Pharmacotherapy of personality disorders: what we know and what we have to search for

Abstract

Pharmacotherapy for personality disorders is in the early stage of development because the evidence base for effective drug treatment is insufficient, biased toward borderline personality disorder and rampant with methodological issues. In this paper, we reviewed randomized, placebo-controlled trials of drugs efficacy in patients with personality disorders published between 1990 and 2016.Overwhelming majority of studies focused on borderline personality disorder (BPD), and the accumulation of evidence resulted in 7 meta-analyses, which are interpreted into better strategies for evidence-based practice. Little research attention was given to schizotypal (SPTD) and antisocial (ASPD) personality disorders, with only indirect treatment efficacy evidence for the obsessivecompulsive (OCPD) and avoidant (AvPD) personality disorders. Some avenues for future efficacy research are indicated.

Mycotherapy: Potential of Fungal Bioactives for the Treatment of Mental Health Disorders and Morbidities of Chronic Pain

“…Potently inhibit the reuptake of 5-HT Effective as a monotherapy or as an augmentation agent in the treatment of impulsive (PG, KM, TTM, IED and pyromania), addiction and compulsive disorders [35][36][37][38][39] Listed above Mood stabilisers e.g., olanzapine, carbamazepine Defined above Naltrexone Non-specific competitive opioid antagonist with highest affinity for the mu-opioid receptors in the CNS [39] Nausea, vomiting, abdominal pain, decreased appetite, dizziness, lethargy, headaches and sleep disorders [40] Personality disorders Antidepressants (SSRIs, SNRIs) Defined above Shown efficacy in the treatment of BPD [41,42] Listed above Quetiapine Naltrexone Abbreviations: SSRI = selective serotonin reuptake inhibitors, SNRI = serotonin and norepinephrine reuptake inhibitor, TCA = Tricyclic antidepressants, MAOIs = Monoamine oxidase inhibitors, FGA = first generation antipsychotics, SGA = second generation antipsychotics, 5-HT = 5-hydroxytryptamine, NE = norepinephrine, DA = dopamine, GABA = γ-AMPA = aminobutyric acid, α-Amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid, PD = panic disorder, GAD = generalised anxiety disorder, SAD = social anxiety disorder, PTSD = post-traumatic stress disorder, BD = bipolar disorder, AN = anorexia nervosa, BN = bulimia nervosa, BED = binge eating disorder, PG = pathological gambling, KM = kleptomania, TTM = trichotillomania, IED = intermittent explosive disorder, BPD = Borderline Personality Disorder, SLE = systemic lupus erythematosus, PCOS = Polycystic ovary syndrome, CNS = central nervous system. * Many drugs listed for the treatment of anxiety are also employed for the treatment of mood disorders including SSRIs, NSRIs and TCAs.…”

Current and emerging medications for borderline personality disorder: is pharmacotherapy alone enough?

“…The guidelines from the National Institute for Health and Clinical Excellence (NICE) [20,21] reached rather different conclusions from the preceding guidelines. They stated that drug therapy was not recommended other than to treat mental disorders in comorbidity or to control specific acute symptoms during a crisis and with a short-term prescription [22]. NICE supported the central role of psychotherapy in treating BPD.…”

“…This class of medications has been found particularly useful in the short-term control of anger and impulsivity in BPD [38]. Although a Cochrane review (2010) [24] found some evidence of the efficacy of mood stabilizers (valproate and lamotrigine) in BPD, since 2010, few trials have been conducted to consolidate the data and reinforce their use in clinical practice [27,22].…”

Pharmacological treatment of borderline personality disorder.

“…Controlled clinical trials of pharmacological intervention for BPD have focused on specific symptoms of the disorder, with some evidence of positive outcomes. The quality of evidence for pharmacological treatments for BPD has been limited by small research sample sizes, co-occurring psychopathology, short follow-up periods, lack of consensus regarding core outcome measures, and nonrepresentative samples of BPD patients (e.g., less severe BPD, absence of male patients, exclusion of patients with co-occurring mental disorders; Bozzatello et al, 2017;Hancock-Johnson, Griffiths, & Picchioni, 2017;Herpertz et al, 2007), which thereby affects the generalizability of findings.…”