Behavioural dyscontrol in borderline patients treated with Amitriptyline

ArticleinPsychopharmacology bulletin 23(1):177-81 · February 1987with8 Reads
Source: PubMed
    • "Lors de cette étude, quatre sujets ont dû abandonner le traitement de manière abrupte, tant leur comportement était devenu dangereux. D'autres études confirment ces résultats expérimentaux, incriminant le rôle de la personnalité limite dans la survenue des réactions paradoxales et notamment l'étude contrôlée de Soloff et al. [41]. Dans ce protocole, les patients limites répondaient effectivement et de manière significativement plus élevée que les autres sujets aux mesures d'idéation paranoïde et d'impulsion comportementale. "
    [Show abstract] [Hide abstract] ABSTRACT: With 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 PREVALENCE: Paradoxical 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. Benzodiazepine-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. In 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.
    Full-text · Article · Oct 2008
    • "Lors de cette étude, quatre sujets ont dû abandonner le traitement de manière abrupte, tant leur comportement était devenu dangereux. D'autres études confirment ces résultats expérimentaux, incriminant le rôle de la personnalité limite dans la survenue des réactions paradoxales et notamment l'étude contrôlée de Soloff et al. [41]. Dans ce protocole, les patients limites répondaient effectivement et de manière significativement plus élevée que les autres sujets aux mesures d'idéation paranoïde et d'impulsion comportementale. "
    [Show abstract] [Hide abstract] ABSTRACT: Les réactions paradoxales d’agressivité sous benzodiazépines ont fait l’objet d’une littérature scientifique spécifique depuis 1960. Si peu d’études contrôlées ont pu être réalisées, de nombreux cas cliniques ont été recensés et discutés dans la littérature. Désinhibition, anxiété, comportements auto ou hétéroagressifs et actes médicolégaux ont été observés chez des patients présentant différents facteurs de vulnérabilité, sans qu’une modélisation des processus incriminés ait pu être élaborée. Cependant, le rôle de la personnalité limite et de la personnalité anxieuse, l’influence du contrôle gabaergique sur le système sérotoninergique ainsi que l’impact de l’alcool semblent être autant d’hypothèses expliquant une partie de ces phénomènes paradoxaux.
    Full-text · Article · Sep 2008
    • "It may be reasonable to conclude that until more definitive data are generated, MAOIs should not be excluded from consideration in the evidence-based pharmacotherapy of BPD. Conversely, every study involving a tricyclic implicated it as being inferior to the comparator, lacking in efficacy, and/or associated with exacerbation of pathology, (Parsons et al., 1989; Soloff et al., 1986b Soloff et al., , 1987 Soloff et al., , 1988 Soloff et al., , 1989 Links et al., 1990) thereby making this class of drugs seem much less desirable. Conventional antipsychotics, certain anticonvulsants, and lithium may be of benefit in BPD, although the degree of their utility remains to be clarified. "
    [Show abstract] [Hide abstract] ABSTRACT: The authors performed a review of double-blind, controlled studies of psychotropic drugs to evaluate the evidence base supporting their use in treatment of borderline personality disorder. English language literature cited in Medline and published between 1970 and 2006 was searched using the following terms: anticonvulsants, antidepressants, antipsychotics, anxiolytics, benzodiazepines, borderline personality disorder, lithium, medication, mood stabilizers, pharmacotherapy, and psychotropics. Only reports of double-blind, randomized, controlled trials were included. Twenty eight double-blind, randomized, controlled trials were identified which included anticonvulsants, classical neuroleptics, the benzodiazepine alprazolam, lithium, monoamine oxidase inhibitors, the novel antipsychotic olanzapine, selective serotonin reuptake inhibitors, tricyclic antidepressants, and omega-3 fatty acids. All but three were placebo-controlled. With the exception of alprazolam and tricyclics, the data from these trials revealed evidence of improvements, although often circumscribed and variable. The novel antipsychotic olanzapine appeared to have the most empirical support for having a favorable effect on borderline personality disorder. A growing body of data suggests that there are psychotropic agents which appear to be well tolerated, and which to varying degrees may be expected to ameliorate the domains of psychopathology associated with borderline personality disorder. The research literature, on which practice should be optimally based, appears to suggest a need for a shift from antidepressants to anticonvulsants and atypical antipsychotics.
    Article · Mar 2008
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