Review of pharmacologic treatment in cluster A personality disorders

Abstract

Introduction:A personality disorder is a pervasive and enduring pattern of behaviors that impacts an individual's social, occupational, and overall functioning. Specifically, the cluster A personality disorders include paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. Patients with cluster A personality disorders tend to be isolative and avoid relationships. The quality of life may also be reduced in these individuals, which provokes the question of how to treat patients with these personality disorders. The purpose of this review is to evaluate the current literature for pharmacologic treatments for the cluster A personality disorders.Methods:A Medline/PubMed and Ovid search was conducted to identify literature on the psychopharmacology of paranoid personality disorder, schizoid personality disorder, and schizotypal personality disorder. There were no exclusions in terms of time frame from article publication or country of publication, in order to provide a comprehensive analysis; however, only articles that contained information on the cluster A disorders were included.Results:Minimal evidence regarding pharmacotherapy in paranoid and schizoid personality disorders was found. Literature was available for pharmacologic treatment of schizotypal personality disorder. Studies evaluating the use of olanzapine, risperidone, haloperidol, fluoxetine, and thiothixene did yield beneficial results; however, treatment with such agents should be considered on a case-by-case basis.Discussion:Most of the literature analyzed in this review presented theoretical ideas of what may constitute the neurobiologic factors of personality and what treatments may address these aspects. Further research is needed to evaluate specific pharmacologic treatment in the cluster A personality disorders. At this time, treatment with pharmacologic agents is based on theory rather than evidence.

Os transtornos de personalidade e abordagens terapêuticas

“…O TEz é descrita como um padrão de distanciamento das relações sociais e capacidade limitada na expressão de emoções e afetos [26].…”

“…Os indivíduos com TPP são considerados "estranhos" e "excêntricos" pelos outros, inexistência de relações de proximidade e com desconfiança pervasiva em relação aos motivos e comportamentos de terceiros em variados contextos [26].…”

“…Os artigos mostram que os antipsicóticos são os fármacos mais usados, sendo que uns estudos mostram eficácia na olanzapina, risperidona, haloperidol, tiotixeno e ainda no antidepressivo fluoxetina [26]. Noutros, a risperidona mostrou melhor resposta, sendo que, relativamente a psicoterapias, a literatura é escassa e não permite que se possam fazer quaisquer recomendações quanto à sua tipologia [22].…”

Hypnotizability and Disordered Personality Styles in Cluster A Personality Disorders

“…Cluster A personality disorders (CAPD, including the paranoid, schizoid and schizotypal types) are characterized by "odd and eccentric" behaviors and share some similar clinical symptomatology with schizophrenia [1], but both their pharmaco-and psychotherapeutic treatment effects are far from satisfactory [2][3][4]. Reasons for their poor therapeutic effects are diverse, and one of them is due to insufficient research regarding their pathology.…”

“…In clinics, limited evidence has shown that the paranoid personality disorder is marked heavily by suspicious-and hostile-related perceptual-cognitive "positive" symptoms, the schizoid by extreme social isolation stemming from a lack of desire for interpersonal relationships, and the schizotypal by both perceptual-cognitive "positive" deficits and interpersonal problems [2]. In general, CAPD patients display interpersonal mistrust and sensitivity, even those related to doctors and therapists [3,4]. The interpersonal problems as the core symptoms in these patients were reported to be highly correlated with the negative core beliefs about the self and others [6,7], and the perception of dissimilarity of the self with others [6,8].…”