quetiapine-fumarate and Borderline-Personality-Disorder

The availability of new atypical antipsychotics provides new opportunities for the treatment of borderline personality disorder (BPD).. Original papers on this topic were sought. Our study reviewed and discussed 14 papers.. 2 RCTs, 4 non-controlled open-label studies and 8 case reports. The patient populations studied were highly diverse and the dropout rate after a long follow-up period was high. All of the articles reported positive effects of olanzapine, clozapine, quetiapine and risperidone.. BPD patients with psychotic-like, impulsive or suicidal symptoms might benefit from atypical antipsychotics. Since the methodological quality of the reviewed articles is poor, further randomised placebo-controlled studies with longer follow-ups are needed before any firm conclusions can be drawn.

Topics: Antipsychotic Agents; Benzodiazepines; Borderline Personality Disorder; Clinical Trials as Topic; Clozapine; Dibenzothiazepines; Humans; Olanzapine; Psychiatric Status Rating Scales; Quetiapine Fumarate; Randomized Controlled Trials as Topic; Research Design; Risperidone

Although quetiapine was introduced as an atypical antipsychotic drug with clinical efficacy in schizophrenia patients, it has been used in a variety of disease states over the last 5 years. The most common conditions have included mood and anxiety disorders, obsessive-compulsive disorder, aggression, hostility, posttraumatic stress disorder, borderline personality disorder, delirium, and comorbid substance abuse. Considering its efficacy in a wide variety of neuropsychiatric conditions and its excellent tolerability profile, quetiapine could emerge as a broad-spectrum psychotropic medication that may be helpful in psychiatry across various diagnostic categories. Traditionally, studies on the predictive validity of psychiatric disorders help with nosologic issues and controversies. Assessing quetiapine's tolerability and its overall treatment response might help tease out the predictive validity of various psychiatric syndromes (based currently on an atheoretical descriptive approach) and may shape psychiatric nosology in the future. Quetiapine's low affinity and fast dissociation from postsynaptic dopamine-2 receptors give the least risk of producing acute extrapyramidal side effects, tardive dyskinesia, and neuroleptic malignant syndrome. These factors suggest that the clinical utility of quetiapine in psychiatric conditions other than schizophrenia has not been fully exploited thus far.

Topics: Adult; Aggression; Antipsychotic Agents; Anxiety Disorders; Bipolar Disorder; Borderline Personality Disorder; Clinical Trials as Topic; Comorbidity; Delirium; Depressive Disorder; Dibenzothiazepines; Forecasting; Hostility; Humans; Mental Disorders; Obsessive-Compulsive Disorder; Quetiapine Fumarate; Stress Disorders, Post-Traumatic; Substance-Related Disorders; Treatment Outcome

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.

Topics: Adult; Amygdala; Antipsychotic Agents; Borderline Personality Disorder; Female; Hippocampus; Humans; Impulsive Behavior; Magnetic Resonance Imaging; Male; Middle Aged; Quetiapine Fumarate; Rest; Young Adult

This study aimed to examine the impact of quetiapine on the symptom and distress domains measured by the Symptom Checklist-90-Revised (SCL-90-R) in patients with borderline personality disorder (BPD).. Ninety-five participants meeting DSM-IV diagnostic criteria for BPD were randomly assigned to low-dosage (quetiapine, 150 mg/d; n = 33), moderate-dosage (quetiapine, 300 mg/d; n = 33), or placebo (n = 29). SCL-90-R was administered weekly over the course of an 8-week double-blind treatment phase. We used a mixed-effects model to analyze subscale scores of the SCL-90-R.. Results showed that both dosages of quetiapine were effective in reducing levels of overall psychological distress, interpersonal sensitivity, depression, and hostility compared with those who received placebo.. SCL-90-R can be a useful tool that would allow clinicians to collect information in addition to the DSM symptoms to better understand the diagnostic heterogeneity found in patients diagnosed with BPD.

Topics: Adult; Antipsychotic Agents; Borderline Personality Disorder; Female; Humans; Male; Outcome Assessment, Health Care; Quetiapine Fumarate

The authors compared the efficacy and tolerability of low and moderate dosages of extended-release quetiapine in adults with borderline personality disorder.. 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.. 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.. 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.

