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1.
Medicine (Baltimore) ; 98(37): e17101, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517840

RESUMO

BACKGROUND: Caregivers encounter serious and substantial challenges in managing hypertension in patients with subclinical or clinical borderline personality disorder (BPD). These challenges include therapeutic conflicts resulting from harmful drug-drug, and drug-disease interactions. Current guidelines provide no recommendations for concurrent psychotropic and antihypertensive treatment of hypertensive BPD patients who are at even greater cardiovascular risk. METHODS: We conducted a systematic literature review to assess the extent of available evidence on prevalence rates, cardiovascular risk factors, therapeutic conflicts, and evidence-based treatment recommendations for patients with co-occurring hypertension and BPD. Search terms were combined for hypertension and BPD in PubMed, MEDLINE, EMBASE, Cochrane, and PsycINFO databases. RESULTS: We included 11 articles for full-text evaluation and found a very high prevalence of hypertension and substantial cardiovascular risk in studies on co-occurring BPD and hypertension. However, we identified neither studies on harmful drug-drug and drug-disease interactions nor studies with treatment recommendations for co-occurring hypertension and BPD. CONCLUSIONS: Increased prevalence of hypertension in BPD patients, and therapeutic conflicts of psychotropic agents strongly suggest careful evaluation of treatment strategies in this patient group. However, no studies or guidelines recommend specific therapies or strategies to resolve therapeutic conflicts in patients with hypertension and BPD. This evidence gap needs attention in this population at high risk for cardiovascular disease.


Assuntos
Transtorno da Personalidade Borderline/complicações , Hipertensão/tratamento farmacológico , Psicotrópicos/efeitos adversos , Transtorno da Personalidade Borderline/tratamento farmacológico , Transtorno da Personalidade Borderline/psicologia , Interações Medicamentosas , Humanos , Hipertensão/psicologia , Prevalência , Psicotrópicos/uso terapêutico
2.
Psychiatr Danub ; 31(2): 157-161, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31291219

RESUMO

Schizophrenia and bipolar disorders are serious psychiatric disorders with substantial health risks. Asenapine is a new second-generation antipsychotic, available as a sublingual tablet, approved in Europe for the treatment of moderate-to-severe manic episodes in adults, and in US for manic or mixed episodes of bipolar I disorder in adults and adolescents. In this review, we searched the available literature to appreciate the role of asenapine in the management of psychiatric conditions such as bipolar disorders and schizophrenia and describe its mechanism of action, efficacy and tolerability. Asenapine has demonstrated efficacy in the management of bipolar disorders and schizophrenia, while a possible role in the management of borderline personality disorder and agitation needs further research. Asenapine has favourable side effects profile and combining with other pharmacological treatment in post-traumatic stress disorder has shown promising results. Asenapine fulfils important requirements of efficacy and tolerability as an anti-psychotic. These findings should support psychiatrists and pharmacists in the care of their patients while on asenapine.


Assuntos
Antipsicóticos/farmacologia , Antipsicóticos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Compostos Heterocíclicos de 4 ou mais Anéis/farmacologia , Compostos Heterocíclicos de 4 ou mais Anéis/uso terapêutico , Esquizofrenia/tratamento farmacológico , Antipsicóticos/administração & dosagem , Transtorno da Personalidade Borderline/tratamento farmacológico , Europa (Continente) , Compostos Heterocíclicos de 4 ou mais Anéis/administração & dosagem , Humanos , Estados Unidos
3.
Psychiatry Res Neuroimaging ; 290: 58-65, 2019 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-31302291

