scholarly journals Second-generation antipsychotic use in borderline personality disorder: What are we targeting?

2016 ◽  
Vol 6 (2) ◽  
pp. 82-88 ◽  
Author(s):  
Adrian Wasylyshen ◽  
Andrew M. Williams
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Literature Review ◽  
Strong Evidence ◽  
Second Generation ◽  
Borderline Personality ◽  
Off Label ◽  
Potential Target ◽  
Second Generation Antipsychotics ◽  
Second Generation Antipsychotic

Abstract Introduction: Borderline personality disorder (BPD) is a personality disorder plagued with high rates of psychotropic polypharmacy. Estimates show that second-generation antipsychotics (SGAs) are used in most of these patients; however, they are being prescribed off label. Methods: A literature review was conducted via PubMed in search for studies evaluating SGA use in BPD. Results: There are available data investigating 8 of 11 SGAs and their use in BPD. Of N = 269 potential articles, N = 34 evaluating the use of SGAs in BPD were included. Discussion: Strong evidence supporting SGAs in BPD is lacking. Potential target symptoms in which a SGA may be useful include depression, anxiety, anger, impulsivity, and paranoia/dissociative behavior.

Off-Label Use of Second-Generation Antipsychotics in Borderline Personality Disorder: A Survey of Italian Psychiatrists

2019 ◽  
pp. 1-15 ◽  
Author(s):  
Andrea Aguglia ◽  
Gianluca Serafini ◽  
Jacopo Nebbia ◽  
Virginio Salvi ◽  
Giovanni Martinotti ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Second Generation ◽  
Borderline Personality ◽  
Published Data ◽  
Off Label Use ◽  
Off Label ◽  
Second Generation Antipsychotics ◽  
Label Use

The guidelines for borderline personality disorder (BPD) treatment suggest non-pharmacological treatment as the first option, but second-generation antipsychotics (SGAs) are among the overprescribed medications. This study aimed to explore Italian psychiatrists’ attitudes toward off-label use of SGAs in BPD. A randomly selected sample of Italian psychiatrists completed a questionnaire regarding off-label prescription of SGAs. Most respondents reported the off-label use of SGAs. Among the reasons supporting the prescription of SGAs, the presence of strong published data was the most determining factor (51.5%). The SGA olanzapine is considered the most appropriate, followed by quetiapine and aripiprazole. Although off-label prescription of SGAs represents a common clinical practice in accordance with a worldwide trend, the use of long-acting injection formulations was considered inappropriate by 69% of psychiatrists in our sample. Our results reiterate the discrepancy between everyday clinical practice and international recommendations, and show how relevant the literature is in off-label drug prescription.

Off-label use of second-generation antipsychotics in borderline personality disorder

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Juan Antonio García-Carmona ◽  
Jorge Simal-Aguado ◽  
María Pilar Campos-Navarro ◽  
Francisco Valdivia-Muñoz ◽  
Alejandro Galindo-Tovar
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Second Generation ◽  
Borderline Personality ◽  
Off Label Use ◽  
Off Label ◽  
Second Generation Antipsychotics ◽  
Label Use

scholarly journals Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials

2010 ◽  
Vol 196 (1) ◽  
pp. 4-12 ◽  
Author(s):  
Klaus Lieb ◽  
Birgit Völlm ◽  
Gerta Rücker ◽  
Antje Timmer ◽  
Jutta M. Stoffers
Keyword(s):  
Systematic Review ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Drug Treatment ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Second Generation ◽  
Borderline Personality ◽  
Current Evidence ◽  
Second Generation Antipsychotics ◽  
Core Symptoms

