Olanzapine Plus Dialectical Behavior Therapy for Women With High Irritability Who Meet Criteria for Borderline Personality Disorder

Department of Psychology, University of Washington, Seattle 98195-1525, USA.
The Journal of Clinical Psychiatry (Impact Factor: 5.5). 05/2008; 69(6):999-1005. DOI: 10.4088/JCP.v69n0617
Source: PubMed


This double-blind study examined whether olanzapine augments the efficacy of dialectical behavior therapy (DBT) in reducing anger and hostility in borderline personality disorder patients.
Twenty-four women with borderline personality disorder (DSM-IV criteria) and high levels of irritability and anger received 6 months of DBT. Subjects were randomly assigned to receive either low-dose olanzapine or placebo and were assessed with standardized measures in a double-blind manner. The study was conducted from September 2000 to December 2002.
Intent-to-treat analyses indicated that both treatment conditions resulted in significant improvement in irritability, aggression, depression, and self-inflicted injury (p < .01 for each). Irritability and aggression scores tended (p < .10) to decrease more quickly for the olanzapine group than for the placebo group. Self-inflicted injury tended (p < .10) to decrease more for the placebo group than for the olanzapine group.
Olanzapine may promote more rapid reduction of irritability and aggression than placebo for highly irritable women with borderline personality disorder. Effect sizes were moderate to large, with the small sample size likely limiting the ability to detect significant results. Overall, there were large and consistent reductions in irritability, aggression, depression, and self-injury for both groups of subjects receiving DBT.

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Available from: Marsha M Linehan, Feb 25, 2014
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    • "Dose ranges are typically lower than for primary psychotic disorders. Well-documented metabolic risks are associated particularly with olanzapine.22,29,43,47,89-93 The only benefit of polypharmacy elicited in one randomized controlled trial with BPD patients is lower risk of metabolic side effects when patients were administered the combination olanzapine-fluoxetine, relative to olanzapine alone.43 "
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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.
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    • "When results based on the same sample were reported in several studies, sample data were included only once, resulting in a total sample of 16. Of all the studies that were selected for the analysis, eight were classified as controlled by randomization (Clarkin et al., 2007; Koons et al., 2001; Linehan et al., 1991, 2002, 1999; Linehan, Comtois, Murray, et al., 2006; McMain et al., 2009; van den Bosch et al., 2005), seven were included as neither randomized nor controlled (Comtois, Elwood, Holdcraft, Smith, & Simpson, 2007; Friedrich, Gunia, & Huppertz, 2003; Höschel, 2006; Kröger et al., 2006; Linehan et al., 2008; Prendergast & McCausland, 2007; Simpson et al., 2004), and one was not randomized but controlled (Bohus et al., 2004). Because this study was not controlled at follow-up (Kleindienst et al., 2008), it was added to the nRCT group of studies. "
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    ABSTRACT: At present, the most frequently investigated psychosocial intervention for borderline personality disorder (BPD) is dialectical behavior therapy (DBT). We conducted a meta-analysis to examine the efficacy and long-term effectiveness of DBT. Systematic bibliographic research was undertaken to find relevant literature from online databases (PubMed, PsycINFO, PsychSpider, Medline). We excluded studies in which patients with diagnoses other than BPD were treated, the treatment did not comprise all components specified in the DBT manual or in the suggestions for inpatient DBT programs, patients failed to be diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, and the intervention group comprised fewer than 10 patients. Using a mixed-effect hierarchical modeling approach, we calculated global effect sizes and effect sizes for suicidal and self-injurious behaviors. Calculations of postintervention global effect sizes were based on 16 studies. Of these, 8 were randomized controlled trials (RCTs), and 8 were neither randomized nor controlled (nRCT). The dropout rate was 27.3% pre- to posttreatment. A moderate global effect and a moderate effect size for suicidal and self-injurious behaviors were found, when including a moderator for RCTs with borderline-specific treatments. There was no evidence for the influence of other moderators (e.g., quality of studies, setting, duration of intervention). A small impairment was shown from posttreatment to follow-up, including 5 RCTs only. Future research should compare DBT with other active borderline-specific treatments that have also demonstrated their efficacy using several long-term follow-up assessment points.
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    • ") y también se asemejan a los datos de un estudio reciente que ha evaluado la eficacia preliminar de la DBT para pacientes con bulimia nerviosa y/o trastorno por atracón y TLP (Chen, Matthews, Allen, Kuo y Linehan, 2008). Con respecto a la asociación entre estos trastornos, nuestros resultados coinciden con los estudios que apoyan el hecho de que las personas que padecen anorexia o bulimia nerviosa que presentan trastornos de personalidad poseen una mayor frecuencia de atracones, vómitos y síntomas ansioso-depresivos, mayores dificultades de integración social y mayor número de intentos de suicidio (p. "

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