RESUMO

Borderline personality disorder (BPD) is a serious illness associated with chronic suffering and self-injurious behavior. Parsing the relationships between specific symptom domains and their underlying biological mechanisms may help us further understand the neural circuits implicated in these symptoms and how they might be amenable to change with treatment. This study examines the association between symptom dimensions (Affective Disturbance, Cognitive Disturbance, Disturbed Relationships, and Impulsivity) and amygdala resting-state functional connectivity (RSFC) in a sample of adults with BPD (n = 18). We also explored the relationships between change in symptom dimensions and change in amygdala RSFC in a subset of this sample (n = 13) following 8 weeks of quetiapine or placebo. At baseline, higher impulsivity was associated with increased positive RSFC between right amygdala and left hippocampus. There were no significant differences in neural change between treatment groups. Improvement in cognitive disturbance was associated with increased positive RSFC between left amygdala and temporal fusiform and parahippocampal gyri. Improvement in disturbed relationships was associated with increased negative RSFC between right amygdala and frontal pole. These results support that specific dimensions of BPD are associated with specific neural connectivity patterns at baseline and with change, which may represent neural treatment targets.


Assuntos
Antipsicóticos/uso terapêutico , Transtorno da Personalidade Borderline/tratamento farmacológico , Transtorno da Personalidade Borderline/psicologia , Fumarato de Quetiapina/uso terapêutico , Adulto , Tonsila do Cerebelo/diagnóstico por imagem , Tonsila do Cerebelo/fisiopatologia , Transtorno da Personalidade Borderline/diagnóstico por imagem , Feminino , Hipocampo/diagnóstico por imagem , Hipocampo/fisiopatologia , Humanos , Comportamento Impulsivo/fisiologia , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Descanso/psicologia , Adulto Jovem
4.
Int J Psychiatry Clin Pract ; 23(3): 178-188, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31140337

RESUMO

Objectives: Borderline personality disorder (BPD) is a life-threatening mental disorder. Guideline recommendations for pharmacological treatment of patients with BPD vary widely. The objective of the present study was to investigate pharmacotherapy of BPD patients in a routine clinical care setting. Methods: Data on the pharmacological treatment of 110 patients (90% female) with BPD (F- 60.3), treated in an inpatient psychiatric-psychosomatic clinic in Austria were assessed. Results: Results show that clinicians frequently prescribe psychotropic medications to patients with BPD, in many cases multiple medications. The most commonly prescribed substance groups were antipsychotics, mood stabilisers and antidepressants. The most commonly prescribed individual drugs were Quetiapine, Lamotrigine and Setraline. There was no significant difference in the different types or overall number of medications prescribed to BPD patients with vs. without comorbid diagnoses. Pharmacotherapy was not related to comorbidity. Conclusions: The present study shows that in routine clinical care settings psychotropic medications are frequently prescribed to patients with BPD, very often resulting in polypharmacy. A positive association between the number of medications and the effectiveness of the inpatient treatment program, as well as the absence of a relationship between number of medications and comorbidity contradicts the often suggested iatrogenic effect of polypharmacy. Key points Guidelines for pharmacotherapy of borderline personality disorders lack consensus Yet, clinicians frequently prescribe psychotropic medications to BPD patients Types/number of medications prescribed to patients with vs. without comorbidities are similar Larger treatment effects are observed for patients with greater numbers of medications Further knowledge is needed about how and why clinicians prescribe medications.


Assuntos
Transtorno da Personalidade Borderline/tratamento farmacológico , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Adulto , Comorbidade , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
6.
Harv Rev Psychiatry ; 27(2): 75-86, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30676404

RESUMO

LEARNING OBJECTIVES: After participating in this activity, learners should be better able to:• Assess medication management in patients with borderline personality disorder (BPD)• Evaluate the role of deprescribing as an active intervention in patients with BPD treated with polypharmacy ABSTRACT: Psychopharmacology in borderline personality disorder (BPD) is complicated by comorbid disorders, substance use, sensitivity to side effects, risk of self-harm through medication misuse, and intense but transient symptoms. Patients' relationships with medications may range from tenuous to highly enmeshed, and may profoundly influence the response to treatment. For these reasons, awareness of current evidence and flexible approaches are particularly relevant to prescribing in BPD. In this narrative review, we illustrate the current status of medication management in BPD by focusing on polypharmacy. We use a single vignette to explore the limitations of prescribing multiple medications and the factors contributing to polypharmacy. With the same vignette, and using the framework of deprescribing, we describe how medication regimens can be reduced to a necessary minimum. Deprescribing, originally developed in geriatric medicine, is an active intervention that involves a risk-benefit analysis for each medication, keeping in mind the patient's medical and psychiatric status and his or her preferences and values. Deprescribing lends itself well to use in psychiatry and especially in BPD because of its emphasis on the patient's preferences and on repeated conversations to revisit and update decisions. In addition to elaborating on the deprescribing framework, we provide recommendations for conducting these critical discussions about medications in BPD, with particular attention to the patient's relationship to the medication. Finally, we summarize our recommendations and strategies for implementing flexible and responsive medication management for patients with BPD. We suggest areas of future research, including testing the efficacy of targeted intermittent medication treatments.


