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Erschienen in: CNS Drugs 5/2017

01.05.2017 | Systematic Review

A Focused Systematic Review of Pharmacological Treatment for Borderline Personality Disorder

verfasst von: Ella Hancock-Johnson, Chris Griffiths, Marco Picchioni

Erschienen in: CNS Drugs | Ausgabe 5/2017

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Abstract

Background

Medicines are routinely prescribed to treat borderline personality disorder (BPD) despite a relative lack of high-quality evidence and in breach of some treatment guidelines. An earlier Cochrane review of pharmacotherapy in BPD underlined the lack of evidence, encouraged the replication of earlier studies, but also emphasised the pressing need for more randomised placebo-controlled trials, and for those studies to employ broadened inclusion criteria.

Method

The authors searched bibliographic databases, reference lists of articles and trials registers. Records were screened to identify those that met the inclusion criteria. Full-text articles were screened and assessed for eligibility. On-going trials of pharmacotherapy in BPD were also identified.

Results

Fifteen new studies of pharmacotherapy for BPD were identified since the earlier review. Eight of those examined second generation antipsychotics, two investigated mood stabilisers, three investigated antidepressants and two studied the effectiveness of opioid antagonists. Results for the effectiveness of antipsychotics appeared to be mixed. There has been little recent evidence to support the use of mood stabilisers. There is a lack of new placebo-controlled, randomised controlled trials investigating antidepressants and limited new evidence to support the use of opioid antagonists.

Conclusions

The review revealed that there remains a dearth of high-quality research evidence to help patients, carers and clinicians make sound and safe evidence-based decisions about medicines to treat BPD.
Fußnoten
1
According to contact with investigators of ‘unknown’ trials, one trial is completed [36], one is in the data analysis stage [43] and one was never completed [41].
 
