Efficacy of extended-release divalproex combined with "condensed" dialectical behavior therapy for individuals with borderline personality disorder.

BACKGROUND: Borderline personality disorder (BPD) is a significant psychiatric illness for which medication treatments are still being explored. The goal of this study was to assess divalproex extended release (ER) vs placebo for patients receiving dialectal behavior therapy (DBT). METHODS: Patients with BPD received 4 weeks of "condensed DBT." Those with Symptom Checklist-90 (SCL-90) scores >150 after this treatment were then randomly and blindly assigned to placebo or divalproex ER for 12 weeks. Repeated measures analysis of variance utilizing last observation carried forward was used to assess the results. RESULTS: Seventeen participants completed the full assessment. Two patients had a significant decrease in SCL-90 in the first 4 weeks, leaving 15 patients for the medication phase of the trial. There were no significant differences between the participants assigned to divalproex ER compared with placebo. However, there was a significant improvement in both groups from baseline to endpoint (P = .001). CONCLUSIONS: The response of 2 of 17 participants in the first 4 weeks prior to medication may point to a practice strategy in approaching outpatients with BPD. Although the patients had a decrease in symptoms during the study, there was no advantage observed for divalproex ER and DBT over placebo and DBT.

Quetiapine in patients with borderline personality disorder: an open-label trial.

BACKGROUND: Quetiapine was assessed in patients diagnosed with borderline personality disorder (BPD) to examine its potential effect on symptoms and explore a tolerated dosing pattern. METHOD: An open label case series with objective rating measures was undertaken. The study was of 8 weeks duration. RESULTS: Sixteen research subjects received quetiapine and completed at least one rating. Nine subjects completed the entire 8 week trial. In the LOCF and completer analyses, significant improvement was noted on GAF, SCL-90, BIS, and SIB. Specifically for the LOCF analysis, GAF increased from 57.7 to 64.6 (p = 0.001), SCL-90 decreased from 120.1 to 78.4 (p = 0.004), BIS improved from 73.4 to 59.9 (p = 0.021), and the SIB started at 267.8 and ended at 202.3 (p < 0.001). The average dose of quetiapine for LOCF analysis was 223.4 mg/d and was 286.1 mg/d for the completers. Common side-effects were similar to those seen in schizophrenic patients--sedation and increased appetite. CONCLUSIONS: Significant reductions in symptoms assessed by objective rating scales were observed in this pilot study of quetiapine administered to subjects with BPD. The dosing strategy in the study was well tolerated.

Comparison of low and moderate dosages of extended-release quetiapine in borderline personality disorder: a randomized, double-blind, placebo-controlled trial.

OBJECTIVE: The authors compared the efficacy and tolerability of low and moderate dosages of extended-release quetiapine in adults with borderline personality disorder. METHOD: Ninety-five participants with DSM-IV borderline personality disorder were randomly assigned to receive 150 mg/day of quetiapine (the low-dosage group; N=33), 300 mg/day of quetiapine (the moderate-dosage group; N=33), or placebo (N=29). Total score over time on the clinician-rated Zanarini Rating Scale for Borderline Personality Disorder ("Zanarini scale") was analyzed in a mixed-effects model accounting for informative dropout. RESULTS: Participants in the low-dosage quetiapine group had significant improvement on the Zanarini scale compared with those in the placebo group. Time to response (defined as a reduction of 50% or more on the Zanarini scale total score) was significantly shorter for both the low-dosage quetiapine group (hazard ratio=2.54, p=0.007) and the moderate-dosage quetiapine group (hazard ratio=2.37, p=0.011) than for the placebo group. Among participants who completed the study, 82% in the low-dosage quetiapine group were rated as "responders," compared with 74% in the moderate-dosage group and 48% in the placebo group. Treatment-emergent adverse events included sedation, change in appetite, and dry mouth. The overall completion rate for the 8-week double-blind treatment phase was 67% (67% for the low-dosage quetiapine group, 58% for the moderate-dosage quetiapine group, and 79% for the placebo group). Participants who experienced sedation were more likely to drop out. CONCLUSIONS: Participants treated with 150 mg/day of quetiapine had a significant reduction in the severity of borderline personality disorder symptoms compared with those who received placebo. Adverse events were more likely in participants taking 300 mg/day of quetiapine.

An exploratory study of the relationship of symptom domains and diagnostic severity to PET scan imaging in borderline personality disorder.

The purpose of this report is to describe the relationship between clinical rating assessments of borderline personality disorder (BPD) and regional brain metabolism as measured by positron emission tomography with fluorodeoxyglucuse-F18 (PET-FDG). Fourteen women with BPD underwent PET-FDG scanning in a medication-free state. Correlations were performed on a voxel-by-voxel basis with Buss-Durkee Hostility Index (BDHI) and the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) which provides a score for BPD severity. There was a significant negative correlation between glucose metabolism in frontal brain areas and the BDHI. Correlations of brain metabolic changes and diagnostic behavioral rating scale scores (ZAN-BPD) were small and seen mostly in posterior areas. The assessment of the statistical relationship of the BDHI to brain regions was substantially more robust than the correlations of the total ZAN-BPD. This exploratory study illustrates regional metabolic values that are highly related to hostile behavior. Our findings replicate some prior studies that have identified a negative relationship between frontal metabolism and aggression in personality disorders. We have also identified a range of other areas that relate to both positive (representing increased drive) and negative (representing impaired control) hostility scores. The substantially greater correlations of the BDHI compared with the ZAN-BPD provide information about the neural underpinnings of BPD.