Assuntos
Transtorno da Personalidade Borderline/tratamento farmacológico , Desprescrições , Prescrições de Medicamentos , Participação do Paciente , Padrões de Prática Médica , Prescrições de Medicamentos/normas , Humanos , Padrões de Prática Médica/normas
7.
Early Interv Psychiatry ; 13(6): 1373-1381, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-30689305

RESUMO

AIM: Up to half of patients with borderline personality disorder report auditory verbal hallucinations that are phenomenologically indistinguishable from those in schizophrenia, occur early in the course of the disorder, and are enduring, distressing and disabling. In clinical practice, this symptom is widely assumed to be unresponsive to treatment with antipsychotic medication and early intervention is rarely offered. The Verbal Experiences Response in Borderline personality disorder to Aripiprazole TrIal Medication (VERBATIM) study aims to be the first controlled trial to investigate the effectiveness of conventional pharmacotherapy for this symptom in this patient group. METHOD: VERBATIM is a 12-week, triple-blind, single-centre, parallel groups randomised controlled trial, with a 27-week follow-up period. Participants between the ages of 15 and 25 years receive either aripiprazole or placebo daily, commencing at 2 mg and increasing to 10 mg by day 15. Further dose escalations (up to 30 mg) may occur, as clinically indicated. This trial was prospectively registered with the Australian and New Zealand Clinical Trials Registry ACTRN12616001192471 on 30/08/2016. RESULTS: The primary outcome is severity of auditory verbal hallucinations assessed using the Psychotic Symptom Rating Scale. Secondary outcomes include the severity of general psychopathology, borderline personality pathology, social and occupational functioning and change in brain resting state connectivity. The primary endpoint is week 12 and secondary endpoint is week 39. CONCLUSION: The results will inform treatment decisions for individuals with borderline personality disorder who present with auditory verbal hallucinations.


Assuntos
Aripiprazol/uso terapêutico , Transtorno da Personalidade Borderline/tratamento farmacológico , Alucinações/tratamento farmacológico , Adolescente , Adulto , Antipsicóticos/uso terapêutico , Austrália , Transtorno da Personalidade Borderline/complicações , Feminino , Alucinações/complicações , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento , Adulto Jovem
9.
Int Clin Psychopharmacol ; 33(4): 233-237, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29847836

RESUMO

Impaired decision making in patients with borderline personality disorder (BPD) has been reported in several studies. Although methylphenidate (MPH) is known to ameliorate impaired decision making in patients with attention-deficit/hyperactivity disorder (ADHD), it has not yet been examined in patients with BPD. We therefore assessed the efficacy of a single dose of MPH on cognitive functions and decision making in patients with BPD. Twenty-two patients diagnosed with BPD participated in the study. The study was a randomized, double-blind placebo-controlled, random block order cross-over trial. Patients participated in two sessions and performed the Test of Variables of Attention, a digit-span test, and the computerized Iowa Gambling Task, after they had been administered either the MPH or a placebo. ADHD symptoms were assessed using the Adult ADHD Self-Report Scale-18. Lower scores on the inattention symptoms scale were associated with a greater improvement in decision making following the administration of MPH when compared with improvements in patients with higher ADHD scores [F(1,17)=5.63, P=0.030]. We conclude that MPH may improve decision making in patients with BPD, although this effect is mediated by the level of ADHD symptoms. Further studies are needed to assess whether a prolonged beneficial effect of MPH on decision making in patients with BPD might also be present in 'real life'.


Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno da Personalidade Borderline/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/uso terapêutico , Tomada de Decisões/efeitos dos fármacos , Metilfenidato/uso terapêutico , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Cognição/efeitos dos fármacos , Estudos Cross-Over , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
10.
J Psychosoc Nurs Ment Health Serv ; 56(5): 16-19, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29715373

RESUMO

Using an evolving case study, the current article demonstrates the principles of working with a client who has borderline personality disorder in relation to medications. The case study poses questions for the reader to consider and answers at the end of the article. [Journal of Psychosocial Nursing and Mental Health Services, 56(5), 16-19.].


Assuntos
Transtorno da Personalidade Borderline/tratamento farmacológico , Serviços de Saúde Mental/estatística & dados numéricos , Enfermagem Psiquiátrica , Psicofarmacologia , Adulto , Transtorno da Personalidade Borderline/enfermagem , Feminino , Humanos , Psicoterapia/métodos
11.
Artigo em Inglês | MEDLINE | ID: mdl-29709541

RESUMO

BACKGROUND: The reflexive startle- and orienting-response have been widely studied in psychiatric disorders. Existing evidence in patients with borderline personality disorder (BPD) is mixed, and limited to adults. The present study addressed clinical correlates of the psychophysiological orienting response in adolescents with BPD. METHODS: Female adolescents (13-19 years) with BPD (n = 30), healthy controls (HC; n = 34), and psychiatric clinical controls (CC; n = 53) participated in the trial. Orienting response was induced using acoustic startle-probes (sinus tones) while heart rate (HR) and skin conductance (SCR) were continuously recorded. Besides clinical interviews, the assessment included self-reports on depressive symptoms, anxiety, dissociation and psychopathological distress. RESULTS: On a group level, relative habituation of the HR-response (regression slope) significantly differed between groups (F(2,114) = 3.74, p = 0.027), with significant contrasts (p = 0.026, Sidak corrected) comparing CC (slope 0.04 ±â€¯0.41) and BPD (slope 0.28 ±â€¯0.40). On a dimensional level, relative HR habituation was significantly correlated with the number of BPD diagnostic criteria endorsed (r(117) = 0.183, p = 0.049) and symptoms of dissociation (r(116) = 0.193, p = 0.038), indicating that delayed HR habituation across probes was associated with greater BPD symptom severity. Analyses of SCR showed no significant findings. CONCLUSION: Findings provide preliminary support for altered habituation of the HR orienting response in adolescent BPD, associated with BPD severity - in particular dissociative experiences. Dissociative experiences may alter the automatic defensive response early in the course of BPD, providing a potential pathway to exaggerated emotional responding in BPD.


Assuntos
Transtorno da Personalidade Borderline , Orientação , Adolescente , Transtorno da Personalidade Borderline/tratamento farmacológico , Transtorno da Personalidade Borderline/fisiopatologia , Transtornos Dissociativos/tratamento farmacológico , Transtornos Dissociativos/fisiopatologia , Feminino , Resposta Galvânica da Pele/fisiologia , Habituação Psicofisiológica/fisiologia , Frequência Cardíaca/fisiologia , Humanos , Entrevista Psicológica , Orientação/fisiologia , Escalas de Graduação Psiquiátrica , Reflexo de Sobressalto/fisiologia , Índice de Gravidade de Doença , Adulto Jovem
12.
Am J Psychiatry ; 175(8): 756-764, 2018 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-29621901

