Recent approaches to pharmacotherapy of personality disorders

Abstract

Recent approaches to pharmacotherapy of personality disorders Practice pointsPharmacotherapy of personality disorders should be considered a symptom-focused treatment, targeting dimensions of affective dysregulation, impulsive-behavioral dyscontrol and cognitive-perceptual symptoms.To date, randomized controlled trials have been performed in samples of patients with antisocial personality disorder, schizotypal personality disorder and borderline personality disorder (BPD). However, the great majority of these trials have been conducted in samples with BPD.There is some evidence that mood stabilizers (topiramate, valproate and lamotrigine), second-generation antipychotics (olanzapine, aripiprazole), and omega-3 fatty acids can be useful for the treatment of affective symptoms and impulsive-behavioral dyscontrol in BPD patients.Antipsychotics produced an improvement of psychotic-like symptoms both in patients with BPD and schizotypal personality disorder.Selective serotonin reuptake inhibitors were found to be effective in decreasing depressed mood, anxiety, and anger in BPD patients, mainly with a comorbid major depressive episode. However, recent evidence no longer supports their use as first-line treatment of affective symptoms and impulsive-behavioral dyscontrol in BPD.Present studies suffer from important methodological limitations. Thus, further investigations are needed to confirm available findings. SUMMARY A growing number of studies on pharmacotherapy of personality disorders have been performed. This article considers controlled trials conducted between 1990 and 2010, and is directed toward the treatment of personality disorders. Data on borderline personality disorder (BPD), antisocial personality disorder and schizotypal personality disorder (STPD) were collected and discussed, in order to provide indications for clinical practice. Concerning antisocial personality disorder and STPD, available evidence is too sparse to propose treatment recommendations. As for BPD, there is some evidence that mood stabilizers (topiramate, valproate, and lamotrigine), second-generation antipsychotics (olanzapine, aripiprazole), and omega-3 fatty acids can be useful to treat affective symptoms For reprint orders, please contact: reprints@futuremedicine.comNeuropsychiatry (2011) 1(3) future science group 260Review Bellino, Rinaldi, Bozzatello & Bogetto Personality disorders (PDs) are defined as endur ing patterns of inner experience and behavior causing distress, which lead to maladaptive functioning in the areas of emotion, cognition, interpersonal relationships and impulse con trol [1]. Since the 1980s there has been increas ing recognition that PDs can be considered as syndromes of interacting dimensional traits that arise from psychosocial development and/or biological vulnerability [2]. Personality dimen sions acquired through social and cultural learning are termed character, whereas those believed to have a biological origin, genetically determined or acquired from overt injury to the CNS, are traditionally referr...

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