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21 - Recent Developments in the Pharmacologic Management of Personality Disorders

from Part V - Treatment

Published online by Cambridge University Press:  24 February 2020

By
Paul S. Links ,
Philippe Boursiquot  and
Madison Links
Edited by
Carl W. Lejuez  and
Kim L. Gratz
Carl W. Lejuez
Affiliation:
University of Kansas
Kim L. Gratz
Affiliation:
University of Toledo, Ohio
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Summary

Pharmacological management of personality disorders (PD) is controversial and some guidelines state medications are not to be used. Yet prescribing medications is endemic in practice. This chapter reviews recent evidence regarding the use of medication for PD patients; and novel approaches highlighting possible neuropathological mechanisms and a clinical approach to psychopharmacological management.

Keywords

personality disordersborderline personality disorderpharmacologypharmacotherapydrugsmedicationsantidepressantsanti-convulsantsanti-psychoticsanxiolyticsemotionally unstable personality disorder
Type
Chapter
Information
The Cambridge Handbook of Personality Disorders , pp. 504 - 513
Publisher: Cambridge University Press
Print publication year: 2020

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References

Alcorn, J. L., Rathnayaka, N., Swann, A. C., Moeller, F. G., & Lane, S. D. (2015). Effects of intranasal oxytocin on aggressive responding in antisocial personality disorder. The Psychological Record, 65(4), 691–703.Google Scholar
Amad, A., Thomas, P., & Perez-Rodriguez, M. M. (2015). Borderline personality disorder and oxytocin: Review of clinical trials and future directions. Current Pharmaceutical Design, 21. doi:10.2174/1381612821666150619093019CrossRefGoogle ScholarPubMed
American Psychiatric Association. (2001). Practice guideline for the treatment of patients with borderline personality disorder. American Journal of Psychiatry, 158, 1–52.Google Scholar
Arbabi, M., Hafizi, S., Ansari, S., Oghabian, M. A., & Hasani, N. (2013). High frequency TMS for the management of borderline personality disorder: A case report. Asian Journal of Psychiatry, 6(6), 614–617.Google Scholar
Bateman, A., Gunderson, J., & Mulder, R. (2015). Treatment of personality disorder. Lancet, 385(9969), 735–743.Google Scholar
Bellino, S., Paradiso, E., Bozzatello, P., & Bogetto, F. (2010). Efficacy and tolerability of duloxetine in the treatment of patients with borderline personality disorder: A pilot study. Journal of Psychopharmacology, 24, 333–339.Google Scholar
Beri, A., & Boydell, J. (2014). Clozapine in borderline personality disorder: A review of the evidence. Annals of Clinical Psychiatry, 26, 139–144.Google ScholarPubMed
Black, D. W., Zanarini, M. C., Romine, A., Shaw, M., Allen, J., & Schulz, S. C. (2014). Comparison of low and moderate dosages of extended-release quetiapine in borderline personality disorder: A randomized, double-blind, placebo-controlled trial. American Journal of Psychiatry, 171(11), 1174–1182.Google Scholar
Cailhol, L., Roussignol, B., Klein, R., Bousquet, B., Simonetta-Moreau, M., Schmitt, L., … Birmes, P. (2014). Borderline personality disorder and rTMS: A pilot study. Psychiatry Research, 216, 155–157.CrossRefGoogle Scholar
Crawford, M. J., Kakad, S., Rendel, C., Mansour, N. A., Crugel, M., Liu, K. W., … Barnes, T. R. (2011). Medication prescribed to people with personality disorders: The influence of patient factors and treatment setting. Acta Psychiatrica Scandinavica, 124(5), 396–402.Google Scholar
Crawford, M. J., Sanatinia, R., Barrett, B., Cunningham, G., Dale, O., Ganguli, P., Lawrence-Smith, G., Leeson, V.C., Lemonsky, F., Lykomitrou-Matthews, G., Montgomery, A.A., Morriss, R., Munjiza, J., Paton, C., Skorodzien, I., Singh, V., Tan, W., Tyrer, P., & Reilly, J. G. (2018). Lamotrigine for people with borderline personality disorder: a RCT. Health Technology Assessment (Winchester, England), 22(17), 1–68. https://doi.org/10.3310/hta22170.Google Scholar
Deckman, T., DeWall, C. N., Way, B., Gilman, R., & Richman, S. (2014). Can marijuana reduce social pain? Social Psychological and Personality Science, 5(2), 131–139.CrossRefGoogle Scholar
Deltito, J. A., & Stam, M. (1989). Psychopharmacological treatment of avoidant personality disorder. Comprehensive Psychiatry, 30(6), 498–504.CrossRefGoogle ScholarPubMed