RESUMO

OBJECTIVE: The authors examined whether lamotrigine is a clinically effective and cost-effective treatment for people with borderline personality disorder. METHOD: This was a multicenter, double-blind, placebo-controlled randomized trial. Between July 2013 and November 2016, the authors recruited 276 people age 18 or over who met diagnostic criteria for borderline personality disorder. Individuals with coexisting bipolar affective disorder or psychosis, those already taking a mood stabilizer, and women at risk of pregnancy were excluded. A web-based randomization service was used to allocate participants randomly in a 1:1 ratio to receive either an inert placebo or up to 400 mg/day of lamotrigine. The primary outcome measure was score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. Secondary outcome measures included depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment, and adverse events. RESULTS: A total of 195 (70.6%) participants were followed up at 52 weeks, at which point 49 (36%) of those in the lamotrigine group and 58 (42%) of those in the placebo group were taking study medication. The mean ZAN-BPD score was 11.3 (SD=6.6) among those in the lamotrigine group and 11.5 (SD=7.7) among those in the placebo group (adjusted difference in means=0.1, 95% CI=-1.8, 2.0). There was no evidence of any differences in secondary outcomes. Costs of direct care were similar in the two groups. CONCLUSIONS: The results suggest that treating people with borderline personality disorder with lamotrigine is not a clinically effective or cost-effective use of resources.


Assuntos
Antipsicóticos/uso terapêutico , Transtorno da Personalidade Borderline/tratamento farmacológico , Lamotrigina/uso terapêutico , Adulto , Antipsicóticos/economia , Transtorno da Personalidade Borderline/economia , Análise Custo-Benefício , Método Duplo-Cego , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Lamotrigina/economia , Masculino , Adesão à Medicação , Escalas de Graduação Psiquiátrica , Resultado do Tratamento
13.
Health Technol Assess ; 22(17): 1-68, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29651981

RESUMO

BACKGROUND: No drug treatments are currently licensed for the treatment of borderline personality disorder (BPD). Despite this, people with this condition are frequently prescribed psychotropic medications and often with considerable polypharmacy. Preliminary studies have indicated that mood stabilisers may be of benefit to people with BPD. OBJECTIVE: To examine the clinical effectiveness and cost-effectiveness of lamotrigine for people with BPD. DESIGN: A two-arm, double-blind, placebo-controlled individually randomised trial of lamotrigine versus placebo. Participants were randomised via an independent and remote web-based service using permuted blocks and stratified by study centre, the severity of personality disorder and the extent of hypomanic symptoms. SETTING: Secondary care NHS mental health services in six centres in England. PARTICIPANTS: Potential participants had to be aged ≥ 18 years, meet diagnostic criteria for BPD and provide written informed consent. We excluded people with coexisting psychosis or bipolar affective disorder, those already taking a mood stabiliser, those who spoke insufficient English to complete the baseline assessment and women who were pregnant or contemplating becoming pregnant. INTERVENTIONS: Up to 200 mg of lamotrigine per day or an inert placebo. Women taking combined oral contraceptives were prescribed up to 400 mg of trial medication per day. MAIN OUTCOME MEASURES: Outcomes were assessed at 12, 24 and 52 weeks after randomisation. The primary outcome was the total score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. The secondary outcomes were depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment and adverse events. Higher scores on all measures indicate poorer outcomes. RESULTS: Between July 2013 and October 2015 we randomised 276 participants, of whom 195 (70.6%) were followed up 52 weeks later. At 52 weeks, 49 (36%) of those participants prescribed lamotrigine and 58 (42%) of those prescribed placebo were taking it. At 52 weeks, the mean total ZAN-BPD score was 11.3 [standard deviation (SD) 6.6] among those participants randomised to lamotrigine and 11.5 (SD 7.7) among those participants randomised to placebo (adjusted mean difference 0.1, 95% CI -1.8 to 2.0; p = 0.91). No statistically significant differences in secondary outcomes were seen at any time. Adjusted costs of direct care for those prescribed lamotrigine were similar to those prescribed placebo. LIMITATIONS: Levels of adherence in this pragmatic trial were low, but greater adherence was not associated with better mental health. CONCLUSIONS: The addition of lamotrigine to the usual care of people with BPD was not found to be clinically effective or provide a cost-effective use of resources. FUTURE WORK: Future research into the treatment of BPD should focus on improving the evidence base for the clinical effectiveness and cost-effectiveness of non-pharmacological treatments to help policy-makers make better decisions about investing in specialist treatment services. TRIAL REGISTRATION: Current Controlled Trials ISRCTN90916365. FUNDING: Funding for this trial was provided by the Health Technology Assessment programme of the National Institute for Health Research (NIHR) and will be published in full in Health Technology Assessment; Vol. 22, No. 17. See the NIHR Journals Library website for further project information. The Imperial Biomedical Research Centre Facility, which is funded by NIHR, also provided support that has contributed to the research results reported within this paper. Part of Richard Morriss' salary during the project was paid by NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands.