Literatur
1.
Zurück zum Zitat American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC; 2013. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC; 2013.
2.
Zurück zum Zitat Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey replication. Biol Psychiatry. 2007;62:533–45.CrossRef Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey replication. Biol Psychiatry. 2007;62:533–45.CrossRef
3.
Zurück zum Zitat Gunderson JG, Links P. Borderline personality disorder: a clinical guide. 2nd ed. Washington, DC: American Psychiatric Press, Inc; 2008. Gunderson JG, Links P. Borderline personality disorder: a clinical guide. 2nd ed. Washington, DC: American Psychiatric Press, Inc; 2008.
4.
Zurück zum Zitat Zanarini MC, Frankenburg FR, Reich DB, Silk KR, Hudson JI, McSweeney LB. The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study. Am J Psychiatry. 2007;164:929–35.CrossRefPubMed Zanarini MC, Frankenburg FR, Reich DB, Silk KR, Hudson JI, McSweeney LB. The subsyndromal phenomenology of borderline personality disorder: a 10-year follow-up study. Am J Psychiatry. 2007;164:929–35.CrossRefPubMed
5.
Zurück zum Zitat Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and stability of sustained symptomatic remission and recover among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry. 2012;169:476–83.CrossRefPubMedPubMedCentral Zanarini MC, Frankenburg FR, Reich DB, Fitzmaurice G. Attainment and stability of sustained symptomatic remission and recover among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study. Am J Psychiatry. 2012;169:476–83.CrossRefPubMedPubMedCentral
6.
Zurück zum Zitat Olabi B, Hall J. Borderline personality disorder: current drug treatments and future prospects. Ther Adv Chronic Dis. 2010;2010(1):59–66.CrossRef Olabi B, Hall J. Borderline personality disorder: current drug treatments and future prospects. Ther Adv Chronic Dis. 2010;2010(1):59–66.CrossRef
10.
Zurück zum Zitat American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry. 2001;158:1–52.CrossRef American Psychiatric Association. Practice guideline for the treatment of patients with borderline personality disorder. Am J Psychiatry. 2001;158:1–52.CrossRef
11.
Zurück zum Zitat Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder. Lancet. 2004;364:453–61.CrossRefPubMed Lieb K, Zanarini MC, Schmahl C, Linehan MM, Bohus M. Borderline personality disorder. Lancet. 2004;364:453–61.CrossRefPubMed
12.
Zurück zum Zitat Paton C, Crawford MJ, Bhatti SF, Patl MX, Barnes TR. The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK mental health services. J Clin Psychiatry. 2015. doi:10.4088/JCP.14m09228.PubMed Paton C, Crawford MJ, Bhatti SF, Patl MX, Barnes TR. The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK mental health services. J Clin Psychiatry. 2015. doi:10.​4088/​JCP.​14m09228.PubMed
13.
Zurück zum Zitat Bridler R, Häberle A, Müller ST, Cattapan K, Grohmann R, Toto S. Kasper, Greil W. Psychopharmacological treatment of 2195 in-patient with borderline personality disorder: a comparison with other psychiatric disorders. Eur Neuropsychopharmacol. 2015;25:763–72.CrossRefPubMed Bridler R, Häberle A, Müller ST, Cattapan K, Grohmann R, Toto S. Kasper, Greil W. Psychopharmacological treatment of 2195 in-patient with borderline personality disorder: a comparison with other psychiatric disorders. Eur Neuropsychopharmacol. 2015;25:763–72.CrossRefPubMed
14.
Zurück zum Zitat Binks CA, Fenton M, McCarthy L, Lee T, Adams CE, Duggan C. Pharmacological interventions for people with borderline personality disorder. Cochrane Database Syst Rev. 2006; CD005652. Binks CA, Fenton M, McCarthy L, Lee T, Adams CE, Duggan C. Pharmacological interventions for people with borderline personality disorder. Cochrane Database Syst Rev. 2006; CD005652.
15.
16.
Zurück zum Zitat Higgins JPT, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. http://www.cochrane-handbook.org. Higgins JPT, Altman DG, Sterne JAC. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration; 2011. http://​www.​cochrane-handbook.​org.
17.
