• [Show abstract] [Hide abstract]
    ABSTRACT: Background: Personality disordered individuals, especially those with severe cluster B disorders, are prescribed psychotropic medications with greater frequency than almost any other diagnostic group. However, prescribing practices in this population often are based on hunches or anecdotal evidence rather than on rigorous or widely replicated data. Aims: We have attempted to provide a comprehensive review of randomized trials of the pharmacotherapy of personality disorders. Method: Pubmed searches using various combinations of the terms “pharmacotherapy”“psychopharmacology”“medication,”“personality disorder” and “Axis II.” Results: Approximately 40 published randomized trials were found and summarized. The vast majority concern borderline personality disorder (BPD); these studies cover almost every known class of psychotropic medications. Most published BPD studies show efficacy for at least one target symptom, with some studies identifying multiple areas of drug response. Medications seem most useful in treating circumscribed symptom areas and to induce only partial improvements. Conclusions: Much work remains to be done in finding wholly effective pharmacological strategies for treating personality disorders. The development of rational pharmacotherapy will require increasing our knowledge of the neurobiological underpinnings of the disorders themselves and of their component dimensions.Declaration of interest: None.
    Journal of Mental Health 07/2009; 16(1). DOI:10.1080/09638230601182078 · 1.40 Impact Factor
  • [Show abstract] [Hide abstract]
    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.
    This article is viewable in ResearchGate's enriched format
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: IntroductionWith growing prescription and availability, benzodiazepine usage in France is on the increase among the general population. Although its anxiolytic action has long been proven, many side effects can be observed.Typology and prevalenceParadoxical reactions of aggressiveness under benzodiazepines have been discussed in the scientific literature since the 1960s. This term was introduced to describe reactions of agitation and disinhibition occurring during anxiolytic or hypnotic treatment. Physical aggression, rape, impulsive decision-making and violence have been reported, as well as autoaggressiveness and suicide. General population studies indicate a prevalence of these reactions of less than 1%, and meta-analysis has shown that use of benzodiazepines generates aggressiveness more frequently than it reduces it. It has also been shown that long-term memory (anterograde amnesia) can be impaired following the ingestion of a benzodiazepine.Risk factorsBenzodiazepine-linked disinhibition, auto and heteroaggressiveness, anxiety and criminal acts have been associated with various vulnerability factors. Although the risk of these paradoxical reactions depends on the number of such factors present in a single patient, the effects of the type and dose of benzodiazepine on the frequency and the intensity of paradoxical symptoms are not clear. In terms of personality, several studies have demonstrated the role of low-stress control (specifically high-trait anxiety) on aggressiveness under benzodiazepines. Other authors underline the role of borderline personality disorder as a major risk factor predicting paradoxical reactions. Results of a study on borderline patients show a prevalence of benzodiazepine-linked disinhibition of 58%. On a neuropharmacological level, the influence of the GABA system on the serotonin control and the impact of alcohol seem to be established. Benzodiazepines, specifically when associated with alcohol, seem to facilitate GABAergic transmission, which can be at the origin of the disinhibited behaviours that have been reported.DiscussionIn 2000, France was the first country in terms of benzodiazepine use 17.4% of the adult population had been prescribed an anxiolytic. Implications for medicolegal and clinical practice are discussed.
    L Encéphale 09/2008; 34(4):330-336. DOI:10.1016/j.encep.2007.05.005 · 0.60 Impact Factor