Topics: Adult; Antipsychotic Agents; Borderline Personality Disorder; Delayed-Action Preparations; Dibenzothiazepines; Dose-Response Relationship, Drug; Double-Blind Method; Drug Administration Schedule; Female; Humans; Male; Middle Aged; Patient Selection; Psychiatric Status Rating Scales; Quetiapine Fumarate; Treatment Outcome

Data on the efficacy of quetiapine in borderline personality disorder (BPD) are still scarce. We aimed to investigate the efficacy of quetiapine for impulsivity and a broad range of affective symptoms in BPD. In this 12-week open-label study, we included individuals with BPD who presented to psychiatric in- and outpatient services. After a gradual titration of quetiapine, a flexible dose (range, 100-800 mg) was administered. The main outcome measures consisted of the scores on patient-rated questionnaires (Barratt Impulsiveness Scale, Buss-Durkee Hostility Inventory, Affective Lability Scale, Spielberger State and Trait Anxiety Inventory, Spielberger State and Trait Anger Inventory, and Beck Depression Inventory) and on neurocognitive tasks related to impulsivity (Stroop Color Word Task and IOWA Gambling Task). A mixed linear model, correcting for age, sex, antidepressant use, and weeks in psychotherapy, was applied. Forty-one patients (34 females and 7 males; mean [SD] age, 27.0 [9.0] years) were enrolled in the study, 32 of which completed the trial. Patients' scores decreased significantly (mean [SD] difference; P value) on the Barratt Impulsiveness Scale (19.7 [2.0]; P < 0.0001), Buss-Durkee Hostility Inventory (11.5 [1.4]; P < 0.0001), Affective Lability Scale (0.75 [0.08]; P < 0.0001), Beck Depression Inventory (25.0 [1.7]; P < 0.0001), Spielberger State and Trait Anxiety Inventory state (19.9 [1.9]; P < 0.0001) and trait (20.8 [1.7]; P < 0.0001) subscale, and Spielberger State and Trait Anger Inventory state (7.3 [1.1]; P < 0.0001) and trait (10.1 [1.0]; P < 0.0001) subscale. In addition, patients showed significantly less inference on the Stroop Color Word Task and had more 'good choices' on the IOWA Gambling Task. These results suggest that quetiapine may be efficacious in the treatment of impulsivity and affective symptoms in BPD.

Topics: Adult; Affective Symptoms; Aggression; Anger; Antipsychotic Agents; Borderline Personality Disorder; Depression; Dibenzothiazepines; Disorders of Excessive Somnolence; Female; Humans; Impulsive Behavior; Male; Neuropsychological Tests; Patient Dropouts; Patient Satisfaction; Quetiapine Fumarate; Receptors, Dopamine D2; Sex Factors; Test Anxiety Scale; Treatment Outcome; Xerostomia

Second-generation antipsychotics with a favorable tolerability profile have offered new treatment options for patients with borderline personality disorder. Sparse data are available on the use of quetia-pine in treating this disorder. The aim of the present study is to investigate efficacy and tolerability of quetia-pine in a group of patients with borderline personality disorder.. Fourteen consecutive outpatients with a DSM-IV diagnosis of borderline personality disorder were treated for 12 weeks with open-label quetiapine at the dose of 200-400 mg/day. Patients were assessed at baseline, week 4, and week 12 with the Clinical Global Impressions (CGI) severity item, the Brief Psychiatric Rating Scale (BPRS), the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Rating Scale for Anxiety (HAM-A), the Social and Occupational Functioning Assessment Scale (SOFAS), the Borderline Personality Disorder Severity Index (BPDSI), and the Barratt Impulsiveness Scale-version 11 (BIS-11). Adverse effects were evaluated using the Dosage Record and Treatment Emergent Symptom Scale. Statistical analysis was performed with the ANOVA for repeated measures. Significant p values were < or = .05.. Eleven patients completed the study. Three patients (21.4%) dropped out due to excessive somnolence or noncompliance. The mean +/- SD dose of quetia-pine was 309.09 +/- 83.12 mg/day. A significant change was found for the scores of the following scales: CGI severity item, BPRS, HAM-A, SOFAS, BPDSI total score, BPDSI items "impulsivity" and "outbursts of anger," and BIS-11. Common adverse effects were mild-to-moderate somnolence, dry mouth, and dizziness.. Initial data suggest that quetiapine is efficacious and well tolerated in treating patients who have borderline personality disorder, particularly when impulsiveness/aggressiveness-related symptoms are prominent. At the moment, no reliable comparison is available in the literature. Double-blind controlled trials are needed to verify these findings.

