Pharmacotherapy for Borderline Personality Disorder—Current Evidence and Recent Trends

Stoffers, Jutta M; Lieb, Klaus

doi:10.1007/s11920-014-0534-0

Cited by 97 publications

(57 citation statements)

References 82 publications

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“…42,43,44 O campo de pesquisa em TP tem evidenciado que tanto os tratamentos psicoterapêuticos quanto os farmacológicos são benéficos. 9,47,48 A psicoterapia é considerada o tratamento de primeira linha. 33,47,49,50 Não há medicamentos específicos recomendados para o tratamento dos TP, assim, são indicadas medicações para controle de sintomas nucleares e tratamento de comorbidades frequentemente presentes.…”

Section: Tratamentounclassified

Personality disorders

Mazer¹,

Macedo²,

Juruena³

2017

Medicina (Ribeirão Preto)

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RESUMOOs Transtornos da personalidade são padrões psicológicos de difícil diagnóstico que exigem uma avaliação criteriosa por parte do profissional da saúde mental. A relação médico-paciente também se configura como fator de extrema importância para o manejo destes quadros. Dentro deste contexto, é imprescindível orientar os alunos das áreas de graduação em saúde sobre a existência de tal categoria de transtornos. O presente artigo consiste em uma revisão descritiva, que busca elucidar a definição de transtornos da personalidade; além de discorrer sobre aspectos históricos, nosológicos e epidemiológi-cos. Nesta publicação ainda serão revisadas as particularidades referentes ao diagnóstico, as comorbidades, ao curso e tratamento destes transtornos. O enfoque maior será no manejo de indivíduos com transtorno da personalidade borderline, dada a maior procura destes por unidades de atendimento psiquiátrico. Palavras ABSTRACTPersonality disorders are psychological patterns of difficult diagnosis that require careful evaluations from mental health professionals. The physician-patient relationship is a crucial condition for the management of these disorders. On this view it must be important guide undergraduate students from health care areas through the existence of such a category of disorders. This article consists of a descriptive review aiming at clarifying the definition of personality disorders; furthermore discuss historical, physiological and epidemiological aspects. On this publication will be reviewed some particularities from diagnostic comorbidity, course and treatment of these disorders. The management of individuals with borderline personality disorder will be emphasized in this publication due to increased seek from this public for mental health care units.

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Section: Tratamentounclassified

Personality disorders

Mazer¹,

Macedo²,

Juruena³

2017

Medicina (Ribeirão Preto)

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“…Concerning the effects of olanzapine on aggression in BPD there is not an overall agreement among the Authors who conducted previous studies. Cochrane systematic reviews on pharmacological treatment for BPD (5,6) concluded that olanzapine induced significant decreases in affective instability, anxiety, anger, and psychotic paranoid symptoms. Aggressiveness was not listed among these effects.…”

Section: Discussionmentioning

confidence: 99%

“…In the last years, results of meta-analyses [4] and findings of systematic reviews [5,6] have induced a noticeable shift of experts' opinions and clinical practice from the use of antidepressants to mood-stabilizers, omega-3 fatty acids, and second generation antipsychotics in the treatment of BPD. Therapeutic effects of antipsychotic drugs were demonstrated across a wide range of symptoms.…”

Section: Introductionmentioning

confidence: 99%

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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“…There are many high-quality reviews 16,27,28 including a Cochrane review. 27,29 The Cochrane group found 33 randomised controlled trials in adults with borderline personality disorder, 27,29…”

Section: Evidence For Drug Therapymentioning

confidence: 99%

“…30,31 In addition, controversy has surrounded the methods of one research group and the integrity of the findings. 29 The available evidence 16,[27][28][29] …”

Section: Guidelinesmentioning

confidence: 99%