Borderline patients often display pathological aggression. We previously tested lamotrigine, an anti-convulsant, in therapy for aggression in women with borderline personality disorder (BPD) (J Psychopharmacol 2005; 19: 287-291), and found significant changes on most scales of the State-Trait Anger Expression Inventory (STAXI) after eight weeks. To assess the longer-term efficacy of lamotrigine in therapy for aggression in women with BPD, this 18-month follow-up observation was carried out, in which patients (treated with lamotrigine: n = 18; former placebo group: n = 9) were tested every six months. According to the intent-to-treat principle, significant changes on all scales of the STAXI were observed in the lamotrigine-treated subjects. All subjects tolerated lamotrigine relatively well. Lamotrigine appears to be an effective and relatively safe agent in the longer-term treatment of aggression in women with BPD.
"However, adverse cognitive sequelae may interfere with psychotherapy for some BPD patients, and potential weight loss may become troubling for patients with comorbid eating disorders. Lamotrigine treatment improves impulsivity, affective symptoms,111 and aggression,41,112 but it requires lengthy titration to avoid life-threatening rash and toxicity. Valproate appears to be particularly efficacious in BPD patients with prominent impulsive aggression, rather than affective instability.113 "
[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.
"In an 18-month follow-up observation study, these patients (lamotrigine group, n = 18; former placebo group, n = 9 (took neither lamotrigine nor placebo) were tested every six months . The lamotrigine group experienced significantly greater changes on all STAXI scales compared to the ex-placebo group. "
[Show abstract][Hide abstract] ABSTRACT: Evidence is reviewed here which suggests that antiepileptic drugs (AEDs) may be effective for the treatment of impulsivity across a range of psychiatric disorders and for impulse control and cluster B personality disorders in particular. AEDs may be effective for the treatment of the brain circuitry related to impulsivity, by modulating GABA, glutamate, serotonin, and norepinephrine. It is suggested that interventions should be directed at the brain circuitry which modulates core symptoms like impulsivity that may be shared across disorders, rather than the disorder itself. In addition to these core symptom domains, clinicians should identify comorbid conditions and associated symptoms related to brain systems as they can also influence overall treatment response. The increasing experience of psychiatrists in treating impulse control disorders, cluster B personality disorders, and impulsivity across disorders should complement the knowledge obtained from research. This will lead to a better understanding of the brain mechanisms underlying impulsive symptom domains within disorders and to more targeted treatments with improved outcomes.
Current Psychiatry Reviews 07/2008; 4(3):114-136. DOI:10.2174/157340008785829922
[Show abstract][Hide abstract] ABSTRACT: Eine moderne psychiatrische Sicht auf Persönlichkeit und Persönlichkeitsstörung betont ein multifaktorielles Modell, in dem
psychobiologische und psychosoziale Faktoren eng miteinander verwoben sind. Kategoriale und dimensionale Diagnosekonzepte
zu Persönlichkeitsstörungen werden derzeit intensiv diskutiert. Für künftige Klassifikations-systeme können bedeutsame Änderungen
erwartet werden. In der vorliegenden Arbeit wird zunächst das Thema der Diagnostik von Persönlichkeitsstörungen in seiner
Grundproblematik skizziert. Mittlerweile vorliegende neurobiologische Erkenntnisse zu einzelnen Persönlichkeitsstörungen werden
dargestellt. Sie bilden das theoretische Rationale für die empirische Erprobung von psychopharmakologischen Ansätzen in der
Behandlung von Persönlichkeitsstörungen. Eine Übersicht über kontrollierte empirische Studien wird gegeben. Die Resultate
werden in Anlehnung an die DSM-IV Clusterbildung von Persönlichkeitsstörungen präsentiert. Einige Anmerkungen und Empfehlungen
zum Einsatz von Medikamenten bei Persönlichkeitsstörungen in der psychiatrischen Behandlungspraxis werden gemacht.
Modern psychiatry favours a multifactorial model of personality and personality disorder stressing close interactions of psychobiological
and psychosocial influences. Currently, categorical and dimensional models are being passionately discussed for revisions
of diagnostics of personality disorders in future systems of classification. Major consequences for the neurobiological research
on personality disorder can be awaited. This paper will deal with some core issues of the diagnostics of personality disorders.
Neurobiological findings with some personality disorders will be presented. The neurobiological underpinnings of personality
disorders form the starting point of pharmacological approaches whose empirical results will be organised according to the
DSM-IV clusters of personality disorders. Some remarks and recommendations will be drawn for the psychiatric treatment of
patients with personality disorders under usual service conditions.
Psychiatrie und Psychotherapie 06/2008; 4(2):37-57. DOI:10.1007/s11326-008-0004-6
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