Topics: Adult; Aggression; Analysis of Variance; Anger; Antipsychotic Agents; Borderline Personality Disorder; Dibenzothiazepines; Disorders of Excessive Somnolence; Dizziness; Drug Administration Schedule; Female; Humans; Impulsive Behavior; Male; Pilot Projects; Psychiatric Status Rating Scales; Quetiapine Fumarate; Severity of Illness Index; Treatment Outcome; Xerostomia

Recent studies indicate that atypical neuroleptics may be safe and useful in treating many symptoms of borderline personality disorder (BPD), including impulsivity, which can constitute the core dimension of this pathology. This study aimed to evaluate the efficacy and safety of quetiapine in patients with well-defined BPD. It was hypothesized that quetiapine would reduce impulsivity (primary hypothesis) and also affective and micropsychotic symptoms, resulting in improved social and global functioning (secondary hypothesis).. Twenty-three outpatients with BPD according to DSM-IV criteria and the revised Diagnostic Interview for Borderlines completed a 12-week open-label study with quetiapine. The study was conducted from May 2001 to May 2003. The clinical efficacy was assessed using the following: Hamilton Rating Scales for Depression and Anxiety, Hopelessness Scale, Brief Psychiatric Rating Scale, Barratt Impulsivity Scale, Buss-Durkee Hostility Inventory, Temperament and Character Inventory, Social Adjustment Scale, and Global Assessment of Functioning.. The mean daily dose of quetiapine (251 +/- 50 mg; range, 175-400 mg) was well tolerated. Impulsivity was significantly improved by quetiapine (p = .0015), as were most of our outcome measures: hostility, depression, anxiety, character dimensions, and social and global functioning (p < .05). In the small subgroup of patients with psychotic symptoms at baseline, there was a significant reduction in these symptoms (N = 8, p = .018).. In a sample of patients with severe BPD without or with only few psychotic symptoms, a low dose of quetiapine was associated with a strong positive clinical impact, including improvement of impulsivity.

Topics: Adolescent; Adult; Antipsychotic Agents; Borderline Personality Disorder; Dibenzothiazepines; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Humans; Impulsive Behavior; Male; Middle Aged; Personality Inventory; Psychiatric Status Rating Scales; Quetiapine Fumarate; Severity of Illness Index; Treatment Outcome

Borderline personality disorder (BPD) is common and poses many clinical challenges. Despite limited evidence of effectiveness, psychotropic medications are often prescribed. We aimed to characterise overdose presentations in patients with BPD.. This is a retrospective observational series of patients with BPD presenting to a tertiary hospital following an overdose from January 2019 to December 2020. Medical records were reviewed to determine baseline characteristics, overdose details, clinical features, treatment, and disposition.. There were 608 presentations in 370 people (76% female), median age 28 years (range 16-75 years). The majority (331[89%]) of patients were prescribed at least one psychotropic medication, with 129 (35%) being prescribed three or more different psychotropic agents. Of the total prescribed psychotropics, 520/1459 (36%) were for off-label indications. The majority of agents (860/1487[58%]) taken in overdose were prescribed. The commonest drug classes taken in overdose were benzodiazepines (241[16%]) and antipsychotics (229[15%]). Severe toxicity occurred in 99 (16%) cases with either coma (GCS<9) or hypotension (systolic BP <90 mmHg). The commonest agent associated with severe toxicity was quetiapine 39/99 (39%).. Psychotropic polypharmacy is common in BPD, often with off-label indications. Prescribed medications are commonly taken in overdose. Quetiapine is over-represented both in off-label prescribing and associated harm.