DeWall, C. N., MacDonald, G., Webster, G. D., Masten, C. L., Baumeister, R. F., Powell, C., … Eisenberger, N. I. (2010). Acetaminophen reduces social pain: Behavioral and neural evidence. Psychological Science, 21(7), 931–937.CrossRefGoogle ScholarPubMed
Dixon-Gordon, K. L., Conkey, L. C., & Whalen, D. J. (2018). Recent advances in understanding physical health problems in personality disorders. Current Opinion in Psychology, 21, 1–5.Google Scholar
Feffer, K., Peters, S. K., Bhui, K., Downar, J., & Giacobbe, P. (2017). Successful dorsomedial prefrontal rTMS for major depression in borderline personality disorder: Three cases. Brian Stimulation, 10, 716–717.Google Scholar
Golubchik, P., Sever, J., Zalsman, G., & Weizman, A. (2008). Methylphenidate in the treatment of female adolescents with cooccurrence of attention deficit/hyperactivity disorder and borderline personality disorder: A preliminary open-label trial. International Clinical Psychopharmacology, 23(4), 228–231.Google Scholar
Gunderson, J. G. (2001). Borderline Personality Disorder: A Clinical Guide. Washington, DC: American Psychiatric Publishing.Google Scholar
Gunderson, J. G., & Links, P. S. (2014). Handbook of Good Psychiatric Management for Borderline Personality Disorder. Washington, DC: American Psychiatric Publishing.Google Scholar
Hancock-Johnson, E., Griffiths, C., & Picchioni, M. (2017). A focused systematic review of pharmacologic treatment for borderline personality disorder. CNS Drugs, 31, 345–356.Google Scholar
Herpertz, S. C., Zanarini, M., Schulz, C. S., Siever, L., Lieb, K., Möller, H., … WFSBP Task Force on Personality Disorders (2007). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Personality Disorders. The World Journal of Biological Psychiatry, 8(4), 212–244.Google Scholar
Ingenhoven, T., Lafay, P., Rinne, T., Passchier, J., & Duivenvoorden, H. (2010). Effectiveness of pharmacotherapy for severe personality disorders: Meta-analyses of randomized controlled trials. Journal of Clinical Psychiatry, 71(1), 14–25.Google Scholar
Koenigsberg, H. W., Reynolds, D., Goodman, M., New, A. S., Mitropoulou, V., Trestman, R. L., … Siever, L. J., (2003). Risperidone in the treatment of schizotypal personality disorder. Journal of Clinical Psychiatry, 64, 628–634.Google Scholar
Lieb, K., Völlm, B., Rücker, G., Timmer, A., & Stoffers, J. M. (2010). Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials. British Journal of Psychiatry, 196, 4–12.Google Scholar
Mazza, M., Marano, G., & Janiri, L. (2016). An update on pharmacotherapy for personality disorders. Expert Opinion on Pharmacotherapy, 17(15), 1977–1979.Google Scholar
McClure, M. M., Harvey, P. D., Goodman, M., Triebwasser, J., New, A., Koenigsberg, H. W., … Siever, L. J. (2010). Pergolide treatment of cognitive deficits associated with schizotypal personality disorder: Continued evidence of the importance of the dopamine system in the schizophrenia spectrum. Neuropsychopharmacology, 35(6), 1356–1362.CrossRefGoogle ScholarPubMed
McMain, S. F., Links, P. S., Gnam, W. H., Guimond, T., Cardish, R. J., Korman, L., & Streiner, D. L. (2009). A randomized trial of dialectical behavior therapy versus general psychiatric management for borderline personality disorder. American Journal of Psychiatry, 166(12), 1365–1374.CrossRefGoogle ScholarPubMed
Mercer, D., Douglass, A. B., & Links, P. S. (2009). Meta-analyses of mood stabilizers, antidepressants and antipsychotics in the treatment of borderline personality disorder: Effectiveness for depression and anger symptoms. Journal of Personality Disorders, 23(2), 156–174.Google Scholar
Moghaddas, A., Dianatkhah, M., Ghaffari, S., & Ghaeli, P. (2017). The potential role of naltrexone in borderline personality disorder. Iran Journal of Psychiatry, 12, 142–146.Google Scholar
National Health and Medical Research Council. (2012). Clinical Practice Guideline for the Management of Borderline Personality Disorder. National Health and Medical Research Council, Canberra, Australia.Google Scholar
National Institute for Health and Clinical Excellence. (2015). Borderline Personality Disorder: Recognition and Management. www.nice.org.uk/guidance/cg78/resources/borderline-personality-disorder-recognition-and-management-pdf-975635141317Google Scholar
Nose, N., Cipriani, A., Biancosino, B., Grassi, L., & Barbui, C. (2006). Efficacy of pharmacotherapy against core traits of borderline personality disorder: Meta-analysis of randomized controlled trials. International Clinical Psychopharmacology, 21, 345–353.Google Scholar
