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Minerva Psichiatrica 2007 March;48(1):21-41

Copyright © 2007 EDIZIONI MINERVA MEDICA

language: Italian

Pharmacological treatment of borderline personality disorder: guidelines and research findings

Bellino S., Paradiso E., Fenocchio M., Bogetto F.

Sezione di Psichiatria Dipartimento di Neuroscienze Università degli Studi di Torino, Torino

Borderline personality disorder is the most common personality disorder in clinical settings, causing marked distress and impairment in social, occupational, and role functioning, and leading to high rates of self-destructive behavior and suicide. The essential feature of borderline personality disorder is a pervasive pattern of instability of interpersonal relationships, affect regulation, self-image, and impulse control. The frequent comorbidity with other psychiatric disorders and the need for long-term therapies represent a clinical challenge when treating borderline patients. Although psychotherapy plays a significant role in the treatment of borderline patients by focusing on maladaptive personality traits and patterns of interpersonal relationships, pharmacotherapy is indicated by the current American Psychiatric Association guidelines to manage state symptoms during acute relapses and trait vulnerability. Treatment strategies for borderline personality disorder target 3 different psychopathological domains, such as affective instability, impulsive-behavioral dyscontrol and cognitive-perceptual symptoms. In particular, guidelines indicate the use of: antidepressant agents—specifically, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors—and mood stabilizers for affective dysregulation; SSRIs and mood stabilizers for impulsive-behavioral dyscontrol; and antipsychotics for cognitive-perceptual symptoms. This article reviews available data concerning the efficacy and tolerability of antidepressants, mood stabilizers, typical and second generation antipsychotics in the treatment of borderline personality disorder. The review also considers recent investigation performed by authors and concerning the use of new pharmacological agents in monotherapy (oxcarbazepine, quetiapine) or as augmentation agents in resistant patients (aripiprazole added to SSRIs).