Topics: Adolescent; Adult; Aged; Antipsychotic Agents; Borderline Personality Disorder; Drug Overdose; Female; Humans; Male; Middle Aged; Off-Label Use; Psychotropic Drugs; Quetiapine Fumarate; Retrospective Studies; Young Adult

We report the case of an 18-year-old woman with personality disorders who was hospitalized a few hours after suicidal ingestion of acetaminophen, quetiapine, acetylsalicylic acid, and ethanol. Twelve hours after admission, severe liver damage was evident, but the patient was stable and awaiting hepatic transplantation. Electrolytes were successfully controlled. The condition of the liver stabilized. Cardiac biomarkers then deteriorated unexpectedly. Localized ST-segment elevations were noted on electrocardiogram, but angiography ruled out myocardial infarction. A computed tomographic scan ruled out cerebral edema. The patient died of irreversible cardiac arrest 40 hours after admission. Heart failure remained unexplained, and the body underwent forensic autopsy.At autopsy, histologic findings were indicative of acute toxic myocarditis and were concluded to be caused by acetaminophen intoxication. Acetaminophen overdose is common and typically leads to liver failure requiring supportive treatment and emergency liver transplantation. Toxic myocarditis is an extremely rare complication of acetaminophen overdose. It has only been reported 4 times in the literature despite the widespread use and misuse of acetaminophen. Toxic myocarditis remains a possibility in many cases of overdose but can be overlooked in a clinical picture dominated by hepatorenal failure and encephalopathy. Clinicians and forensic pathologists should be aware of this rare potential complication.

Topics: Acetaminophen; Adolescent; Analgesics, Non-Narcotic; Anti-Inflammatory Agents, Non-Steroidal; Antipsychotic Agents; Aspirin; Borderline Personality Disorder; Central Nervous System Depressants; Drug Overdose; Ethanol; Female; Gas Chromatography-Mass Spectrometry; Heart Failure; Humans; Myocarditis; Quetiapine Fumarate; Suicide

Topics: Antipsychotic Agents; Borderline Personality Disorder; Clinical Trials as Topic; Dibenzothiazepines; Humans; Prescription Drug Misuse; Quetiapine Fumarate; Scientific Misconduct

Pharmacotherapy still seems to play a major role in the treatment of patients suffering from borderline personality disorder (BPD). However, little is known about psychiatrists' detailed perspective on indication and significance of medication. A total of 233 psychiatrists in the city of Munich and in Upper Bavaria were asked by questionnaire about their treatment habits in the medical treatment of patients with BPD. One hundred and forty-one psychiatrists answered the questionnaire (60.5%). In total, 94% of BPD patients were treated with psychotropic medication. Psychiatrists predominantly saw an indication to prescribe antidepressants (98%), followed by antipsychotics, mood stabilizers, and benzodiazepines. Citalopram/escitalopram and quetiapine were mentioned most frequently. The results are discussed in conjunction with the international guidelines for the treatment of BPD.

Topics: Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Borderline Personality Disorder; Citalopram; Combined Modality Therapy; Dibenzothiazepines; Dietary Supplements; Germany; Guideline Adherence; Health Care Surveys; Humans; Phytotherapy; Practice Guidelines as Topic; Practice Patterns, Physicians'; Private Practice; Psychiatry; Psychotherapy; Psychotropic Drugs; Quetiapine Fumarate; Rural Health Services; Urban Health Services; Workforce

Topics: Adolescent; Aggression; Antipsychotic Agents; Borderline Personality Disorder; Child; Depression; Dibenzothiazepines; Drug Therapy, Combination; Humans; Irritable Mood; Male; Pilot Projects; Quetiapine Fumarate; Suicidal Ideation; Treatment Outcome

There exists a growing argument in favour of a more dimensional approach to the diagnosis and treatment of psychiatric patients. This encompasses first the idea of a spectrum of symptoms correlating to severity within a single disorder, and secondly, the idea of spectra of different disorders sharing overlapping collections of symptoms. Here we consider the issue in light of specific clinical examples we have observed, which support the idea of a 'mental illness spectrum', both with symptoms within a single disorder, and between different mental disorders.