BackgroundMany patients with borderline personality disorder receive pharmacological treatment, but there is uncertainty about the usefulness of such therapies.AimsTo evaluate the evidence of effectiveness of pharmacotherapy in treating different facets of the psychopathology of borderline personality disorder.MethodA Cochrane Collaboration systematic review and meta-analysis of randomised comparisons of drug v. placebo, drug v. drug, or single drug v. combined drug treatment in adult patients with borderline personality disorder was conducted. Primary outcomes were overall disorder severity as well as specific core symptoms. Secondary outcomes comprised associated psychiatric pathology and drug tolerability.ResultsTwenty-seven trials were included in which first- and second-generation antipsychotics, mood stabilisers, antidepressants and omega-3 fatty acids were tested. Most beneficial effects were found for the mood stabilisers topiramate, lamotrigine and valproate semisodium, and the second-generation antipsychotics aripiprazole and olanzapine. However, the robustness of findings is low, since they are based mostly on single, small studies. Selective serotonin reuptake inhibitors so far lack high-level evidence of effectiveness.ConclusionsThe current evidence from randomised controlled trials suggests that drug treatment, especially with mood stabilisers and second-generation antipsychotics, may be effective for treating a number of core symptoms and associated psychopathology, but the evidence does not currently support effectiveness for overall severity of borderline personality disorder. Pharmacotherapy should therefore be targeted at specific symptoms.

Psychopharmacological Treatment of Personality Disorders

2015 ◽  
Author(s):  
M. Mercedes Perez-Rodriguez ◽  
Larry J. Siever
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Borderline Personality ◽  
Mood Stabilizers ◽  
Omega 3 ◽  
Psychopharmacological Treatment ◽  
Limited Effectiveness ◽  
Second Generation Antipsychotics

Despite the lack of approval by the U.S. Food & Drug Administration, drugs are used widely to treat personality disorders, particularly borderline personality disorder, based on their effects known from clinical trials in other psychiatric disorders (off-label use). The role of medications in personality disorders is limited to moderate effects on some but not all of the symptom domains. There are no medications available that improve the global severity of any personality disorder as a whole. In borderline personality disorder, evidence is strongest for second-generation antipsychotics and mood stabilizers, while dietary supplements like omega-3 fatty acids hold some promise. However, medications have limited effectiveness and are still viewed as adjunctive to other forms of treatment, particularly psychotherapy.

Current Clinical Psychopharmacology in Borderline Personality Disorder

2021 ◽  
Vol 19 ◽  
Author(s):  
Antonio Del Casale ◽  
Luca Bonanni ◽  
Paride Bargagna ◽  
Francesco Novelli ◽  
Federica Fiaschè ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Clinical Psychopharmacology ◽  
Treatment Strategies ◽  
Borderline Personality ◽  
Global Functioning ◽  
Comprehensive Overview ◽  
Pubmed Database ◽  
Second Generation Antipsychotics ◽  
Core Symptoms

Background: Patients with Borderline Personality Disorder (BPD) manifest affective and behavioural symptoms causing personal distress, relationship difficulties, and reduced quality of life with global functioning impairment, mainly when the disease takes an unfavourable course. A substantial amount of healthcare costs is dedicated to addressing these issues. Many BPD patients receive medications, mostly those who do not respond to psychological interventions. Objective: Our aim was to assess the efficacy of the most used strategies of pharmacological interventions in BPD with a comprehensive overview of the field. Methods: We searched the PubMed database for papers focused on the most used psychotropic drugs for BPD. We included randomized controlled trials and open studies in adult patients with BPD, focusing on the efficacy and tolerability of single classes of drugs with respect to specific clinical presentations that may occur during the course of BPD. Results: Specific second-generation antipsychotics (SGAs) and/or serotonergic antidepressants can be effective for different core symptoms of BPD, mainly including mood symptoms, anxiety, and impulse dyscontrol. Some atypical antipsychotics can also be effective for psychotic and dissociative symptoms. Specific antiepileptics can be useful in some cases in treating specific BPD symptoms, mainly including mood instability, impulsiveness, and anger. Conclusions: No medication is currently approved for BPD, and clinicians should carefully assess the benefits and risks of drug treatment. Further studies are needed to identify specific personalized treatment strategies, also considering the clinical heterogeneity and possible comorbidities of BPD.

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