naloxone and Borderline-Personality-Disorder

Recent theory has proposed that a dysfunction of the opioid system modulates mood, reward and pain; seems to be unstable in people with Borderline Personality Disorder. Our purpose is to analyze the evidence on the efficacy of the use of buprenorphine, nalmefene, naloxone and naltrexone, in the treatment of dissociative symptoms, self-mutilation and suicidal behavior of these patients.. We conducted a systematic search of MEDLINE and LILACS databases, to retrieve relevant articles. Included studies were experimental and observational designs of borderline personality samples in which dissociative symptoms, self mutilation or suicidal behavior was reported as an outcome and evaluated with some impact measures.. A total of eight studies were reviewed. These provided interesting expectations about posible treatment lines in Borderline Personality Disorder using opioid antagonists. The subgroup most benefited was the one who has analgesia and highest number of diagnostic criteria.. Studies of higher methodological quality are needed, in larger population samples and using control of confounding variables that allow us to estimate a value power calculation, and thus be able to support firm conclusions.

Topics: Borderline Personality Disorder; Buprenorphine; Dissociative Disorders; Humans; Naloxone; Naltrexone; Narcotic Antagonists; Observational Studies as Topic; Self Mutilation; Suicidal Ideation

Acute dissociative states are common in patients with borderline personality disorder (BPD). However, there are no established pharmacotherapeutic treatment options for this severe clinical condition.. The effect of 0.4 mg naloxone administered intravenously in acute dissociative states was examined as compared to placebo in a double-blind crossover study in nine patients who met DSM-IV-criteria for BPD. Dissociative symptoms before and 15 min after a single dose of naloxone or saline placebo were assessed using a self-rating instrument for dissociation and aversive inner tension (DSS) and the observer-based items of the Clinician Administered Dissociative States Scale (CADSS).. Dissociative symptoms before treatment with naloxone or saline placebo were moderate to severe. After injection of either naloxone or placebo, dissociative symptoms significantly decreased on the DSS (p < 0.01) and the CADSS (p < 0.05). However, there were no significant differences between naloxone and placebo in the reduction of symptoms. Patients who showed the most prominent response to naloxone fulfilled the highest number of DSM-IV-criteria for BPD.. Although it is difficult to draw definite conclusions from this small sample of patients, this study does not support the assumption that naloxone in a single dose of 0.4 mg is superior to placebo in acute dissociative states in patients with BPD. Further studies will investigate whether patients benefit from naloxone in a higher dose or whether subgroups of patients with BPD profit from naloxone in acute dissociative states.

Topics: Acute Disease; Adult; Borderline Personality Disorder; Cross-Over Studies; Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Double-Blind Method; Female; Humans; Injections, Intravenous; Naloxone; Narcotic Antagonists; Severity of Illness Index

Topics: Adult; Borderline Personality Disorder; Double-Blind Method; Female; Humans; Male; Naloxone; Pain Measurement; Pain Threshold; Self-Injurious Behavior

Opiate dependence (OD) and borderline personality disorder (BPD), separately and together, are significant public health problems with poor treatment outcomes. BPD is associated with difficulties in emotion regulation, and brain-imaging studies in BPD individuals indicate differential activation in prefrontal cingulate cortices and their interactions with limbic regions. Likewise, a similar network is implicated in drug cue responsivity in substance abusers. The present, preliminary study used functional MRI to examine activation of this network in comorbid OD/BPD participants when engaged in an "oddball" task that required attention to a target in the context of emotionally negative distractors. Twelve male OD/BPD participants and 12 male healthy controls participated. All OD/BPD participants were taking the opiate replacement medication Suboxone, and a subset of participants was positive for substances of abuse on scan day. Relative to controls, OD/BPD participants demonstrated reduced activation to negative stimuli in the amygdala and anterior cingulate. Unlike previous studies that demonstrated hyperresponsivity in neural regions associated with affective processing in individuals with BPD versus healthy controls, comorbid OD/BPD participants were hyporesponsive to emotional cues. Future studies that also include BPD-only and OD-only groups are necessary to help clarify the individual and potentially synergistic effects of these two conditions.

Topics: Adult; Analysis of Variance; Arousal; Borderline Personality Disorder; Brain Mapping; Buprenorphine; Buprenorphine, Naloxone Drug Combination; Case-Control Studies; Comorbidity; Cues; Drug Combinations; Emotions; Functional Laterality; Humans; Limbic System; Magnetic Resonance Imaging; Male; Naloxone; Narcotic Antagonists; Opiate Substitution Treatment; Opioid-Related Disorders; Reaction Time; Self Report