Pharmacotherapy and bpd

PHARMACOTHERAPY AND BPD
DIMEFF, L.A., MCDAVID, J., & LINEHAN, M.M.(1999)
Double-Blind Pharmacotherapy Outcome Studies Using BPD Samples Double-blind randomized six-week acute treatment Eleven of the total N (13.8%) failed to complete at least three weeks of the trial. Both trial with BPD outpatients (n=80). Each condition medications resulted in statistically significant improvements compared to baseline scores included 24 female and 16 male Ss. No placebo- thorughout the evaulation. Ss using loxapine were significantly more improved on anxiety and control condition was used. The assessment battery depressed mood at Week 1 and Week 2 as measured by the Brief Psychiatric Rating Scale focused almost exclusively on measurement of (BPRS) and systematic nursing observations. Differences between medication conditions affective dysregulation, including anxiety, depressed disappeared by Week 4. One statistically significant finding -- reduction in depressed mood on mood, and hostility, with very limited assessment of the BPRS-- was observe at the post-treatment follow-up assessessment favoring loxapine.
cognitive dysregulation (only confusion was assessed Double-blind, randomized trial of outpatients (n=52) Attrition information is scant. Ten Ss withdrew from the study within the first month due to side meeting criteria for BPD, Schizotypal Personality effects and/or inefficacy of the treatment. This group was apparently excluded from the intent to Disorder (SPD) or both (35.6%). Ss were divided treat sample (n=52). Of the 52, 46 Ss (88%) remained in the study throughout the three-month evenly between two active treatment conditions, each trial. Eighty-four percent were markedly to moderately improved at the 3-month follow-up, with with 18 males and 8 females. No placebo-control Ss responded more favorably to thiothixene than haloperidol in reducing general symptoms, anxiety, depression, and paranoia. Outcomes did not vary as a result of diagnoses. Over 80% of Ss in both conditions reported numerous adverse medication reactions. It is possible that that thiothixene’s superior performance in this trial resulted from the failure to use a sufficient Double-blind, placebo-controlled trial involving Only 45.8% of experimental Ss (11 of 24) completed the trial, compared to 57.8% Ss in placebo outpatients (n=50) meeting criteria for BPD and/or condition (15 of 26). Thiothixene significantly reduced illusions, ideals of reference, Schizotypal PD. About 40% met diagnostic criteria for psychoticism, phobic anxiety, and obsessive-compulsivity in comparison to placebo. Near both BPD and SPD. Ss selected on the basis of significant trends favoring thiothixene were observed on depersonalization-derealization, anger- having < 1 psychotic symptom. One week medication hostility, and somatization. No differences were observed on pre/post depression scores. Ss washout followed by random assignment to 12-week with BPD-only has a significantly greater pre/post reduction in social phobia compared to Ss with SPD or both. No other differences as a result of diagnosis were observed.
Double-blind, placebo-controlled randomized trial in Ss in all groups demonstrated statistically significant improvements over time, however the Ss diagnosed with BPD and/or SPD (n=64).
greatest gains occurred in the active medication conditions. Haloperidol was significantly Following one- week washout, 13 Ss no longer superior to placebo and amitriptyline across a broad range of symptoms, including subjective demonstrated ongoing symptom severity so were complaints of hostility, paranoid or psychotic ideation, anxiety, phobic anxiety, obsessive- excluded from analysis. The intent to treat sample compulsive behaviors, and depressed mood and interpersonal sensitivity. Modest effects in the was restricted to Ss who had taken medications for amitriptyline condition were limited to reductions in depression. Haloperidol had only a modest effect against schizotypal symptoms. Haloperidol was equivalent to amitriptyline in reducing depression. Ss with greatest response to haloperidol presented a sustained pattern of both affective and schizotypal symptoms. Magnitude of change was modest, but considered clinically and statistically significant.
Reprinted from permission by publishers and authors. Table published in Dimeff, L.A., McDavid, J., & Linehan, M.M. (1999).
Pharmacotherapy for borderline personality disorder: A review of the literature and recommendations for treatment. Journal of Clinical Psychology, 6, 113-138.
PHARMACOTHERAPY AND BPD
DIMEFF, L.A., MCDAVID, J., & LINEHAN, M.M.(1999)
Double-Blind Pharmacotherapy Outcome Studies Using BPD Samples Double-blind, placebo-controlled crossover trial in an Differential completion rates were reported by condition, ranging from 38% (trifluoperazine) to outpatient setting while Ss also received 75% (tranycypromine). The most favorable outcomes were achieved with tranylcyromine which psychotherapy. All Ss (n=16) were female and had enhanced mood, reduced anxiety and impulsivity. Carbamazepine produced dramatic BPD, as well as histories of severe dysphoric mood improvements, especially in decreasing the severity of behavioral dyscontrol, however severe and behavioral dyscontrol but no current major melancholic depression developed in three Ss. Alprazolam significantly increased behavioral depression. A full medication trial involved a two- dyscontrol and suicidality ratings, but was regarded by patients as more beneficial than other week induction, four week maintenance with constant agents. Patients having a favorable response to one medication were not likely to respond dosage, a week of medication taper, and at least one medication-free week before beginning next drug trial.