Assuntos
Antipsicóticos/economia , Antipsicóticos/uso terapêutico , Transtorno da Personalidade Borderline/tratamento farmacológico , Lamotrigina/economia , Lamotrigina/uso terapêutico , Adulto , Antipsicóticos/efeitos adversos , Transtorno da Personalidade Borderline/epidemiologia , Análise Custo-Benefício , Depressão/epidemiologia , Método Duplo-Cego , Feminino , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Humanos , Relações Interpessoais , Lamotrigina/efeitos adversos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Anos de Vida Ajustados por Qualidade de Vida , Comportamento Autodestrutivo/epidemiologia , Medicina Estatal/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Avaliação da Tecnologia Biomédica
14.
CNS Drugs ; 32(2): 179-187, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29549516

RESUMO

BACKGROUND: Borderline personality disorder (BPD) is a complex, severe and highly stigmatised psychiatric illness. Several lines of evidence highlight the causal link between chronic stress, glucocorticoid response to stress and glutamatergic overactivity as a key event in the pathophysiology of BPD. Therefore, molecular mechanisms capable of regulating glutamate excitotoxicity represent novel and potentially promising treatment targets. Memantine-HCl is a voltage-dependent N-methyl-D-aspartate (NMDA) receptor 'channel blocker' that selectively blocks pathological glutamate overactivity. OBJECTIVE: The aim of the current study was to determine if memantine can improve BPD symptoms. METHOD: An 8-week, double-blind, placebo-controlled trial of adjunctive memantine to treatment as usual was conducted. Treatment as usual comprised antidepressants (selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, noradrenergic and specific serotonin antagonists and serotonin noradrenaline reuptake inhibitors), mood stabilisers and antipsychotics, as well as psychotherapy and other psychosocial interventions. Sixteen participants received oral placebo while 17 participants received daily oral memantine 10 mg for 7 days, with subsequent titration to daily oral memantine 20 mg. Eligibility criteria included men and women aged between 16-65 years, with a diagnosis of BPD according to the Diagnostic Interview for Borderline Patients. Primary outcome measures included the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD), assessed fortnightly. Secondary measures included an adverse effect questionnaire administered fortnightly to assess adverse effects known to be related to memantine use. RESULTS: According to intention-to-treat, latent growth curve analyses, a significant change in total score of ZAN-BPD symptom severity was observed in the memantine group at 20 mg/daily across time, compared with placebo (p = 0.02). No adverse effects were significantly more frequent among participants receiving active memantine than among those receiving placebo. CONCLUSION: Memantine at a 20-mg daily dose is a well tolerated drug that can improve BPD symptomatology and may be a promising novel therapeutic for its treatment. Further studies are needed to explore the efficacy of memantine versus placebo, as well as in comparison with other potential treatments for BPD. ClinicalTrials.gov identifier: NCT02097706.


Assuntos
Transtorno da Personalidade Borderline/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Memantina/uso terapêutico , Adolescente , Adulto , Idoso , Austrália , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Estatísticas não Paramétricas , Resultado do Tratamento , Adulto Jovem
15.
J Psychosoc Nurs Ment Health Serv ; 56(4): 8-11, 2018 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-29596715

RESUMO

Treating individuals with borderline personality disorder (BPD) is a complex and challenging process fraught with clinician stigma and bias. Clinically, polypharmacy is the most common approach, even though it is more likely to produce greater drug-drug adverse effects and interactions than effective improvement in symptoms. Currently, there are no approved medications specific for the treatment of BPD. The current article reviews the extant literature on psychopharmacology and provides treatment recommendations. [Journal of Psychosocial Nursing and Mental Health Services, 56(4), 8-11.].


