Which drugs can be used for Borderline Personality Disorder (BPD)

* Quetiapine: In a recent 8-week RCT, the investigators compared the efficacy of quetiapine sustained release 150 mg, quetiapine sustained release 300 mg and placebo for 95 adult BPD patients. The results showed that the interpersonal relationship, affective, anger and cognitive problems of quinolipine sustained-release 150mg group were significantly improved, the main outcome index was -0.79, while in the event of impulsivity, depression, general psychosis In the case of schizophrenia, quetiapine was not significantly superior to placebo. There was no significant difference between the moderate dose quetiapine group and placebo (d = 20.41, P = .265).

(ADA) has a total of 9 RCTs to explore the efficacy of olanzapine for BPD, of which 6 for the placebo-controlled study, the other three of the control drug (APA2014) quetiapine XR can be effective in the treatment of BPD) Respectively, haloperidol, sertraline and fluoxetine / amfhf mixture, treatment time from 12 weeks to 6 months, individual research by the olanzapine manufacturer Lilly to sponsor the company.

In placebo-controlled studies, olanzapine significantly improved emotional instability, anger, psychotic paranoid symptoms, and anxiety. Among them, two studies show that olanzapine can reduce the degree of recurrent suicidal ideation. When compared with fluoxetine and haloperidol, olanzapine did not show significant advantages in any disease-related outcome. Compared with sertraline, olanzapine in improving anxiety, aggressive, paranoid symptoms and self-mutilation has advantages. In addition, compared with olanzapine or fluoxetine alone, there was no significant advantage in the combination.

Antipsychotics: Summary

Antipsychotics, olanzapine’s supportive evidence is most adequate: studies have shown that the drug can significantly reduce the anger, paranoia, anxiety and interpersonal sensitivity of BPD patients. In addition, aripiprazole also helps to improve impulsivity, anger, anxiety, psychosis and interpersonal sensitivity. In the case of classical antipsychotics, haloperidol significantly improves the anger symptoms of BPD patients and reduces the suicidal behavior of alfloxacin, both of which are statistically significant.

other

* Omega-3 Fatty Acids: In a 8-week, double-blind, placebo-controlled study, the researchers compared e-eicosapentaenoic acid (E-EPA) 1 g / d versus placebo to 30 women with BPD Efficacy. The results showed that E-EPA significantly reduced the patient’s aggressive behavior and depressive symptoms (SMD, -0.346); another 12-week RCT showed that EPA (1.2 g / d) was used in combination with standard psychiatric treatment Dichenohexaenoic acid (DHA, 0.9g / d) can significantly improve the depressive symptoms, suicidal tendencies and response to daily stress in BPD patients.

A study of 15 young patients with BPD who also met the high risk criteria for psychosis showed that compared with placebo, 1.2 g / d of EPA significantly improved the functional level of these subjects and relieved psychiatric symptoms (SMD, -1.516 ). A further 12-week study showed that EPA and DHA alone could significantly reduce the patient’s specific BPD symptoms, including impulse control problems (SMD, -1.6343), anger compared to valproic acid alone Outbreak (SMD, -1.7843) and self-mutilation behavior.

* Naltrexone (opioid antagonist): Two small-scale (25 subjects) double-blind placebo-controlled study compared the efficacy of naltrexone 50 mg / d or 200 mg / d to relieve BPD-related symptoms. Both studies have shown that naltrexone has a numerical advantage in improving symptom intensity and duration compared to placebo; however, the results are not statistically significant due to the small sample size.

* Clonidine (α2 receptor agonist): In a randomized, double-blind, placebo-controlled cross-study, the investigators attempted to investigate whether oral clonidine 450 mg / d could help reduce hyperarousal symptoms in BPD patients The 18 patients with BPD who had a significantly high awakening performance had a co-morbid or co-diseased PTSD. The physician-assessed PTSD scale showed that clonidine was significantly lower in patients with both PTSD and PTSD High awakening symptoms (18%, P = .003).

* Emotional symptoms: topiramate, lamotrigine, dipropionate, haloperidol, aripiprazole, olanzapine, quetiapine sustained release, omega-3 fatty acids and amitriptyline Gains; * impulse control problems: topiramate, lamotrigine, aripiprazole and omega-3 fatty acids may be effective; * psychotic symptoms: aripiprazole, olanzapine and quetiapine sustained release.

There is also some evidence that aripiprazole, dipropionate and topiramate or help to improve the interpersonal relationship between BPD patients; omega-3 fatty acids show the potential to reduce suicidal tendencies in patients with BPD.

Conclusion

The mainstay of BPD therapy is still psychotherapy; drug therapy can be used as a means of stabilizing symptoms and behavior in emergencies. There is overlap between the effects of different drugs on BPD, and multidrug treatment should be avoided as much as possible. Next, larger and longer RCTs are needed to test the efficacy of BPD drug therapy.

Title: Francois D, Roth S D, Klingman D. The Efficacy of Pharmacotherapy for Borderline Personality Disorder: A Review of the Available Randomized Controlled Trials [J]. Psychiatric Annals, 2015, 45 (8): 431-437.

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