Skip to main content
SpringerLink
Log in

Psychopharmacological Treatment of Personality Disorders

A Review

  • Chapter
Treatment of Personality Disorders

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Akiskal H.S., Silva J.A.C.E., Frances A. et al. (1995) Dysthymia in clinical practice. Br. J. Psychiatry, 166: 174–183.

    Article  Google Scholar 

  • Albani E, Riva R., and Baruzzi A. (1995) Carbamazepine clinical pharmacology: A review. Pharmacopsychiatry, 28: 235–244.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Calabrese J.R., Fatemi H., Kujawa M. et al. (1996) Predictors of response to mood stabilizers. J. Clin. Psychopharmacol., 6: S24 - S31.

    Article  Google Scholar 

  • Casey D.E. (1992) What makes a neuroleptic atypical? In: Novel antipsychotic drugs. New York: Raven Press, 241–251.

    Google Scholar 

  • Cole J.O., Salomon M., Gunderson J. et al. (1984) Drug therapy in borderline patients. Comprehensive Psychiatry, 25: 249–254.

    Article  PubMed  CAS  Google Scholar 

  • Collard J. (1979) Pimozide in the treatment of some “social maladjustments” in “personality disorders”. Acta Psychiatrica Belgica, 79: 686–703.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • Cowdry R.W. and Gardner D.L. (1988) Pharmacotherapy of borderline personality disorder; alprazolam, carbamazepine, trifluoperazine, and tranylcypromine. Arch. Gen. Psychiatry, 45: 111–119.

    Article  PubMed  CAS  Google Scholar 

  • Dale P.G. (1980) Lithium therapy in aggressive mentally subnormal patients. Br. J. Psychiatry, 137:469–474.

    Google Scholar 

  • 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 

  • Dulz B., and Schneider A. boek, editor. (1996) Borderline-Störungen; Theorie and Therapie. 2nd: Stuttgart: SchattauerVerlagsgesellschaft; 110.

    Google Scholar 

  • Gitlin M.J. (1993) Pharmacotherapy of Personality Disorders—Conceptual Framework and Clinical Strategies. J Clin. Psychopharmacol., 13: 343–353.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Gunderson J.G., Kolb J.E., and Austin V. (1981) The diagnostic interview for borderline patients. Am. J. Psychiatry, 138: 896–903.

    PubMed  CAS  Google Scholar 

  • Hymowitz P, Frances A., Jacobsberg L.B. et al. (1991) Neuroleptic treatment of schizotypal personality disorders. Comprehensive Psychiatry, 48: 1064–1067.

    Google Scholar 

  • Jensen H.V. and Andersen J. (1989) An open, noncomparative study of amoxapine in borderline disorders. Acta Psychiatr. Scand., 79: 89–93.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • Klein D.F. and Fink M. (1962) Psychiatric reaction patterns to imipramine. Am. J. Psychiatry, 119: 432–438.

    PubMed  CAS  Google Scholar 

  • Leone N.F. (1982) Response of borderline patients to loxapine and chlorpromazine. J. Clin. Psychiatry, 43: 148–150.

    PubMed  CAS  Google Scholar 

  • Links P.S., Steiner M., Boiago I. et al. (1990) Lithium therapy for borderline patients: preliminary findings. Journal of Personality Disorders, 4: 173–181.

    Article  Google Scholar 

  • Lion J.R. (1979) Benzodiazepine in the treatment of aggressive patients. J. Clin. Psychiatry, 40: 70–109.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • Markovitz P.J. and Wagner S.C. (1995) Venlafaxine in the treatment of borderline personality disorder. Psychopharmacol. Bull., 31: 773–777.

    PubMed  CAS  Google Scholar 

  • Mattes J.A. (1984) Carbamazepine for uncontrolled rage outbursts. Lancet, 11: 1164–1165.

