Olanzapine safety and efficacy in patients with borderline personality disorder and comorbid dysthymia

Schulz, S. Charles; Camlin, Kelly L.; Berry, Sally A.; Jesberger, John A.

doi:10.1016/s0006-3223(99)00128-6

Cited by 97 publications

(48 citation statements)

References 28 publications

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“…A number of open label trials of atypical antipsychotic agents in the treatment of BPD have been reported, including risperidone (Szigethy and Schulz, 1997;Rocca et al, 2002), clozapine (Frankenburg and Zanarini, 1993;Benedetti et al, 1998;Chengappa et al, 1999), and olanzapine (Schulz et al, 1999), uniformly suggesting efficacy in one or more of the dimensions of BPD.…”

Section: Pharmacological Evidencementioning

confidence: 99%

Dopamine Dysfunction in Borderline Personality Disorder: A Hypothesis

Friedel

2004

Neuropsychopharmacol

121

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Research on the biological basis of borderline personality disorder (BPD) has focused primarily on the serotonin model of impulsive aggression. However, there is evidence that dopamine (DA) dysfunction may also be associated with BPD. Pertinent research and review articles, identified by Medline searches of relevant topics, books, references from bibliographies, and conference proceedings from 1975 to 2003, were reviewed. Evidence of DA dysfunction in BPD derives from the efficacy of traditional and atypical antipsychotic agents in BPD, and from provocative challenges with amphetamine and methylphenidate of subjects with the disorder. In addition, human and animal studies indicate that DA activity plays an important role in emotion information processing, impulse control, and cognition. The results of this review suggest that DA dysfunction is associated with three dimensions of BPD, that is, emotional dysregulation, impulsivity, and cognitive-perceptual impairment. The main limitation of this hypothesis is that the evidence reviewed is circumstantial. There is no study that directly demonstrates DA dysfunction in BPD. In addition, the therapeutic effects of antipsychotic agents observed in BPD may be mediated by non-DA mechanisms of action. If the stated hypothesis is correct, DA dysfunction in BPD may result from genetic, developmental, or environmental factors directly affecting specific DA pathways. Alternatively, DA dysfunction in BPD may be a compensatory response to alterations in the primary neural systems that control emotion, impulse control, and cognition, and that are mediated by the brain's main neurotransmitters, glutamate, and GABA, or in one or more other neuromodulatory pathways such as serotonin, acetylcholine, and norepinephrine.

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Section: Pharmacological Evidencementioning

confidence: 99%

Dopamine Dysfunction in Borderline Personality Disorder: A Hypothesis

Friedel

2004

Neuropsychopharmacol

121

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“…However, the effect of olanzapine on this symptom domain in BPD patients has been widely reported in previous open-label and controlled studies. Thus, Schultz and colleagues [12] demonstrated a significant reduction of psychoticism in BPD patients treated with olanzapine. Moreover, Zanarini and Frankenburg [19] reported a significant improvement of paranoid ideation in BPD subjects treated with olanzapine versus placebo.…”

Section: Discussionmentioning

confidence: 95%

“…The study Concerning previous investigations, the only study of asenapine in BPD patients (33) used a broad dose range of 5-20 mg/day. As for olanzapine, several studies (12,13,17,21) chose the same dose range of 5-10 mg/day used in our study.…”

Section: Methodsmentioning

confidence: 99%

“…Among novel antipsychotics olanzapine is the most extensively studied across case-reports [10], open-label studies [11,12] and double-blind controlled trials (RCT) of patients with a diagnosis of BPD [13][14][15][16][17][18][19][20][21]. Antipsychotic drugs may owe their therapeutic efficacy to actions at D2-D4 and 5HT-2A receptors, while adverse effects are believed to be induced by antagonist activity at H1, M1-M5, and α1 receptors [22].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and Tolerability of Asenapine Compared with Olanzapine in Borderline Personality Disorder: An Open-Label Randomized Controlled Trial