Zurück zum Zitat Black DW, Zanarini MC, Romine A, Shaw M, Allen J, Schulz SC. Comparison of low and moderate dosages of extended-release quetiapine in borderline personality disorder: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry. 2014;171:1174–82.CrossRefPubMed Black DW, Zanarini MC, Romine A, Shaw M, Allen J, Schulz SC. Comparison of low and moderate dosages of extended-release quetiapine in borderline personality disorder: a randomized, double-blind, placebo-controlled trial. Am J Psychiatry. 2014;171:1174–82.CrossRefPubMed
18.
Zurück zum Zitat Moen R, Freitag M, Miller M, Lee S, Romine A, Song S, Adityanjee A, Schulz SC. Efficacy of extended-release divalproex combined with “condensed” dialectical behaviour therapy for individuals with borderline personality disorder. Ann Clin Psychiatry. 2012;24:255–60.PubMed Moen R, Freitag M, Miller M, Lee S, Romine A, Song S, Adityanjee A, Schulz SC. Efficacy of extended-release divalproex combined with “condensed” dialectical behaviour therapy for individuals with borderline personality disorder. Ann Clin Psychiatry. 2012;24:255–60.PubMed
19.
Zurück zum Zitat Schmahl C, Kleindienst N, Limberger M, Ludäscher P, Mauchnik J, Deibler P, Brünen S, Hiemke C, Lieb K, Herpertz S, Reicherzer M, Berger M, Bohus M. Evaluation of naltrexone for dissociative symptoms in borderline personality disorder. Int Clin Psychopharmacol. 2012;27:61–8.CrossRefPubMed Schmahl C, Kleindienst N, Limberger M, Ludäscher P, Mauchnik J, Deibler P, Brünen S, Hiemke C, Lieb K, Herpertz S, Reicherzer M, Berger M, Bohus M. Evaluation of naltrexone for dissociative symptoms in borderline personality disorder. Int Clin Psychopharmacol. 2012;27:61–8.CrossRefPubMed
20.
Zurück zum Zitat Shafti SS, Shahveisi B. Olanzapine versus haloperidol in the management of borderline personality disorder. J Clin Psychopharmacol. 2010;30:44–7.CrossRefPubMed Shafti SS, Shahveisi B. Olanzapine versus haloperidol in the management of borderline personality disorder. J Clin Psychopharmacol. 2010;30:44–7.CrossRefPubMed
21.
Zurück zum Zitat Zanarini MC, Schulz SC, Detke HC, Tanaka Y, Zhao F, Lin D, Deberdt W, Kryzhanovskaya L, Corya S. A dose comparison of olanzapine for the treatment of borderline personality disorder: a 12-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2011;72:1353–62.CrossRefPubMed Zanarini MC, Schulz SC, Detke HC, Tanaka Y, Zhao F, Lin D, Deberdt W, Kryzhanovskaya L, Corya S. A dose comparison of olanzapine for the treatment of borderline personality disorder: a 12-week randomized, double-blind, placebo-controlled study. J Clin Psychiatry. 2011;72:1353–62.CrossRefPubMed
22.
Zurück zum Zitat Bellino S, Rinaldi C, Bogetto F. Adaptation of interpersonal psychotherapy to borderline personality disorder: a comparison of combined therapy and single pharmacotherapy. Can J Psychiatry. 2010;55:74–81.CrossRefPubMed Bellino S, Rinaldi C, Bogetto F. Adaptation of interpersonal psychotherapy to borderline personality disorder: a comparison of combined therapy and single pharmacotherapy. Can J Psychiatry. 2010;55:74–81.CrossRefPubMed
23.
Zurück zum Zitat Bellino S, Bozzatello P, Rocca G, Bogetto F. Efficacy of omega-3 fatty acids in the treatment of borderline personality disorder: a study of the association with valproic acid. J Psychopharmacol. 2014;28:125–32.CrossRefPubMed Bellino S, Bozzatello P, Rocca G, Bogetto F. Efficacy of omega-3 fatty acids in the treatment of borderline personality disorder: a study of the association with valproic acid. J Psychopharmacol. 2014;28:125–32.CrossRefPubMed
24.
Zurück zum Zitat Jariani M, Saaki M, Nazari H, Birjandi M. The effect of olanzapine and sertraline on personality disorder in patients with methadone maintenance therapy. Psychiatria Danubina. 2010;22:544–7.PubMed Jariani M, Saaki M, Nazari H, Birjandi M. The effect of olanzapine and sertraline on personality disorder in patients with methadone maintenance therapy. Psychiatria Danubina. 2010;22:544–7.PubMed
25.
