Despite the prevalence and clinical significance of borderline personality disorder, its treatment remains understudied.
To evaluate treatment with variably dosed olanzapine in individuals with borderline personality disorder.
In this 12-week randomised, double-blind trial, individuals received olanzapine (2.5-20 mg/day; n=155) or placebo (n=159) (trial registry: NCT00091650). The primary efficacy measure was baseline to end-point change on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) using last-observation-carried-forward methodology.
Both olanzapine and placebo groups showed significant improvements but did not differ in magnitude at end-point (-6.56 v. -6.25, P=0.661). Response rates (50% reduction in ZAN-BPD) were 64.7% with olanzapine and 53.5% with placebo (P=0.062); however, time to response was significantly shorter for olanzapine (P=0.022). Weight gain was significantly greater (2.86 v. -0.35 kg, P<0.001), with higher incidence of treatment-emergent abnormal high levels of prolactin for the olanzapine group.
Individuals treated with olanzapine and placebo showed significant but not statistically different improvements on overall symptoms of borderline personality disorder. The types of adverse events observed with olanzapine treatment appeared similar to those observed previously in adult populations.
"Despite one trial failing to establish statistically significant improvement with low-dose olanzapine,91 a larger, multisite sample recently showed significant but modest decreases in overall BPD severity,92 with further improvements seen in open-label continuation.93 Similarly broad benefits are seen in trials of aripiprazole improving impulsivity, aggression, affective instability, self-injury, and interpersonal symptoms.87-88 "
[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.
"Cette e ´ tude a e ´ té conduite dans un groupe de 91 patients ayant commis ré cemment une tentative de suicide, ne ré pondant pas aux critè res d'un e ´ pisode dé pressif majeur, et dont 74 pré sentaient des critè res compatibles avec le diagnostic d'au moins un trouble de personnalité du cluster B. Les antipsychotiques atypiques, et notamment l'olanzapine, sont dé sormais les produits les plus e ´ tudié s dans les personnalité s e ´ tats-limites . L'essai contrôlé le plus ré cent n'a cependant pas montré de supé riorité de l'olanzapine par rapport au placebo sur l'ensemble de la pathologie . Une e ´ tude contrôlé e a par ailleurs permis de montrer l'inté rêt de l'association de l'olanzapine a ` une thé rapie cognitive dialectique chez des patients souffrant de "
[Show abstract][Hide abstract] ABSTRACT: Drug treatment of personality disorders is less developed than are psychological treatments in this area, but they are a logical prolongation of psychobiological models of personality and temperament, and respond to the need of many clinicians in front of difficult patients. The results obtained in the field of pharmacotherapy of personality disorders can be classified according to DSM-IV axis-II categorization. In anxious personalities (clusterC), some isolated studies suggest a favourable effect of antidepressants on obsessive-compulsive dimension, on avoidant personality disorder, and on inhibition and trait-anxiety, especially when serotoninergic agents are used. Few studies have been conducted in cluster A personality disorders, and some are in favour of the interest of low doses of antipsychotic drugs in this group. Most studies have been conducted in cluster B, and especially in antisocial and borderline personality disorders. Partial positive results have been obtained using various classes of drugs for dealing with aggression and impulsive behaviors, including lithium, beta-blockers, carbamazepine, valproate, antipsychotic drugs, and also SSRIs. Self-harm and suicidal behaviors seem to be partially but significantly improved by antidepressants and low doses of antipsychotics. Overall, the pharmacotherapy of personality disorder may lead in the future to the development of effective treatments, in complement to psychotherapy, for actually severe, chronic, and disabling disorder.
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