et al. 2017

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ObjectiveThe present open label randomised controlled trial aimed to evaluate the efficacy and tolerability of asenapine in comparison with olanzapine, the most broadly studied antispychotic in BPD. Methods51 outpatients aged between 18 and 50 years, with a diagnosis of BPD based on DSM-5 criteria were assigned for 12 weeks to: (1) asenapine (5-10 mg/day) or (2) olanzapine (5-10 mg/day).Participants were assessed at baseline and after 12 weeks with: Clinical Global Impression Scale, Severity item (CGI-S), Hamilton Depression Rating Scale (HAM-D), Hamilton Anxiety Rating Scale (HAM-A), Social Occupational Functioning Assessment Scale (SOFAS), Borderline Personality Disorder Severity Index (BPDSI), Barratt Impulsiveness Scale, version 11 (BIS-11), Modified Overt Aggression Scale (MOAS), Self Harm Inventory (SHI), and Dosage Record and Treatment Emergent Symptom Scale (DOTES).Analysis of variance repeated measures was performed. Intention to treat analysis with last observation carried forward was conducted. ResultsDrop-outs were 11 (21.57%): six patients taking asenapine and five patients receiving olanzapine.Two patients who received asenapine stopped the drug, one due to oral hypoesthesia and the other due to moderate anxiety. Two patients receiving olanzapine discontinued the treatment for a significant weight gain ( ≥ 3 Kg). The remaining seven drop-outs resulted from the lack of compliance with the trial prescription. Forty out of the 51 patients (78%) completed the trial: 19 3 patients received asenapine, while 21 patients received olanzapine.We found a significant withinsubjects effect (trial duration) for all rating scales, except from the HAM-D, the MOAS, and two items of the BPDSI: namely, "identity disturbance" and "parasuicidal behaviors". A significant effect between subjects was found for the two items of the BPDSI: "affective instability" and "dissociation/paranoid ideation". Asenapine was found superior to olanzapine in reducing the affective instability score (P = 0.001), whereas olanzapine was found superior to asenapine in reducing dissociation/paranoid ideation (P = 0.012). However, the study was found to be underpowered to detect a difference between the drugs on the dissociation/paranoid ideation item of the BPDSI. Two patients receiving asenapine experienced akathisia and another two restlessness/anxiety, while three patients receiving olanzapine reported somnolence and two fatigue. ConclusionsAsenapine and olanzapine were demonstrated to have a similar efficacy. While asenapine was found to be more efficacious than olanzapine in treating affective instability, olanzapine was superior to asenapine in treating paranoid ideation and dissociation. However, the study was underpowered to detect a difference between groups on the dissociation/paranoid ideation item.Both medications were well tolerated, with asenapine being related to a higher frequency of oral hypoaestesia and akathisia, and olanzapine being prone to induce weight gain.The open label study design, lack of a placebo group, and smal...

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“…[56] BKB ve distimili hastalarda yapılan açık uçlu bir çalışmada olanzapinin bu kişilerde dürtüselliği tetikleyen öfke, kişiler arası duyarlılık gibi semptomlarda iyileşmeye yol açtığı bildirilmiş-tir. [57] Başka bir çift kör plasebo kontrollü çalışmada, diyalektik davranış terapisi alan hastalarda olanzapinin plaseboya göre dürtüsel ve agresif davranışı azaltmada anlamlı derecede etkili olduğu belirlenmiştir. [58] Ketiyapin Son yıllarda BKB, çocuklarda davranım bozukluğu, demans ve travmatik beyin hasarı gibi durumlarda dürtüsel agresif davranışı azaltmada ketiyapinin etkinliği araştırılmıştır.…”

Section: Klozapinunclassified

Impulsivity and Its Treatment

Özdemir¹,

Selvı²,

Aydın³

2012

Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychia

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ÖZETBirçok nörolojik ve psikiyatrik hastalığın temelinde yer alan ya da beraberinde seyreden dürtüselliğin tanımlanması ve tedavisinin düzenlenmesi oldukça önemlidir. Tedavide dürtüsellik ile ortaya çıkan hastalığın tedavisi ya da dür-tüsel davranışın kendisinin tedavi edilmesi şeklinde iki yola başvurulabilir. Dürtüselliğin eşlik ettiği bozukluklar arasında antisosyal ve borderline kişilik bozuklukları, şizofreni, bipolar bozukluk, dikkat eksikliği hiperaktivite bozukluğu, yeme bozuklukları, madde kullanım bozuklukları sayılabilir. Ayrıca dürtü kontrol bozuklukları olan patolojik kumar oynama, aralıklı patlayıcı bozukluk, piromani, kleptomani ve trikotillomani tanı ölçütleri içerisinde bir ölçüt olarak bulunur. Bu bozuklukların tedavi planında etkin olan davranışsal ve farmakolojik müdahalelerin bütünleştirilmesi gerekir. Bunlar içgörü yöne-limli ve bilişsel-davranışçı psikoterapiler, beklenmedik olayların yönetimi ve farmakoterapi olarak sıralanabilir. Bu yazıda, dürtüselliğin tanımı, diğer psikiyatrik bozukluklarla birlikteliği ve tedavisi aktarılmıştır. Anahtar Sözcükler: Dürtüsellik, tedavi, psikiyatrik bozukluk ABSTRACT Identification, description and therapeutic management of impulsivity, which underlies the mechanism and coexistence of many neurological and psychiatric diseases, are considered to be very crucial. Treatment can be applied in two ways; either for the disorder that occurs with impulsivity or for the treatment of the impulsive behavior itself. Disorders associated with or accompanied by impulsivity can be classified as borderline and antisocial personality disorders, schizophrenia, bipolar disorder, attention deficit and hyperactivity disorder, eating disorders, substance use disorders. In addition, impulsivity can manifest itself within the context of diagnostic criteria implicated in the impulse control disorders which include pathological gambling, intermittent explosive disorder, pyromania, kleptomania and trichotillomania. Behavioral and pharmacological interventions that are effective in treatment plans for these disorders should be integrated. These can be listed as insight-oriented psychotherapy and cognitive-behavioral psychotherapies, contingency man-

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Olanzapine safety and efficacy in patients with borderline personality disorder and comorbid dysthymia

Cited by 97 publications

References 28 publications

Dopamine Dysfunction in Borderline Personality Disorder: A Hypothesis

Dopamine Dysfunction in Borderline Personality Disorder: A Hypothesis

Efficacy and Tolerability of Asenapine Compared with Olanzapine in Borderline Personality Disorder: An Open-Label Randomized Controlled Trial

Impulsivity and Its Treatment

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