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Psychopharmacological Treatment of Personality Disorders

A Review
  • Peter Moleman
  • Karin van Dam
  • Veron Dings
Chapter

Summary

Studies for each of five (groups) of psychopharmaca are reviewed: antipsychotics, antidepressants, benzodiazepines, lithium, and carbamazepine. Large placebo effects are observed in all studies and show a positive effect on general level of funcioning. Antipsychotics certainly are effective in borderline personality disorder. Classical (tricyclic) antidepressants are found to be detrimental for borderline and/or schizotypal patients, while MAO-I show beneficial effects in patients with borderline personality disorder. Treating patients with personality disorders with benzodiazepines (anxiolytics) has a frail scientific basis. Lithium appears to be usefullness in a diversity of subjects with aggression and/or impulsivity. Carbamazepine (an anti-epilepticum) may be effective in patients with symptoms of behavioural dyscontrol and impulsiveness.

Issues relevant in our opinion to put the data into perspective are discussed at the end of each section. At the end conclusions for treatment of personality disorders with psychopharmacological agents are presented.

Keywords

Psychotic Symptom Personality Disorder Borderline Personality Disorder Borderline Personality Disorder Patient Positron Emission Tomographic 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Akiskal H.S., Silva J.A.C.E., Frances A. et al. (1995) Dysthymia in clinical practice. Br. J. Psychiatry, 166: 174–183.CrossRefGoogle Scholar
  2. Albani E, Riva R., and Baruzzi A. (1995) Carbamazepine clinical pharmacology: A review. Pharmacopsychiatry, 28: 235–244.PubMedCrossRefGoogle Scholar
  3. Brinkley J.R., Beitman B.D., and Friedel R.O. (1979) Low-dose neuroleptic regimens in the treatment of borderline patients. Arch. Gen. Psychiatry, 36: 319–326.PubMedCrossRefGoogle Scholar
  4. Calabrese J.R., Fatemi H., Kujawa M. et al. (1996) Predictors of response to mood stabilizers. J. Clin. Psychopharmacol., 6: S24 - S31.CrossRefGoogle Scholar
  5. Casey D.E. (1992) What makes a neuroleptic atypical? In: Novel antipsychotic drugs. New York: Raven Press, 241–251.Google Scholar
  6. Cole J.O., Salomon M., Gunderson J. et al. (1984) Drug therapy in borderline patients. Comprehensive Psychiatry, 25: 249–254.PubMedCrossRefGoogle Scholar
  7. Collard J. (1979) Pimozide in the treatment of some “social maladjustments” in “personality disorders”. Acta Psychiatrica Belgica, 79: 686–703.PubMedGoogle Scholar
  8. Cornelius J.R., Soloff P.H., Perd J.M. et al. (1991) A Preliminary Trial of Fluoxetine in Refractory Borderline Patients. J. Clin. Psychopharmacol., 11: 116–120.PubMedCrossRefGoogle Scholar
  9. Cornelius J.R., Soloff P.H., Perel J.M. et al. (1993) Continuation Pharmacotherapy of Borderline Personality Disorder with Haloperidol and Phenelzine. Am. J. Psychiatry, 150: 1843–1843.PubMedGoogle Scholar
  10. Cowdry R.W. and Gardner D.L. (1988) Pharmacotherapy of borderline personality disorder; alprazolam, carbamazepine, trifluoperazine, and tranylcypromine. Arch. Gen. Psychiatry, 45: 111–119.PubMedCrossRefGoogle Scholar
  11. Dale P.G. (1980) Lithium therapy in aggressive mentally subnormal patients. Br. J. Psychiatry, 137:469–474.Google Scholar
  12. Dardennes R., Even C., Bange F. et al. (1995) Comparison of carbamazepine and lithium in the prophylaxis of bipolar disorders—a meta-analysis. Br. J. Psychiatry,166:378–381.Google Scholar
  13. Dulz B., and Schneider A. boek, editor. (1996) Borderline-Störungen; Theorie and Therapie. 2nd: Stuttgart: SchattauerVerlagsgesellschaft; 110.Google Scholar