Paton, C., Crawford, M. J., Bhatti, S. F., Patel, M. X., & Barnes, T. R. E. (2015). The use of psychotropic medication in patients with emotionally unstable personality disorder under the care of UK Mental Health Services. Journal of Clinical Psychiatry, 76(4), e512–e518.Google Scholar
Prada, P., Nicastro, R., Zimmermann, J., Hasler, R., Aubry, J.-M., & Perroud, N. (2015). Addition of methylphenidate to intensive dialectical behaviour therapy for patients suffering from comorbid borderline personality disorder and ADHD: A naturalistic study. ADHD Attention Deficit and Hyperactivity Disorders, 7(3), 199–209.CrossRefGoogle ScholarPubMed
Reich, D. B., Zanarini, M. C., & Bieri, K. A. (2009). A preliminary study of lamotrigine in the treatment of affective instability in borderline personality disorder. International Clinical Psychopharmacology, 24, 270–275.Google Scholar
Ripoll, L. H., Triebwasser, J., & Siever, L. J. (2011). Evidence-based pharmacotherapy for personality disorders. International Journal of Neuropsychopharmacology, 14(9), 1257–1288.CrossRefGoogle ScholarPubMed
Roberts, I. D., Krajbich, I., Cheavens, J. S., Campo, J. V., & Way, B. M. (2018). Acetaminophen reduces distrust in individuals with borderline personality disorder features. Clinical Psychological Science, 6(1), 145–154.Google Scholar
Roepke, S., Danker-Hopfe, H., Repantis, D., Behnia, B., Bernard, F., Hansen, M.-L., & Otte, C. (2017). Doxazosin, an alpha-1-adrenergic-receptor antagonist for nightmares in patients with posttraumatic stress disorder and/or borderline personality disorder: A chart review. Pharmacopsychiatry, 50, 26–31.Google Scholar
Roepke, S., Merkl, A., Dams, A., Ziegenhorn, A., Anghelescu, I., Heuser, I., & Lammers, C. (2008). Preliminary evidence of improvement of depressive symptoms but not impulsivity in Cluster B personality disorder patients treated with quetiapine: An open label trial. Pharmacopsychiatry, 41, 176–181.Google Scholar
Rogers, B., & Acton, T. (2012). “I think we’re all guinea pigs really”: A qualitative study of medication and borderline personality disorder. Journal of Psychiatric and Mental Health Nursing, 19, 341–347.Google Scholar
Rohde, C., Polcwiartek, C., Correll, C. U., & Nielsen, J. (2017). Real-world effectiveness of clozapine for borderline personality disorder: Results from a 2-year mirror-image study. Journal of Personality Disorders, 31, 1–15.Google Scholar
Shamay-Tsoory, S. G., Fischer, M., Dvash, J., Harari, H., Perach-Bloom, N., & Levkovitz, Y. (2009). Intranasal administration of oxytocin increases envy and schadenfreude (gloating). Biological Psychiatry, 66(9), 864–870.Google Scholar
Silk, K. R. (1996). Rational pharmacotherapy for patients with personality disorders. In Links, P. S. (Ed.), Clinical Assessment and Management of Severe Personality Disorders (pp. 109–142). Washington, DC: American Psychiatric Publishing.Google Scholar
Soloff, P. H. (2000). Psychopharmacology of borderline personality disorder. Psychiatric Clinics of North America, 23, 169–192.Google Scholar
Stoffers, J. M., & Lieb, K. (2015). Pharmacotherapy for borderline personality disorder: Current evidence and recent trends. Current Psychiatry Reports, 17, 534–545.Google Scholar
Yovell, Y., Bar, G., Mashiah, M., Baruch, Y., Briskman, I., Asherov, J., … Panksepp, J. (2016). Ultra-low-dose buprenorphine as a time-limited treatment for severe suicidal ideation: A randomized controlled trial. American Journal of Psychiatry, 173, 491–498.CrossRefGoogle ScholarPubMed
Zanarini, M. C., Frankenberg, F. R., Hennen, J., & Silk, K. R. (2004). Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospective for 6 years. Journal of Clinical Psychiatry, 65, 28–36.Google Scholar
Zanarini, M. C., Frankenberg, F. R., & Parachini, E. A. (2004). A preliminary randomized trial of fluoxetine, olanzapine and the olanzapine-fluoxetine combination in women with borderline personality disorder. Journal of Clinical Psychiatry, 65, 903–907.Google Scholar
Zanarini, M. C., Schulz, S. C., Detke, H. C., Tanaka, Y., Zhao, F., Lin, D., … Corya, S. (2011). A dose comparison of olanzapine for the treatment of borderline personality disorder: A 12-week randomized, doubleblind, placebo-controlled study. Journal of Clinical Psychiatry, 72, 1353–1362.Google Scholar
Zanarini, M. C., Schulz, S., Detke, H., Zhao, F., Lin, D., Pritchard, M., … Corya, S. (2012). Open-label treatment with olanzapine for patients with borderline personality disorder. Journal of Clinical Psychopharmacology, 32, 398–402.Google Scholar

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