Assuntos
Transtorno da Personalidade Borderline/tratamento farmacológico , Polimedicação , Psicofarmacologia/métodos , Psicotrópicos/uso terapêutico , Feminino , Humanos , Psicoterapia/métodos , Estigma Social
16.
Clin Drug Investig ; 38(4): 367-372, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29302857

RESUMO

BACKGROUND AND OBJECTIVES: Some evidence of efficacy has been found for omega-3 fatty acids in patients with borderline personality disorder (BPD). In a previous 12-week randomized trial we assessed the efficacy of the combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) with valproic acid, in comparison with valproic acid monotherapy, in 43 BPD outpatients. Combined therapy was superior to valproic acid monotherapy (the control group) in the treatment of some BPD symptoms: impulsive-behavioral dyscontrol, outbursts of anger, and self-harm. The present study is a 24-week follow-up aimed at evaluating whether the differences in efficacy between the two subgroups were maintained after discontinuation of omega-3 fatty acids. METHODS: Thirty-four patients who completed the 12-week trial entered the follow-up study. Participants were evaluated at the beginning and at the end of the follow-up period using the rating scales that showed a significant difference between the groups after the 12-week trial with fatty acids supplementation: the Borderline Personality Disorder Severity Index (BPDSI) (items 'impulsivity' and 'outbursts of anger'), Barratt Impulsiveness Scale-Version 11 (BIS-11), and Self Harm Inventory (SHI). Statistical analysis was performed with analysis of variance (ANOVA) for repeated measures. RESULTS: At the end of the follow-up a significant difference within groups was maintained for all four variables examined, while a significant difference between groups was maintained for outbursts of anger. Concerning tolerability, no clinically significant adverse effects were registered during the follow-up period. CONCLUSIONS: Combined therapy with omega-3 fatty acids showed long-lasting effects after discontinuation in terms of anger control. TRIAL REGISTRATION: The trial was registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) and allocated the code: ACTRN12612001150831.


Assuntos
Transtorno da Personalidade Borderline/tratamento farmacológico , Ácidos Docosa-Hexaenoicos/uso terapêutico , Ácido Eicosapentaenoico/uso terapêutico , Ácido Valproico/uso terapêutico , Suspensão de Tratamento , Adulto , Ensaios Clínicos Controlados como Assunto , Feminino , Seguimentos , Humanos , Masculino , Índice de Gravidade de Doença , Adulto Jovem
17.
Psychopharmacol Bull ; 48(4): 15-19, 2018 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-30618472

RESUMO

Due to the stringent regulatory environment for therapeutics, common side-effects of drugs in the general population are largely well-documented. This is however less the case with certain patient subgroups who may exhibit significant adverse responses to therapeutics that are otherwise well-tolerated. We report a case of psychosis induced by exposure to a commonly prescribed drug to treat muscle spasms and associated pain cyclobenzaprine (Flexeril®). Cyclobenzaprine is structurally very similar to tricyclic anti-depressants, such as amyltriptine. While it is well known that agitation caused by cyclobenzaprine is not an uncommon occurrence in the elderly, there have also been sporadic reports of significant psychosis in association with the use of cyclobenzaprine in younger patients. We report a case of reversible mania in a susceptible 44-year-old patient with a lengthy history of mild borderline personality and bipolar disorder. Shortly after being treated with cyclobenzaprine for pain due to a minor injury, this patient exhibited significant signs of mania although these signs were readily reversible upon termination of the treatment with cyclobenzaprine. The patient's severe adverse reaction to this normally innocuous drug adds weight to the notion that there is reason for caution with its prescription for potentially susceptible patient subgroups.