    Article  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Moleman P. (1992) Praktische Psychopharmacologie. 2nd: Houten: Bohn Stafleu van Loghem.

    Google Scholar 

  • Montgomery S.A. and Montgomery D. (1982) Pharmacolgical prevention of suicidal behaviour. J. Affective Disord., 4: 291–298.

    Article  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • New A.S., Trestman R.L., and Siever L.J. (1994) The pharmacotherapy of borderline personality disorder. CNS Drugs, 2: 347–354.

    Article  Google Scholar 

  • Norden M.J. (1989) Fluoxetine in borderline personality disorder. Progr. Neuro-Psychopharmacology & Biological Psychiatry, 13: 885–893.

    Article  CAS  Google Scholar 

  • 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.

    PubMed  Google Scholar 

  • 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 

  • Reyntjens A.M. (1972) A series of multicentre trials with pimozide in psychiatric practice. Acta Psychiatrica Belgica, 72: 30–36.

    Google Scholar 

  • Rifkin A., Quitkin F., and Carillo C. (1972) Lithium carbonate in emotionally unstable character disorder. Arch. Gen. Psychiatry, 27: 519–523.

    Article  PubMed  CAS  Google Scholar 

  • Rosenberg R. (1994) Borderline States—Pharmacotherapy and Psychobiology of Personality—A Discussion of Soloffs Article. Acta Psychiatr. Scand., 89: 56–60.

    Article  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • 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.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Soloff P.H., Anselm G., Nathan S. et al. (1986) Paradoxical effects of amitriptyline on borderline patients. Am. J. Psychiatry, 143: 1603–1605.

    PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Stein G. (1992) Drug Treatment of the Personality Disorders. Br. J. Psychiatry, 161: 167–184.

    Article  PubMed  CAS  Google Scholar 

  • Thase M.E., Trivedi M.H., and Rush A.J. (1995) MAOIs in the contemporary treatment of depression. Neuropsychopharmacology, 12: 185–219.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • Tunks E.R. and Dermer S.W. (1977) Carbamazepine in the dyscontrol syndrome associated with limbic dysfunction. J. Nerv. Ment. Dis., 164: 56–63.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  PubMed  CAS  Google Scholar 

  • 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.

    Article  CAS  Google Scholar 

  • 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.

    CAS  Google Scholar 

  • Wickham E.A. and Reed J.V. (1987) Lithium for the control of aggressive and self-mutilating behaviour. Int. Clin. Psychopharmacol., 2: 181–190.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Moleman Research BV, Burg. Jhr. H. v.d. Boschstraat 11, 3958 CA, Amerongen, The Netherlands

    Peter Moleman

  2. Afdeling Klinische Psychologie en Persoonlijkheidsleer, Katholieke Universiteit Nijmegen, Nijmegen, The Netherlands

    Karin van Dam & Veron Dings

Authors
  1. Peter Moleman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Karin van Dam
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Veron Dings
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. University of Nijmegen, Nijmegen, The Netherlands

    Jan Derksen

  2. Free University of Brussels, Brussels, Belgium

    Jan Derksen

  3. Vita-Salute San Raffaele University and Scientific Institute San Raffaele, Milan, Italy

    Cesare Maffei

  4. Forensic Psychiatric Institute “Oldenkotte”, Rekker, The Netherlands

    Herman Groen

Rights and permissions

Reprints and permissions

Copyright information

© 1999 Springer Science+Business Media New York

About this chapter

Cite this chapter

Moleman, P., van Dam, K., Dings, V. (1999). Psychopharmacological Treatment of Personality Disorders. In: Derksen, J., Maffei, C., Groen, H. (eds) Treatment of Personality Disorders. Springer, Boston, MA. https://doi.org/10.1007/978-1-4757-6876-3_15

Download citation

  • DOI: https://doi.org/10.1007/978-1-4757-6876-3_15

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4419-3326-3

  • Online ISBN: 978-1-4757-6876-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation