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This is the full Cochrane systematic review of the pharmacotherapy of BPD. It is a fascinating and thoroughly detailed document, but it may be easier to digest in the more condensed version by Lieb et al. [29••]
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•• Stoffers J, Völlm BA, Rücker G, et al.: Pharmacological interventions for borderline personality disorder. Cochrane Database Syst Rev. 2010, 6:CD005653. This is the full Cochrane systematic review of the pharmacotherapy of BPD. It is a fascinating and thoroughly detailed document, but it may be easier to digest in the more condensed version by Lieb et al. [29••].
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•• National Institute for Health and Clinical Excellence (NICE). Borderline Personality Disorder, Treatment and Management. London: The British Psychological Society and The Royal College of Psychiatrists. Available at http://www.nice.org.uk/CG78. Accessed May 1, 2010. As part of the NICE Guideline, this is a thorough review of the psychopharmacologic treatment of BPD. The authors are fairly negative about the usefulness of pharmacologic treatment, but they do give, in the fuller version, guidelines on psychopharmacologic treatment and many details as to how they evaluated the existing literature.
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Borderline Personality Disorder, Treatment and Management
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DOI 10.1176/appi.ajp.158.1.1
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American Psychiatric Association 2001 Practice Guideline for the Treatment of Patients with Borderline Personality Disorder Am J Psychiatry 158 1 52 10.1176/appi.ajp.158.1.1 (Pubitemid 32047238)
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Gabbard, G.O.1
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57449115534
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Olanzapine for the treatment of borderline personality disorder: Variable dose 12-week randomised double-blind placebo-controlled study
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This is the largest clinical trial in terms of numbers of participants of BPD pharmacotherapy ever conducted. Unfortunately, the results are not impressive
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• Schulz SC, Zanarini MC, Bateman A, et. al.: Olanzapine for the treatment of borderline personality disorder: variable dose 12-week randomised double-blind placebo-controlled study. Br J Psychiatry 2008, 193:485-492. This is the largest clinical trial in terms of numbers of participants of BPD pharmacotherapy ever conducted. Unfortunately, the results are not impressive.
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Br J Psychiatry
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Schulz, S.C.1
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Olanzapine plus dialectical behavior therapy for women with high irritability who meet criteria for borderline personality disorder: A double-blind, placebo-controlled pilot study
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This study combined dialectical behavioral therapy plus medication or placebo. It re-creates clinical reality, in which most patients receive pharmacotherapy as well as psychosocial (psychotherapeutic) treatment. Both groups improved, and the active medication group improved more (but not significantly more) quickly
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• Linehan MM, McDavid JD, Brown MZ, et al.: Olanzapine plus dialectical behavior therapy for women with high irritability who meet criteria for borderline personality disorder: a double-blind, placebo-controlled pilot study. J Clin Psychiatry 2008, 69:999-1005. This study combined dialectical behavioral therapy plus medication or placebo. It re-creates clinical reality, in which most patients receive pharmacotherapy as well as psychosocial (psychotherapeutic) treatment. Both groups improved, and the active medication group improved more (but not significantly more) quickly.
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J Clin Psychiatry
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Linehan, M.M.1
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Olanzapine versus haloperidol in the management of borderline personality disorder: A randomized double-blind trial
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SS Shafti B Shahveisi 2010 Olanzapine versus haloperidol in the management of borderline personality disorder: a randomized double-blind trial J Clin Psychopharm 30 44 47 1:CAS:528:DC%2BC3cXlvFalsA%3D%3D 10.1097/JCP. 0b013e3181c826ff
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44849135999
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Ziprasidone in the treatment of borderline personality disorder: A double-blind, placebo-controlled, randomized study
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This is a negative study for an atypical antipsychotic. The only solidly positive RCT for an atypical antipsychotic is with aripiprazole (Nickel et al. [44]), with some contradictory evidence for olanzapine
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• Pascual JC, Soler J, Puigdemont D, et al.: Ziprasidone in the treatment of borderline personality disorder: a double-blind, placebo-controlled, randomized study. J Clin Psychiatry 2008, 69:603-608. This is a negative study for an atypical antipsychotic. The only solidly positive RCT for an atypical antipsychotic is with aripiprazole (Nickel et al. [44]), with some contradictory evidence for olanzapine.
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Pascual, J.C.1
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Loew TH, Nickel MK, Muehlbacher M, et. al.: Topiramate treatment for women with borderline personality disorder: a double-blind, placebo-controlled study. J Clin Psychopharm 2006, 26:61-66. (Pubitemid 43167093)
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Loew, T.H.1
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Kaplan, P.4
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Fartacek, R.7
Lahmann, C.8
Buschmann, W.9
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Mitterlehner, F.12
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13
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39649119092
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Treatment of aggression with topiramate in male borderline patients, part II: 18-month follow-up
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This study complements this group's previous study showing the effectiveness of topiramate in women
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• Nickel MK, Loew TH: Treatment of aggression with topiramate in male borderline patients, part II: 18-month follow-up. Eur Psychiatry 2008, 23:115-117. This study complements this group's previous study showing the effectiveness of topiramate in women.
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Nickel, M.K.1
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14
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69549091810
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A preliminary study of lamotrigine in the treatment of affective instability in borderline personality disorder
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This is another study that supports the effectiveness of mood stabilizers in the BPD population
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• Reich DB, Zanarini MC, Bieri KA: A preliminary study of lamotrigine in the treatment of affective instability in borderline personality disorder. Int Clin Psychopharm 2009, 24:270-275. This is another study that supports the effectiveness of mood stabilizers in the BPD population.
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Reich, D.B.1
Zanarini, M.C.2
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15
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67649331672
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This is an intriguing study that revealed the effectiveness of clonidine. However, the effectiveness seemed restricted to patients who also had comorbid PTSD
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• Ziegenhorn AA, Roepke S, Schommer NC, et.al. : Clonidine improves hyperarousal in borderline personality disorder with or without comorbid posttraumatic stress disorder: a randomized, double-blind, placebo-controlled trial. J Clin Psychopharma 2009, 29:170-173. This is an intriguing study that revealed the effectiveness of clonidine. However, the effectiveness seemed restricted to patients who also had comorbid PTSD.
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J Clin Psychopharma
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Ziegenhorn, A.A.1
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MC Zanarini AA Vujanovic EA Parachini, et al. 2003 Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD): a continuous measure of DSM-IV borderline psychopathology J Personal Disord 17 233 142 10.1521/pedi.17.3.233. 22147 (Pubitemid 36741563)
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George Nurnberg H: Olanzapine versus placebo in the treatment of borderline personality disorder
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MP Bogenschutz 2004 George Nurnberg H: Olanzapine versus placebo in the treatment of borderline personality disorder J Clin Psychiatry 65 104 109 1:CAS:528:DC%2BD2cXhs12qsbs%3D 10.4088/JCP.v65n0118 14744178
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S Bellino E Paradiso F Bogetto 2006 Efficacy and tolerability of quetiapine in the treatment of borderline personality disorder: A pilot study J Clin Psychiatry 67 1042 1046 1:CAS:528:DC%2BD28XoslGis7g%3D 10.4088/JCP.v67n0705 16889446
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FM Quitkin 1999 Placebos, drug effects, and study design: a clinician's guide Am J Psychiatry 156 829 836 1:STN:280:DyaK1M3ovVeqsw%3D%3D 10360119
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24
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Adaptation of interpersonal psychotherapy to borderline personality disorder: A comparison of combined therapy and single pharmacotherapy
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This is another study (though open-label) exploring the effectiveness of combined psychotherapy and psychopharmacology. Length of treatment seemed to be the most important variable related to improvement.
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• Bellino S, Rinaldi C, Bogetto F: Adaptation of interpersonal psychotherapy to borderline personality disorder: a comparison of combined therapy and single pharmacotherapy Can J Psychiatry 2010, 55:74-81. This is another study (though open-label) exploring the effectiveness of combined psychotherapy and psychopharmacology. Length of treatment seemed to be the most important variable related to improvement.
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Can J Psychiatry
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A Arntz M van den Hoorn J Cornelis, et al. 2003 Reliability and validity of the borderline personality disorder severity index J Person Disord 17 45 59 10.1521/pedi.17.1.45.24053 (Pubitemid 36343239)
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CA Binks M Fenton L McCarthy, et al. 2006 Pharmacological interventions for people with borderline personality disorder Cochrane Database Syst Rev 25 CD005653
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This is the shorter, more concise, more accessible version of the Cochrane review (Stoffers et al. [5••])
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•• Lieb K, Völlm B, Rücker G, et al.: Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials. Br J Psychiatry 2010, 196:4-12. This is the shorter, more concise, more accessible version of the Cochrane review (Stoffers et al. [5••]).
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PF Abraham JR Calabrese 2008 Evidenced-based pharmacologic treatment of borderline personality disorder: a shift from SSRIs to anticonvulsants and atypical antipsychotics? J Affect Disord 111 21 30 1:CAS:528:DC%2BD1cXhtFylsrrJ 10.1016/j.jad.2008.01.024 18304647
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Meta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: Effectiveness for depression and anger symptoms
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This is an excellent meta-analysis that limited itself to studying the outcomes for depression and anger symptoms. Mood stabilizers had the largest effect on anger, with a moderate effect on depression. Antidepressants had a moderate effect on anger but only a small effect on depression. Antipsychotics (particularly aripiprazole) had a moderate effect on anger but no effect on depression. It is worth comparing these results with those of Ingenhoven et al. [35•]
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•• Mercer D, Douglass AB, Links PS: Meta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: effectiveness for depression and anger symptoms. J Personal Disord 2009, 23:156-174. This is an excellent meta-analysis that limited itself to studying the outcomes for depression and anger symptoms. Mood stabilizers had the largest effect on anger, with a moderate effect on depression. Antidepressants had a moderate effect on anger but only a small effect on depression. Antipsychotics (particularly aripiprazole) had a moderate effect on anger but no effect on depression. It is worth comparing these results with those of Ingenhoven et al. [35•].
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J Personal Disord
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Effectiveness of pharmacotherapy for severe personality disorders: Meta-analyses of randomized controlled trials
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This excellent meta-analysis found that antipsychotics have a moderate effect on cognitive-perceptual symptoms and a moderate to large effect on anger, while antidepressants have no significant effect on impulsivity or depressed mood but a small effect on anxiety and anger. Mood stabilizers had a very large effect on impulsivity, a large effect on anxiety, and a moderate effect on depressed mood. This study provides support for mood stabilizer use in BPD patients, and it is worth comparing and contrasting it with the Mercer et al. [33••] meta-analysis
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• Ingenhoven T, Lafay P, Rinne T, et al.: Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials. J Clin Psychiatry 2010, 71:14-25. This excellent meta-analysis found that antipsychotics have a moderate effect on cognitive-perceptual symptoms and a moderate to large effect on anger, while antidepressants have no significant effect on impulsivity or depressed mood but a small effect on anxiety and anger. Mood stabilizers had a very large effect on impulsivity, a large effect on anxiety, and a moderate effect on depressed mood. This study provides support for mood stabilizer use in BPD patients, and it is worth comparing and contrasting it with the Mercer et al. [33••] meta-analysis.
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36
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Psychopharmacological treatment in borderline personality disorder
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This is a very thorough review that proposes updated algorithms for the pharmacologic treatment of the following temperamental dimensions found in BPD: impulsivity-aggression, emotion instability, cognitive-perceptual distortions, and anxiety-inhibition. It is in English
-
• Díaz-Marsá M, González Bardanca S, Tajima K, et al.: Psychopharmacological treatment in borderline personality disorder. Actas Esp Psiquiat.2008, 36:39-49. This is a very thorough review that proposes updated algorithms for the pharmacologic treatment of the following temperamental dimensions found in BPD: impulsivity-aggression, emotion instability, cognitive-perceptual distortions, and anxiety-inhibition. It is in English.
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