Assuntos
Amitriptilina/análogos & derivados , Antidepressivos Tricíclicos/efeitos adversos , Transtorno Bipolar/tratamento farmacológico , Transtorno da Personalidade Borderline/tratamento farmacológico , Relaxantes Musculares Centrais/efeitos adversos , Psicoses Induzidas por Substâncias/etiologia , Tranquilizantes/uso terapêutico , Adulto , Amitriptilina/efeitos adversos , Feminino , Humanos
18.
J Diet Suppl ; 15(1): 124-128, 2018 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-28558251

RESUMO

Use of omega-3 in psychiatric practice is on the rise. It has been used in diverse indications, notably mood disorders, schizophrenia, dementia, borderline personality, and neurodevelopmental disorders, with varying levels of evidence base. Here, the author sheds some light on the therapeutic potential of omega-3 as an appealing addition to psychopharmacological armamentarium.


Assuntos
Ácidos Graxos Ômega-3/uso terapêutico , Transtornos Mentais/tratamento farmacológico , Psicotrópicos/uso terapêutico , Transtorno da Personalidade Borderline/tratamento farmacológico , Demência/tratamento farmacológico , Medicina Baseada em Evidências , Humanos , Transtornos do Humor/tratamento farmacológico , Transtornos do Neurodesenvolvimento/tratamento farmacológico , Esquizofrenia/tratamento farmacológico
19.
Brain Imaging Behav ; 12(1): 217-228, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28247156

RESUMO

Borderline Personality Disorder (BPD) is a disabling and difficult-to-treat mental disease. One of its core features is a significant difficulty in affect regulation, which is often accompanied by Non-Suicidal Self-Injury (NSSI). It is suggested that this type of behavior elicits positive emotions and mitigates emotional distress, and therefore can ultimately be reinforced and promoted. In spite of the high prevalence of NSSI behaviors (also in non-BPD samples), their role in modulating reward-related processes has not yet been investigated in BPD patients. In the present study, this lack of research was addressed. A large sample of BPD patients (N = 40), divided into two groups depending on the presence of NSSI, and a group of matched healthy controls underwent functional Magnetic Resonance Imaging (fMRI) while performing a gambling task. Patients who committed NSSI acts exhibited enhanced activation of the orbitofrontal cortex following an unexpected reward, when compared with controls and BPD patients with no NSSI behavior. In addition, the NSSI group showed diminished functional connectivity between the left orbitofrontal cortex and the right parahippocampal gyrus. These findings might suggest impaired ability to update reward associations of potential choices when both BPD and NSSI are present. We propose that the presence of NSSI involves alterations in the reward system independently of BPD, and thus can be considered as a possible phenotype for reward-related alterations.


Assuntos
Transtorno da Personalidade Borderline/fisiopatologia , Jogo de Azar/fisiopatologia , Córtex Pré-Frontal/fisiopatologia , Recompensa , Comportamento Autodestrutivo/fisiopatologia , Adolescente , Adulto , Transtorno da Personalidade Borderline/diagnóstico por imagem , Transtorno da Personalidade Borderline/tratamento farmacológico , Transtorno da Personalidade Borderline/psicologia , Mapeamento Encefálico , Feminino , Jogo de Azar/diagnóstico por imagem , Jogo de Azar/psicologia , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Testes Neuropsicológicos , Córtex Pré-Frontal/diagnóstico por imagem , Comportamento Autodestrutivo/diagnóstico por imagem , Comportamento Autodestrutivo/psicologia , Adulto Jovem
20.
Curr Top Behav Neurosci ; 35: 499-514, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-28812272

RESUMO

Borderline personality disorder (BPD) is a prevalent and severe mental disorder with affect dysregulation, impulsivity, and interpersonal dysfunction as its core features. Up to now, six studies have been performed to investigate the role of oxytocin in the pathogenesis of BPD. While a beneficial effect of oxytocin on threat processing and stress responsiveness was found, other studies using an oxytocin challenge design presented with rather heterogeneous results. Future studies have to include a sufficiently large sample of patients, control for gender, and focus on mechanisms known to be related to aversive early life experiences.


Assuntos
Transtorno da Personalidade Borderline/tratamento farmacológico , Transtorno da Personalidade Borderline/etiologia , Emoções/efeitos dos fármacos , Ocitocina/uso terapêutico , Afeto/efeitos dos fármacos , Humanos , Ocitocina/administração & dosagem , Ocitocina/metabolismo , Resultado do Tratamento
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