einsatz von Naltrexon zur Behandlung von Selbstverletzungen und Flashbacks [5][6][7]. In einer offenen Studie wurde ein signifikanter Rückgang der dissoziativen Symptome bei Patienten mit BPD unter Behandlung mit Naltrexon beobachtet [8]. Eine kleine randomisiertkontrollierte Studie konnte jedoch keine signifikante Wirkung von Naltrexon bei dissoziativen Symptomen bestätigen [9].…”

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Behandlung dissoziativer Symptome mit Nalmefen bei Patienten mit Borderline-Persönlichkeitsstörung und komplexer posttraumatischer Belastungsstörung

Enning

Schmahl

2021

Nervenarzt

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HintergrundDissoziative Phänomene einschließlich Flashbacks und dissoziative Anfälle sind häufige und therapiehemmende Probleme bei Patienten mit Borderline-Persönlichkeitsstörung und komplexer Posttraumatischer Belastungsstörung (PTBS). Es wird angenommen, dass das Endogene Opioidsystem (EOS) dabei eine wichtige Rolle spielt. Bezüglich des EOS wurde bisher nur Naltrexon und sein Wirkmechanismus bei der Behandlung dissoziativer Symptome untersucht. Nalmefen ist ein weiterer Opioid-Antagonist und wir untersuchten seine Wirkung im Rahmen eines individuellen Behandlungsversuchs bei Patienten mit Borderline-Persönlichkeitsstörung, komplexer PTBS und schweren dissoziativen Symptomen. Nalmefen zeigte vielversprechende Ergebnisse als mögliche Alternative zu Naltrexon, insbesondere bei Unverträglichkeit oder unzureichender Wirksamkeit.

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“…[52] untersuchten den nicht-selektiven Opiat-Rezeptor-Antagonisten bei Patienten mit Borderline-Persçnlichkeitsstçrung und Patienten mit posttraumatischer Belastungsstçrung (PTSD), die vorwiegend dissoziative Symptome aufwiesen. Mit einer Dosis von 50 -150 mg/Tag nahmen dissoziative Zustände (Derealisations-bzw.…”

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Psychopharmakologische Behandlung von und bei Persönlichkeitsstörungen

Quante

Röpke²,

Merkl³

et al. 2008

Fortschr Neurol Psychiatr

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There is only a paucity of studies concerning the pharmacological treatment of personality disorders per se. On the other hand the clinical use of medication in these conditions is quite high, although there is no effective psychopharmacological treatment of distinct personality disorders. The psychopharmacological treatment of patients suffering from a personality disorder focuses on distinct symptoms and its comorbidity. Some symptoms could also be associated with other disorders like depression or psychosis, which often makes an exact differentiation of these disorders and a personality disorder difficult. Since symptoms of personality disorders are ego-syntonic, chronic and very often dependent on psychosocial factors, it is unlikely that a solely psychopharmacological treatment will be successful in most patients with a personality disorder. However, severe syndromes like depressive, impulsive, aggressive, dissociative, anxious or psychotic features may render a pharmacotherapy necessary. For the treatment of depressive syndromes or impulsivity a medical therapy with serotonin reuptake inhibitors, for the treatment of psychotic syndromes a medication with atypical antipsychotics is recommended. Impulsive or aggressive behaviour could be treated with mood stabilizers as well. Furthermore, there are indications for the use of alpha2-agonists, micro-opiate-antagonists and omega-3 fatty acid. The general use of benzodiazepines should be avoided as well as polypragmasy. Advantages versus potential damage of a high dose pharmacotherapy should be carefully weighed against each other. This article gives an overview over the today's most common psychopharmacological treatment possibilities in patients with a personality disorder.

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Behandlung von dissoziativen Symptomen bei Borderline-Persönlichkeitsstörungen mit Naltrexon

Cited by 9 publications

References 7 publications

The meaning of lithium and naltrexone pharmacotherapy in the treatment of borderline personality disorder – a narrative review

The meaning of lithium and naltrexone pharmacotherapy in the treatment of borderline personality disorder – a narrative review

Behandlung dissoziativer Symptome mit Nalmefen bei Patienten mit Borderline-Persönlichkeitsstörung und komplexer posttraumatischer Belastungsstörung

Psychopharmakologische Behandlung von und bei Persönlichkeitsstörungen

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