Topics: Antipsychotic Agents; Bipolar Disorder; Borderline Personality Disorder; Combined Modality Therapy; Comorbidity; Depressive Disorder, Major; Diagnosis, Differential; Dibenzothiazepines; Humans; International Classification of Diseases; Mental Disorders; Prodromal Symptoms; Psychotherapy; Quetiapine Fumarate; Schizophrenia; Schizophrenic Psychology; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Borderline Personality Disorder; Cardiomyopathy, Dilated; Depression; Dibenzothiazepines; Echocardiography; Female; Humans; Male; Quetiapine Fumarate; Schizophrenia, Catatonic; Stroke Volume

Topics: Adult; Antipsychotic Agents; Borderline Personality Disorder; Dibenzothiazepines; Female; Humans; Male; Quetiapine Fumarate; Substance-Related Disorders

We aimed to assess whether executive functioning improved over time in a sample of borderline personality disorder (BPD) subjects that took part in a quetiapine treatment trial.. Performance on the following neurocognitive tasks was assessed at enrolment and at the end of the 12 weeks quetiapine treatment: Trail Making Task, Word Fluency Task and Tower of London Task. Forty-one BPD patients were recruited, of whom 32 completed the trial. An intention-to-treat analysis with a mixed linear model was applied.. The data show that participants significantly improved on most executive functioning measures. Patients' scores decreased significantly (mean [SD] difference; p-value) on the Trail Making Task Part A (11.7 [2.3]; p < 0.0001), Part B (51.8 [9.2]; p < 0.0001) and 'B minus A' (40.1 [8.2]; p < 0.0001), on a Phonological (15.9 [1.6]; p < 0.0001) and Semantic (9.8 [1.1]; p < 0.0001) Verbal Fluency tasks, and on the Tower of London total correct score (2.5 [0.4]; p < 0.0001), total move score (29.5 [4.5]; p < 0.0001) and total time (172.9 [35.8]; p < 0.0001).. In this study we have demonstrated that executive functioning in BPD is improved after treatment with quetiapine. Neurocognitive measures of executive functioning should be considered as valuable outcomes in the study of treatment efficacy in BPD.

Topics: Adolescent; Adult; Antipsychotic Agents; Borderline Personality Disorder; Cognition Disorders; Dibenzothiazepines; Executive Function; Female; Humans; Linear Models; Male; Neuropsychological Tests; Quetiapine Fumarate; Young Adult

Topics: Antipsychotic Agents; Borderline Personality Disorder; Dibenzothiazepines; Female; Humans; Middle Aged; Obsessive Behavior; Psychiatric Status Rating Scales; Quetiapine Fumarate

Only a few studies have commented on the use of atypical antipsychotics for the treatment of Borderline Personality Disorder (BPD) features, including affective dysregulation and aggression. We aimed at evaluating both efficacy and safety of quetiapine in a sample of consecutive BPD patients.. 29 BPD outpatients entered, and 23 completed, a 12 week, open-label, regime of quetiapine at an average daily dosage of 540 mg (range: 400-800 mg). Efficacy assessment psychometric instruments included: Hamilton Rating Scales for Depression (HAM-D); Brief Psychiatric Rating Scale (BPRS); Global Assessment of Functioning (GAF); Clinical Global Impression Scale (CGI); and Aggression Questionnaire (AQ).. Both completer and intent-to-treat analysis showed that most psychometric scales' scores exhibited a highly significant (HAM-D: p=.003; BPRS Hostility and Suspiciousness subscales; CGI; GAF; AQ: all at p=.000) improvement over time. Six patients dropped out early from treatment due to side effects; quetiapine was associated with two cases of transient thrombocytopenia.. Present findings would suggest that quetiapine may be effective for the treatment of a number of BPD features, including low mood and aggression. However, monitoring blood counts in patients receiving quetiapine seems to be justified.

Topics: Adult; Affect; Aggression; Antipsychotic Agents; Borderline Personality Disorder; Depression; Dibenzothiazepines; Female; Humans; Male; Psychiatric Status Rating Scales; Quetiapine Fumarate