  14. Gitlin M.J. (1993) Pharmacotherapy of Personality Disorders—Conceptual Framework and Clinical Strategies. J Clin. Psychopharmacol., 13: 343–353.PubMedGoogle Scholar
  15. Goldberg S.C., Schulz S.C., Schulz P.M. et al. (1986) Borderline and schizotypal personality disorders treated with low-dose thiothixene vs placebo. Arch. Gen. Psychiatry, 43: 680–6686.PubMedCrossRefGoogle Scholar
  16. Gunderson J.G., Kolb J.E., and Austin V. (1981) The diagnostic interview for borderline patients. Am. J. Psychiatry, 138: 896–903.PubMedGoogle Scholar
  17. Hymowitz P, Frances A., Jacobsberg L.B. et al. (1991) Neuroleptic treatment of schizotypal personality disorders. Comprehensive Psychiatry, 48: 1064–1067.Google Scholar
  18. Jensen H.V. and Andersen J. (1989) An open, noncomparative study of amoxapine in borderline disorders. Acta Psychiatr. Scand., 79: 89–93.PubMedCrossRefGoogle Scholar
  19. Kapur S., Remington G., Jones C. et al. (1996) High levels of dopamine D-2 receptor occupancy with low-dose haloperidol treatment: A PET study. Am. J. Psychiatry, 153: 948–529.PubMedGoogle Scholar
  20. Klein D.F. and Fink M. (1962) Psychiatric reaction patterns to imipramine. Am. J. Psychiatry, 119: 432–438.PubMedGoogle Scholar
  21. Leone N.F. (1982) Response of borderline patients to loxapine and chlorpromazine. J. Clin. Psychiatry, 43: 148–150.PubMedGoogle Scholar
  22. Links P.S., Steiner M., Boiago I. et al. (1990) Lithium therapy for borderline patients: preliminary findings. Journal of Personality Disorders, 4: 173–181.CrossRefGoogle Scholar
  23. Lion J.R. (1979) Benzodiazepine in the treatment of aggressive patients. J. Clin. Psychiatry, 40: 70–109.PubMedGoogle Scholar
  24. Marder S.R., Midha K.K., Vanputten T. et al. (1991) Plasma Levels of Fluphenazine in Patients Receiving Fluphenazine Decanoate—Relationship to Clinical Response. Br. J. Psychiatry, 158: 658–665.PubMedCrossRefGoogle Scholar
  25. Markovitz PJ., Calabrese J.R., Schulz S.C. et al. (1991) Fluoxetine in the Treatment of Borderline and Schizotypal Personality Disorders. Am. J. Psychiatry, 148: 1064–1067.PubMedGoogle Scholar
  26. Markovitz P.J. and Wagner S.C. (1995) Venlafaxine in the treatment of borderline personality disorder. Psychopharmacol. Bull., 31: 773–777.PubMedGoogle Scholar
  27. Mattes J.A. (1984) Carbamazepine for uncontrolled rage outbursts. Lancet, 11: 1164–1165.CrossRefGoogle Scholar
  28. Mcevoy J.P., Hogarty G.E., and Steingard S. (1991) Optimal Dose of Neuroleptic in Acute Schizophrenia—A Controlled Study of the Neuroleptic Threshold and Higher Haloperidol Dose. Arch. Gen. Psychiatry, 48: 739–745.PubMedCrossRefGoogle Scholar
  29. Moleman P. (1992) Praktische Psychopharmacologie. 2nd: Houten: Bohn Stafleu van Loghem.Google Scholar
  30. Montgomery S.A. and Montgomery D. (1982) Pharmacolgical prevention of suicidal behaviour. J. Affective Disord., 4: 291–298.CrossRefGoogle Scholar
  31. Murphy S.M. and Tyrer P.A. (1991) Double-Blind Comparison of the Effects of Gradual Withdrawal of Lorazepam, Diazepam, and Bromazepam in Benzodiazepine Dependence. Br. J. Psychiatry, 158: 511–516.PubMedCrossRefGoogle Scholar
  32. New A.S., Trestman R.L., and Siever L.J. (1994) The pharmacotherapy of borderline personality disorder. CNS Drugs, 2: 347–354.CrossRefGoogle Scholar
  33. Norden M.J. (1989) Fluoxetine in borderline personality disorder. Progr. Neuro-Psychopharmacology & Biological Psychiatry, 13: 885–893.CrossRefGoogle Scholar
  34. Nyberg S., Nordstrom A.L., Halldin C. et al. (1995) Positron emission tomography studies on D-2 dopamine receptor occupancy and plasma antipsychotic drug levels in man. Int. Clin. Psychopharmacol., 10: 81–85.PubMedGoogle Scholar