Zurück zum Zitat Shafti SS, Kaviani H. A comparative study on olanzapine and aripiprazole for symptom management in female patients with borderline personality disorder. Bull Clin Psychopharmacol. 2015;25:38–43.CrossRef Shafti SS, Kaviani H. A comparative study on olanzapine and aripiprazole for symptom management in female patients with borderline personality disorder. Bull Clin Psychopharmacol. 2015;25:38–43.CrossRef
26.
Zurück zum Zitat Zanarini MC, Schulz SC, Detke H, Zhao F, Lin D, Pritchard M, Deberdt W, Fitzmaurice G, Cora S. Open-label treatment with olanzapine for patients with borderline personality disorder. J Clin Psychopharmacol. 2012;32:398–402.CrossRefPubMed Zanarini MC, Schulz SC, Detke H, Zhao F, Lin D, Pritchard M, Deberdt W, Fitzmaurice G, Cora S. Open-label treatment with olanzapine for patients with borderline personality disorder. J Clin Psychopharmacol. 2012;32:398–402.CrossRefPubMed
27.
Zurück zum Zitat Bozzatello P, Bellino S. Combined therapy with interpersonal psychotherapy adapted for borderline personality disorder: a two-years follow-up. Psychiatry Res. 2016;240:151–6.CrossRefPubMed Bozzatello P, Bellino S. Combined therapy with interpersonal psychotherapy adapted for borderline personality disorder: a two-years follow-up. Psychiatry Res. 2016;240:151–6.CrossRefPubMed
28.
Zurück zum Zitat Bellino S, Paradiso E, Bozzatello P, Bogetto F. Efficacy and tolerability to duloxetine in the treatment of patients with borderline personality disorder: a pilot study. J Psychopharmacol. 2010;24:333–9.CrossRefPubMed Bellino S, Paradiso E, Bozzatello P, Bogetto F. Efficacy and tolerability to duloxetine in the treatment of patients with borderline personality disorder: a pilot study. J Psychopharmacol. 2010;24:333–9.CrossRefPubMed
30.
Zurück zum Zitat Van den Eynde F, De Saedeleer S, Naudts K, Day J, Vogels C, van Heeringen C, Audenaert K. Quetiapine treatment and improved cognitive functioning in borderline personality disorder. Hum Psychopharm Clin. 2009;24:646–9.CrossRef Van den Eynde F, De Saedeleer S, Naudts K, Day J, Vogels C, van Heeringen C, Audenaert K. Quetiapine treatment and improved cognitive functioning in borderline personality disorder. Hum Psychopharm Clin. 2009;24:646–9.CrossRef
31.
Zurück zum Zitat Martín-Blanco A, Patrizi B, Soler J, Gasol X, Elices M, Gasol M, Carmona C, Pascual JC. Use of nalmefene in patients with comorbid borderline personality disorder and alcohol use disorder: a preliminary report. Int Clin Psychopharmacol. 2017. doi:10.1097/YIC.0000000000000170.PubMed Martín-Blanco A, Patrizi B, Soler J, Gasol X, Elices M, Gasol M, Carmona C, Pascual JC. Use of nalmefene in patients with comorbid borderline personality disorder and alcohol use disorder: a preliminary report. Int Clin Psychopharmacol. 2017. doi:10.​1097/​YIC.​0000000000000170​.PubMed
48.
Zurück zum Zitat Schulz SC, Zanarini MC, Bateman A, Bohus M, Detke HC, Trzaskoma Q, Tanaka Y. Lin, Deberdt W, Corya S. Olanzapine for the treatment of borderline personality disorder: variable dose 12-week randomised double-blind placebo-controlled study. Br J Psychiatry. 2008;193:485–92.CrossRefPubMed Schulz SC, Zanarini MC, Bateman A, Bohus M, Detke HC, Trzaskoma Q, Tanaka Y. Lin, Deberdt W, Corya S. Olanzapine for the treatment of borderline personality disorder: variable dose 12-week randomised double-blind placebo-controlled study. Br J Psychiatry. 2008;193:485–92.CrossRefPubMed
49.
Zurück zum Zitat Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry. 2004;161:2108–14.CrossRefPubMed Zanarini MC, Frankenburg FR, Hennen J, Reich DB, Silk KR. Axis I comorbidity in patients with borderline personality disorder: 6-year follow-up and prediction of time to remission. Am J Psychiatry. 2004;161:2108–14.CrossRefPubMed
Metadaten
Titel
A Focused Systematic Review of Pharmacological Treatment for Borderline Personality Disorder
verfasst von
Ella Hancock-Johnson
Chris Griffiths
Marco Picchioni
Publikationsdatum
01.05.2017
Verlag
Springer International Publishing
Erschienen in
CNS Drugs / Ausgabe 5/2017
Print ISSN: 1172-7047
Elektronische ISSN: 1179-1934
DOI
https://doi.org/10.1007/s40263-017-0425-0

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