Double-blind, placebo-controlled trial of Ss with BPD Phenelzine was consistently superior to imipramine. Using the more stringent cut off for BPD (5 and atypical depression but no other Axis I diagnosis.
or more criteria), 20% of the original sample responded to the placebo, 38% to imipramine, and Part of a larger pharmacotherapy trial for atypical 89% to phenelzine. In the second trial, 19% responded favorably to the placebo, 42% to depression, 40 of the original sample (n=171) met 5 or imipramine, and 100% to phenelzine. Results from this study demonstrated a strong more diagnostic criteria for BPD; 61 met 4 or more of relationship between the number of BPD symptoms and the efficacy of phenelzine. In patients the BPD criteria. Trial divided into two six-week having four or more BPD symptoms, 92% of phenelzine- and 35% of imipramine-treated patients phases; non-responders and Ss who responded to the were deemed “responders.” In patients meeting fewer than four BPD criteria, there appeared placebo in the initial phase were removed from the little difference in efficacy between the two medications (65% of phenelzine-treated patients second phase while responders received another six were judged as “responders” compared to 63% of the imipramine-treated patients).
weeks of acute treatment. The second phase was intended to ensure that clinical gains persisted and Preliminary findings from a double-blind, random- Meaningful interpretation of this data and generalization is hampered by significant drop out order placebo-control crossover trial lasting 22 weeks rates. Two patients (11.8%) dropped out of treatment before taking any medication. Five comparable in to the Cowdry & Gardner (1988) dropped out after completing the first arm (29.4%). Only 58.8% of Ss completed two or more crossover trial. Ss (n=19) met criteria for BPD; 18 arms of the study. With few exceptions, no significant differences were found between lithium vs.
were female and one was male; 42% had comorbid placebo and desipramine vs. placebo using the Hamilton Depression Scale and Carroll Scale for atypical depression. Of the 57 outpatient Ss referred Depression. While not statistically significant, eight of 11 Ss on lithium improved on measures of to the study, 24 refused to participate in this trial.
anger and suicidal symptoms (vs. four of 11 in the desipramine condition). The only statistically significant finding that emerged was on therapists’ rating of improvement, favoring lithium.
Reprinted from permission by publishers and authors. Table published in Dimeff, L.A., McDavid, J., & Linehan, M.M. (1999).
Pharmacotherapy for borderline personality disorder: A review of the literature and recommendations for treatment. Journal of Clinical Psychology, 6, 113-138.
PHARMACOTHERAPY AND BPD
DIMEFF, L.A., MCDAVID, J., & LINEHAN, M.M.(1999)
Double-Blind Pharmacotherapy Outcome Studies Using BPD Samples Double-blind, placebo-controlled trial in Ss diagnosed This study was published as a non-peer reviewed chapter, but is the first published outcome data with BPD (n=17). Acute treatment lasted 14 weeks.
from a controlled clinical trial on the efficacy of SSRIs in Ss with BPD. The review of this study is Primary measures included Hamilton Anxiety Scale very general and provides a very limited view of the specific findings. Seven of nine Ss in (HAM-A), Hamilton Depression Scale (HAM-D), Beck fluoxetine condition completed the entire trial, compared to seven of eight in the placebo Depression Inventory (BDI), and Global Assessment condition. Statistically significant improvements favoring fluoxetine were found across all outcome measures. Ss receiving fluoxetine continued to demonstrate ongoing significant gains over time, suggesting that the 14-week trial may have been insufficient to capture the full extent of improvement able to be derived from its use. In open trials using fluoxetine, Markowitz and colleagues (1991) reported reductions in self-injury. No data is provided from this double-blind trial regarding self-injury or other impulsive behaviors.
Double-blind, placebo-controlled randomized trial of Thirty-two Ss (30%) dropped out from the study. Three way comparisons between groups consecutive admits with BPD to inpatient psychiatric revealed superior efficacy of phenelzine, followed by placebo and haloperidol on measures of hospital (n=108); 82 (75.9%) were female and 26 depression, borderline psychopathology, and anxiety. Pairwise comparisons between (24.1%) were male. One-week drug washout was medication and placebo revealed significant efficacy of phenelzine to reduce anger and hostility; followed by a five-week acute treatment phase.
phenelzine was not efficacious in treating atypical depression or hysteroid dysphoria. Unable to Patients with drug and/or alcohol deficits or replicate prior reports demonstrating efficacy of antipsychotics. Phenelzine dosage may have dependence were excluded from this study.
been insufficient, but patients were experiencing numerous side effects and were uncooperative Replication study of prior Soloff et al. (1986) research.
about using higher dosage. Unable to replicate prior findings that demonstrated the efficacy of Double-blind, placebo-controlled continuation study in The purpose of this continuation trial was to aid in determining how long to continue 14 male and 40 female Ss with BPD (n=54). This 16 pharmacotherapy in patients who have stabilized with acute therapy. Attrition rates considerably week trial followed a five-week acute therapy phase high among haloperidol Ss (64%) within the first eight weeks, compared to 28% among placebo (see Soloff, et al., 1993). Eligibility for this trial was Ss. While haloperidol continued to be effective beyond the acute phase for irritability, Ss in this based on improvement obtained in the acute group had higher levels of depression, hypersomnia, and leaden paralysis. Phenelzine produced treatment phase as measured by a five or more point only modest effects beyond acute phase for depression and irritability; it was however activating.
increase on the GAS and an absolute improvement over the criteria for initial inclusion. Of the 54 Ss, 14 were on haloperidol, 22 on phenelzine, and 18 on Reprinted from permission by publishers and authors. Table published in Dimeff, L.A., McDavid, J., & Linehan, M.M. (1999).
Pharmacotherapy for borderline personality disorder: A review of the literature and recommendations for treatment. Journal of Clinical Psychology, 6, 113-138.

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