To evaluate clinical outcomes and the tolerability of 2 weeks' quetiapine (QTP) treatment for hospitalised patients in a naturalistic setting.. Patients with schizophrenia (n = 18), drug-induced psychosis (n = 10; 3 cocaine, 4 hashish and marijuana, and 3 all three substances) or borderline personality disorder (n = 13), were diagnosed by two expert clinicians on the basis of an unstructured clinical interview, and were treated with QTP (250-1000 mg/day). The subjects were then clinically assessed at baseline, and after 7 and 15 days, using the Brief Psychiatric Rating Scale, the Positive and Negative Symptoms Scale (PANSS) and the Hamilton Rating Scale for Depression. At the end of the study, plasma QTP levels were determined and examined in relation to clinical outcome and tolerability.. The mean scores of each rating scale were significantly lower at the end of the study in the population as a whole, and within each diagnostic group. The percentage improvement was significantly greater in the patients with drug-induced psychosis than in those with schizophrenia (42.4 +/- 9.1% versus 23.6 +/- 13.5%). QTP was well tolerated, and the incidence of extrapyramidal side effects was low. There was a linear correlation between plasma levels and dose/kg of QTP (r = 0.31; p < 0.05). The improvement in PANSS significantly correlated with plasma levels and dose/kg in each diagnostic category (Spearman's coefficient was 0.75 [p < 0.01] for schizophrenia and borderline personality disorder, and was 0.68 [p < 0.05] for drug-induced psychosis).. The results suggest that 2 weeks' QTP treatment may improve the clinical outcome of psychotic re-exacerbation phases in different diagnostic categories and indicate that QTP improves clinical outcome in drug-induced psychosis, as QTP levels correlated with the clinical improvement measured by PANSS.

Topics: Acute Disease; Adolescent; Adult; Aged; Borderline Personality Disorder; Dibenzothiazepines; Dose-Response Relationship, Drug; Female; Humans; Male; Middle Aged; Psychiatric Status Rating Scales; Psychoses, Substance-Induced; Quetiapine Fumarate; Schizophrenia; Time Factors

We report three consecutive cases of women with borderline personality disorder with psychotic symptoms, who received pharmacotherapy with the new atypical antipsychotic drug aripiprazole. Therapeutic effects were measured using the SCL-90R (symptom check list) and the BSL (borderline symptom list). We observed different responses to aripiprazole. In the first patient we had to discontinue the drug before we were able to observe any therapeutic effects. The second patient also complained about initial side effects. However, after the dose was lowered, the drug was tolerated and she responded well to aripiprazole with respect to all psychopathological aspects. The third patient did not suffer from any side effects under aripiprazole. She responded partially to the drug. Aripiprazole may have a potential role in the pharmacotherapy of borderline personality disorder and may not only target psychotic symptoms in these patients.

Topics: Adolescent; Adult; Akathisia, Drug-Induced; Antipsychotic Agents; Aripiprazole; Borderline Personality Disorder; Cognitive Behavioral Therapy; Combined Modality Therapy; Comorbidity; Dibenzothiazepines; Dose-Response Relationship, Drug; Female; Follow-Up Studies; Humans; Hypotension, Orthostatic; Personality Assessment; Piperazines; Psychiatric Status Rating Scales; Quetiapine Fumarate; Quinolones

Affective dysregulation, impulsivity and cognitive-perceptual difficulties are the psychopathological nuclear dimensions of Borderline Personality Disorder (BPD). Psychopharmacological treatment may become necessary during episodes of acute decompensation in which suicidal or self-destructive behaviour erupts. Some classes of psychotropic drugs have demonstrated efficacy in diminishing symptom severity and optimising functioning, such as antidepressants, mood stabilizers, benzodiazepines, opiate antagonists and antipsychotics. Conventional antipsychotics are the best-studied psychotropic medications for BPD, but nonadherence is often due to their severe side effects. Preliminary data reveal efficacy of atypical antipsychotics in BPD. We describe the impact of the novel antipsychotic drug quetiapine on severe self-mutilation in two female patients with the diagnoses of BPD. In both cases, monotherapeutic treatment with quetiapine was well tolerated and resulted in a marked improvement of impulsive behaviour and, over time, overall level of function. Though promising, our findings have to be regarded as preliminary. Due to the overall paucity of data there still is insufficient evidence to make a strong recommendation concerning continuation and maintenance therapy with atypical antipsychotics in BPD. Thus, there is a clear need for further controlled studies to evaluate pharmacological treatment options for this disorder.

Topics: Adult; Antipsychotic Agents; Borderline Personality Disorder; Dibenzothiazepines; Female; Humans; Quetiapine Fumarate