Efficacy of phenelzine and haloperidol in borderline personality disorder

Department of Psychiatry, University of Pittsburgh, Pa.
Archives of General Psychiatry (Impact Factor: 14.48). 06/1993; 50(5):377-85. DOI: 10.1001/archpsyc.1993.01820170055007
Source: PubMed


To compare the efficacy of a neuroleptic (haloperidol) to a monoamine oxidase inhibitor antidepressant (phenelzine sulfate) against the affective, cognitive, and impulsive-aggressive symptoms of criteria-defined borderline inpatients in an effort to dissect apart affective and schizotypal symptom patterns or subtypes using medication response.
Randomized, double-blind, placebo-controlled trial.
Inpatient unit of a tertiary care university psychiatric hospital serving a large public catchment area.
One hundred eight consecutively admitted borderline inpatients defined by Gunderson's Diagnostic Interview for Borderline Patients and DSM-III-R criteria, randomly assigned to 38 phenelzine, 36 haloperidol, and 34 placebo trials.
Following 1 week free of medication, haloperidol (average dose, 4 mg/d), phenelzine sulfate (average dose, 60 mg/d), or placebo were given for 5 weeks with weekly symptom ratings and plasma drug level determinations.
Efficacy was measured on depression (Hamilton Rating Scale, Beck Depression Inventory), global severity (Global Assessment Scale, Symptom Checklist-90 items [SCL-90]), anxiety, anger-hostility (SCL-90, Inpatient Multidimensional Psychiatric Scale [IMPS], Buss-Durkee Hostility Inventory), psychoticism (Schizotypal Symptom Inventory, SCL-90, IMPS), impulsivity (Ward Scale, Barratt Impulsiveness Scale, Self-Report Test of Impulse Control), and borderline psychotherapy (Borderline Syndrome Index).
Three-way comparisons between groups indicated superior efficacy for phenelzine, followed by placebo and haloperidol on measures of depression, borderline psychopathologic symptoms, and anxiety. Pairwise comparisons between medication and placebo revealed significant efficacy for phenelzine against anger and hostility but no efficacy against atypical depression or hysteroid dysphoria. We were unable to replicate prior reports of efficacy for the neuroleptic.
Pharmacologic dissection of borderline personality disorder patients into affective and schizotypal subtypes could not be demonstrated.

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    • "Historically, monoamine oxidase inhibitors (MAOIs) have been considered the treatment of choice for patients with atypical depression characterized by rejection sensitivity and affective reactivity. Consistent with the high rates of rejection sensitivity associated with BPD,75,76 MAOIs demonstrated robust improvements (particularly in aggression and anxiety) in older trials.77-80 However, lower tolerability profiles of MAOIs and potential adverse reactions (eg, hypertensive crises during dietary indiscretion) have limited their utility for BPD patients with severe impulsivity or suicidality. "
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    ABSTRACT: The best available evidence for psychopharmacologic treatment of borderline personality disorder (BPD) is outlined here. BPD is defined by disturbances in identity and interpersonal functioning, and patients report potential medication treatment targets such as impulsivity, aggression, transient psychotic and dissociative symptoms, and refractory affective instability Few randomized controlled trials of psychopharmacological treatments for BPD have been published recently, although multiple reviews have converged on the effectiveness of specific anticonvulsants, atypical antipsychotic agents, and omega-3 fatty acid supplementation. Stronger evidence exists for medication providing significant improvements in impulsive aggression than in affective or other interpersonal symptoms. Future research strategies will focus on the potential role of neuropeptide agents and medications with greater specificity for 2A serotonin receptors, as well as optimizing concomitant implementation of evidence-based psychotherapy and psychopharmacology, in order to improve BPD patients' overall functioning.
    06/2013; 15(2):213-24.
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    • "Research has also examined MAO inhibitors [46] [55] and tricyclic antidepressants [56] in BPD, but the side effects and potential lethality of these agents on overdose have not encouraged their use. Like neuroleptics, antidepressants ''take the edge off'' symptoms of BPD, but do not lead to remission of a personality disorder. "
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    ABSTRACT: The objective of this review is to examine clinical trials of the treatment of personality disorders (PDs). The method is a narrative review of published controlled trials of psychotherapy and pharmacotherapy. Results show that a variety of methods reduce impulsivity, with less striking results for affective instability. There is good support for well-structured methods of psychotherapy, mainly in borderline personality disorder (BPD), but evidence for the efficacy of pharmacotherapy is weak. Research on other PD categories is sparse.
    The Psychiatric clinics of North America 09/2008; 31(3):517-26, viii. DOI:10.1016/j.psc.2008.03.013 · 1.87 Impact Factor
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    • "). Conventional antipsy - chotics are typically prescribed for the psychotic features of BPD ( Cornelius et al., 1993 ; Soloff et al . , 1993 ) , but this may be limited by poor compliance due to side effects . Since the introduction of atypical antipsychotic drugs , rates of ' off label ' use for the treatment of BPD have increased ( Villeneuve and Lemelin , 2005 ) . Yi - gan san ( YGS , yokukan - san in Japanese ) was developed in 1555 by Xue Kai as a remedy for restlessnes"
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    ABSTRACT: Numerous medications have been tested on patients with borderline personality disorder (BPD). Although many of these medications have been demonstrated to be useful, no clear main treatment for BPD has emerged. Despite the efficacy of some of the medicines, acceptability and side effects have proven to be barriers to their use. Recent studies indicate that the traditional Chinese herbal medicine yi-gan san (YGS, yokukan-san in Japanese) may be safe and useful in treating behavioral and psychological symptoms in dementia patients. We aimed at evaluating both efficacy and safety of yi-gan san in patients with well-defined BPD. Twenty female outpatients diagnosed with BPD according to DSM-IV criteria and the revised Diagnostic Interview for Borderlines completed a 12-week open-label study with yi-gan san at an average daily dosage of 6.4+/-1.9 g (2.5-7.5 g). Psychometric instruments to assess efficacy included the Brief Psychiatric Rating Scale (BPRS), Hamilton Rating Scales for Depression (HAM-D), Global Assessment of Functioning (GAF), Clinical Global Impression Scale (CGI), and Aggression Questionnaire (AQ). Most psychometric scale scores exhibited a highly significant improvement (total BPRS; BPRS somatic concern, anxiety, tension, depressive mood, hostility, suspiciousness, motor retardation, uncooperativeness, and excitement subscale; CGI; GAF; AQ) over time. In this open-label pilot study, patients treated with YGS showed statistically significant reduction on self-rated and clinician-rated scales. The present findings suggest that yi-gan san might be effective for the treatment of a number of BPD symptoms, including low mood, impulsivity, and aggression.
    Progress in Neuro-Psychopharmacology and Biological Psychiatry 02/2008; 32(1):150-4. DOI:10.1016/j.pnpbp.2007.07.026 · 3.69 Impact Factor
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