Olanzapine Versus Haloperidol in the Management of Borderline Personality Disorder

Shafti, Saeed Shoja; Shahveisi, Bahman

doi:10.1097/jcp.0b013e3181c826ff

Cited by 30 publications

(19 citation statements)

References 14 publications

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“…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%

“…To date, ten RCTs have been conducted in samples with BPD to assess the efficacy of olanzapine versus placebo [13,16,23,19,21], versus active drugs [14,17,20], or versus placebo in a combined treatment with psychotherapy (dialectical behavioral therapy) [15,18]. The majority of accumulated evidence suggests that olanzapine is efficacious in treating cognitive-perceptual symptoms (psychotic-like symptoms), and in producing significant reduction in mood instability and impulsive behavioral dyscontrol.…”

Section: Introductionmentioning

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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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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“…In a recent 8week doubleblind study com paring olanzapine (mean dose 7 mg/day) with haloperidol (mean dose 7 mg/day) in 28 female inpatients with BPD, Shafti and Shahveisi did not find significant differences between drugs in reducing the severity of generic behavioral symptoms (anxiety, depressive mood and hos tility subscales of the Brief Psychiatric Rating Scale) [50]. It must be noted that this trial did not use a control group with placebo.…”

Section: Review Bellino Rinaldi Bozzatello and Bogettomentioning

confidence: 99%

Recent approaches to pharmacotherapy of personality disorders

Bellino

Rinaldi²,

Bozzatello³

et al. 2011

Neuropsychiatry

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Recent approaches to pharmacotherapy of personality disorders Practice pointsPharmacotherapy of personality disorders should be considered a symptom-focused treatment, targeting dimensions of affective dysregulation, impulsive-behavioral dyscontrol and cognitive-perceptual symptoms.To date, randomized controlled trials have been performed in samples of patients with antisocial personality disorder, schizotypal personality disorder and borderline personality disorder (BPD). However, the great majority of these trials have been conducted in samples with BPD.There is some evidence that mood stabilizers (topiramate, valproate and lamotrigine), second-generation antipychotics (olanzapine, aripiprazole), and omega-3 fatty acids can be useful for the treatment of affective symptoms and impulsive-behavioral dyscontrol in BPD patients.Antipsychotics produced an improvement of psychotic-like symptoms both in patients with BPD and schizotypal personality disorder.Selective serotonin reuptake inhibitors were found to be effective in decreasing depressed mood, anxiety, and anger in BPD patients, mainly with a comorbid major depressive episode. However, recent evidence no longer supports their use as first-line treatment of affective symptoms and impulsive-behavioral dyscontrol in BPD.Present studies suffer from important methodological limitations. Thus, further investigations are needed to confirm available findings. SUMMARY A growing number of studies on pharmacotherapy of personality disorders have been performed. This article considers controlled trials conducted between 1990 and 2010, and is directed toward the treatment of personality disorders. Data on borderline personality disorder (BPD), antisocial personality disorder and schizotypal personality disorder (STPD) were collected and discussed, in order to provide indications for clinical practice. Concerning antisocial personality disorder and STPD, available evidence is too sparse to propose treatment recommendations. As for BPD, there is some evidence that mood stabilizers (topiramate, valproate, and lamotrigine), second-generation antipsychotics (olanzapine, aripiprazole), and omega-3 fatty acids can be useful to treat affective symptoms For reprint orders, please contact: reprints@futuremedicine.comNeuropsychiatry (2011) 1(3) future science group 260Review Bellino, Rinaldi, Bozzatello & Bogetto Personality disorders (PDs) are defined as endur ing patterns of inner experience and behavior causing distress, which lead to maladaptive functioning in the areas of emotion, cognition, interpersonal relationships and impulse con trol [1]. Since the 1980s there has been increas ing recognition that PDs can be considered as syndromes of interacting dimensional traits that arise from psychosocial development and/or biological vulnerability [2]. Personality dimen sions acquired through social and cultural learning are termed character, whereas those believed to have a biological origin, genetically determined or acquired from overt injury to the CNS, are traditionally referr...

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“…In particular, olanzapine (mean dose 7 mg/day) or haloperidol (mean dose 7 mg/day) were randomly administered to 28 female inpatients with BPD over 8 weeks [80]. No significant differences were found between treatment drugs in reducing the severity of general behavioural symptoms (anxiety, depressive mood, and hostility).…”

Section: 2) Second Generation Antipsychoticsmentioning

confidence: 99%

Pharmacotherapy of personality disorders: what we know and what we have to search for

et al. 2017

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Pharmacotherapy for personality disorders is in the early stage of development because the evidence base for effective drug treatment is insufficient, biased toward borderline personality disorder and rampant with methodological issues. In this paper, we reviewed randomized, placebo-controlled trials of drugs efficacy in patients with personality disorders published between 1990 and 2016.Overwhelming majority of studies focused on borderline personality disorder (BPD), and the accumulation of evidence resulted in 7 meta-analyses, which are interpreted into better strategies for evidence-based practice. Little research attention was given to schizotypal (SPTD) and antisocial (ASPD) personality disorders, with only indirect treatment efficacy evidence for the obsessivecompulsive (OCPD) and avoidant (AvPD) personality disorders. Some avenues for future efficacy research are indicated.

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Olanzapine Versus Haloperidol in the Management of Borderline Personality Disorder

Abstract: There seems to be no significant difference between olanzapine and haloperidol regarding the management of mental and behavioral symptoms of patients with BPD.

Cited by 30 publications

References 14 publications

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

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

Recent approaches to pharmacotherapy of personality disorders

Pharmacotherapy of personality disorders: what we know and what we have to search for

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