  35. Quitkin F.M., Stewart J.W., Mcgrath P.J. et al. (1993) Columbia Atypical Depression—A Subgroup of Depressives with Better Response to MAOI Than to Tricyclic Antidepressants or Placebo. Br. J. Psychiatry, 163: 30–34.Google Scholar
  36. Reyntjens A.M. (1972) A series of multicentre trials with pimozide in psychiatric practice. Acta Psychiatrica Belgica, 72: 30–36.Google Scholar
  37. Rifkin A., Quitkin F., and Carillo C. (1972) Lithium carbonate in emotionally unstable character disorder. Arch. Gen. Psychiatry, 27: 519–523.PubMedCrossRefGoogle Scholar
  38. Rosenberg R. (1994) Borderline States—Pharmacotherapy and Psychobiology of Personality—A Discussion of Soloffs Article. Acta Psychiatr. Scand., 89: 56–60.CrossRefGoogle Scholar
  39. Salzman C., Wolfson A.N., Schatzberg A. et al. (1995) Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. J Clin. Psychopharmacol., 15: 23–29.PubMedCrossRefGoogle Scholar
  40. Serban G. and Siegel S. (1984) Response of borderline and schizotypal patients to small doses of thithixene and haloperidol. Am. J. Psychiatry, 141: 1455–1458.PubMedGoogle Scholar
  41. Sheard M.H., Marini J.L., Bridges C.I. et al. (1976) The effect of lithium on impulsive aggressive behaviour in man. Am. J. Psychiatry, 133: 1409–1413.PubMedGoogle Scholar
  42. Soloff P.H., George A., Nathan S. et al. (1986) Progress in pharmacotherapy of borderline disorders; a double blind study of amitriptyline, haloperidol, and placebo. Arch. Gen. Psychiatry, 43: 691–697.PubMedCrossRefGoogle Scholar
  43. Soloff P.H., Anselm G., Nathan S. et al. (1986) Paradoxical effects of amitriptyline on borderline patients. Am. J. Psychiatry, 143: 1603–1605.PubMedGoogle Scholar
  44. Soloff P.H., George A., Nathan S. et al. (1989) Amitriptyline versus haloperidol in borderlines: final outcomes and predictors of response. J. Clin. Psychopharmacol., 9: 238–246.PubMedCrossRefGoogle Scholar
  45. Soloff P.H., Cornelius J., George A. et al. (1993) Efficacy of Phenelzine and Haloperidol in Borderline Personality Disorder. Arch. Gen. Psychiatry, 50: 377–385.PubMedCrossRefGoogle Scholar
  46. Stein G. (1992) Drug Treatment of the Personality Disorders. Br. J. Psychiatry, 161: 167–184.PubMedCrossRefGoogle Scholar
  47. Thase M.E., Trivedi M.H., and Rush A.J. (1995) MAOIs in the contemporary treatment of depression. Neuropsychopharmacology, 12: 185–219.PubMedCrossRefGoogle Scholar
  48. Thiel A., Nau R., Lehmann K. et al. (1993) Intoxication in Manic Patients Following Chaotic Self Administration of Lithium. Acta Psychiatr. Scand., 88: 289–291.PubMedCrossRefGoogle Scholar
  49. Tunks E.R. and Dermer S.W. (1977) Carbamazepine in the dyscontrol syndrome associated with limbic dysfunction. J. Nerv. Ment. Dis., 164: 56–63.PubMedCrossRefGoogle Scholar
  50. Tupin J.P., Smith D.B., Clanon T.L. et al. (1973) The long-term use of lithium in aggressive prisoners. Comprehensive Psychiatry, 14: 311–317.PubMedCrossRefGoogle Scholar
  51. Vanputten T., Marder S.R., and Mintz J. (1990) A Controlled Dose Comparison of Haloperidol in Newly Admitted Schizophrenic Patients. Arch. Gen. Psychiatry, 47: 754–758.CrossRefGoogle Scholar
  52. Vanputten T., Marder S.R., Mintz J. et al. (1992) Haloperidol Plasma Levels and Clinical Response—A Therapeutic Window Relationship. Am. J. Psychiatry, 149: 500–505.Google Scholar
  53. Wickham E.A. and Reed J.V. (1987) Lithium for the control of aggressive and self-mutilating behaviour. Int. Clin. Psychopharmacol., 2: 181–190.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Peter Moleman
    • 1
  • Karin van Dam
    • 2
  • Veron Dings
    • 2
  1. 1.Moleman Research BVAmerongenThe Netherlands
  2. 2.Afdeling Klinische Psychologie en PersoonlijkheidsleerKatholieke Universiteit NijmegenNijmegenThe Netherlands

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