topiramate and Borderline-Personality-Disorder

There is a common practice of polypharmacy and an increased use of mood stabilizers in personality disorders (PD). This paper reviews all randomized controlled trials (RCTs) of anticonvulsants to evaluate the evidence base supporting their use in treatment of PD.. German and English language literature cited in Medline and published between 1970 and 2008 was searched using the following terms: Borderline/personality disorder, anticonvulsant, mood stabilizer, carbamazepine, felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenytoine, pregabalin, tiagabine, topiramate, and valproate.. Twelve RCTs were identified which included anticonvulsants in treatment of personality disorders. The anticonvulsants valproate and topiramate appeared to have the most empirical support for having a favorable effect on symptoms of borderline personality disorder. Evidence for the use of other anticonvulsants in patients with PD is sparse.. Valproate and topiramate, probably also lamotrigine, carbamazepine, and oxcarbazepine as well, were useful in treating symptoms of affective dysregulation and impulsive aggression in PD. However, further RCTs of anticonvulsants are greatly needed as clinical use of these agents has risen without sufficient evidence supporting their efficacy and safety in personality disorders.

Topics: Amines; Anticonvulsants; Borderline Personality Disorder; Carbamazepine; Cyclohexanecarboxylic Acids; Fructose; Gabapentin; gamma-Aminobutyric Acid; Humans; Lamotrigine; Oxcarbazepine; Personality Disorders; Pregabalin; Randomized Controlled Trials as Topic; Topiramate; Triazines; Valproic Acid

Borderline Personality Disorder (BPD) constitutes a profound instability with dysfunction in three psychopathological dimensions as cognitive-perceptual symptoms, affective dysregulation and behavioral impulsivity. Psychopharmacotherapy has a crucial role in the treatment of this complex disorder and targets the respective core symptoms. It comprises basically atypical antipsychotics, antidepressant agents and moodstabilizers, often requiring a combination of these substances in case of complex, multidimensional symptoms. Regarding the predominantly young and female patients the teratogenic risk demands critical consideration. This study focuses on the use of moodstabilizers in the treatment of BPD and gives an overview of the currently available studies on this substance class, in particular on lithium, carbamazepine, divalproex sodium, topiramate and lamotrigine. Results show significant effects on core features of BPD, but nevertheless, there are considerable limits in comparability and validity among the studies because of heterogeneities in the patient groups, study design, additive medication and outcome measures. Disregarding the off-label use in this indication the data reflect however an established clinical practice of use for these substances and underline the pivotal impact of moodstabilizers in the treatment of core symptoms of BPD.

Topics: Anticonvulsants; Antimanic Agents; Borderline Personality Disorder; Carbamazepine; Female; Fructose; Humans; Lamotrigine; Lithium Compounds; Male; Randomized Controlled Trials as Topic; Topiramate; Triazines; Valproic Acid

We previously tested topiramate, an anticonvulsant, in the treatment of aggression in men with borderline personality disorder (BPD) (Nickel M, Nickel C, Kaplan P, Lahmann C, Mühlbacher M, Tritt K, et al. Treatment of aggression with topiramate in male borderline patients: a double-blind, placebo-controlled study. Biol Psychiatry 2005;57:495-9), and found significant changes on most scales of the state-trait anger expression inventory (STAXI) and significant weight loss eight weeks later. The aim of this trial was to assess topiramate's efficacy in the long-term therapy for aggression in men with BPD.. This 18-month follow-up observation, in which the previous patients (topiramate group: n=22; former placebo group: n=22) were examined bianually, was carried out.. According to the intent-to-treat principle, significant changes on all scales of the STAXI were observed in the subjects treated with topiramate. Additional significant weight loss was observed. All subjects tolerated topiramate relatively well.. Topiramate appears to be an effective, relatively safe agent in the long-term treatment of patients with BPD. Mild, non-transient weight loss can be expected.

Topics: Adult; Aggression; Anger; Anticonvulsants; Borderline Personality Disorder; Double-Blind Method; Follow-Up Studies; Fructose; Humans; Male; Personality Inventory; Topiramate; Weight Loss

Topics: Adolescent; Adult; Anticonvulsants; Borderline Personality Disorder; Double-Blind Method; Female; Follow-Up Studies; Fructose; Humans; Topiramate

Topics: Adult; Anticonvulsants; Borderline Personality Disorder; Double-Blind Method; Follow-Up Studies; Fructose; Humans; Male; Personality Assessment; Topiramate; Treatment Outcome

Topics: Aggression; Analysis of Variance; Borderline Personality Disorder; Double-Blind Method; Female; Follow-Up Studies; Fructose; Humans; Neuroprotective Agents; Psychiatric Status Rating Scales; Topiramate

Borderline personality disorder is a common and severe psychiatric illness. The goal of this study was to determine whether topiramate can influence patients' borderline psychopathology, health-related quality of life, and interpersonal problems. Women meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Structured Clinical Interview II criteria for borderline personality disorder were randomly assigned in a 1:1 ratio to topiramate titrated from 25 to 200 mg/d (n = 28) or placebo (n = 28) for 10 weeks. Primary outcome measures were changes on the Symptom-Checklist, on the SF-36 Health Survey, and on the Inventory of Interpersonal Problems. Body weight and additional side effects were assessed weekly. According to the intent-to-treat principle, significant changes (all P < 0.001) on the somatization, interpersonal sensitivity, anxiety, hostility, phobic anxiety, and Global Severity Index scales of the Symptom Checklist were observed in the topiramate-treated subjects after 10 weeks (no significant changes on the obsessive-compulsive, depression, paranoid ideation, and psychoticism scales). In the SF-36 Health Survey, significant differences were observed on all 8 scales (all P < 0.01 or P < 0.001). In the Inventory of Interpersonal Problems, significant differences (all P < 0.001) were found in the scales for overly autocratic, overly competitive, overly introverted, and overly expressive (no significant differences in the scales for overly cold, overly subassertive/subservient, overly exploitable/compliant, and overly nurturant/friendly). Weight loss was additionally observed (p < 0.001). Topiramate appears to be a safe and effective agent in the treatment in women with borderline personality disorder. Additional weight loss can be expected.

Topics: Adolescent; Adult; Anger; Anticonvulsants; Anxiety; Borderline Personality Disorder; Double-Blind Method; Female; Fructose; Humans; Interpersonal Relations; Personality Inventory; Placebos; Psychiatric Status Rating Scales; Quality of Life; Topiramate; Weight Loss

Borderline personality disorder (BPD) is a complex mental disease associated with severe serious functional impairment, affective instability, and impulsive aggression. The aim of this study was to compare the efficacy of topiramate versus placebo in the treatment of aggression in men with borderline personality disorder.. We conducted an 8-week, double-blind, placebo-controlled study of topiramate in 42 male subjects (42 of 44) meeting DSM-IV criteria for BPD. The Structured Clinical Interview (SCID I and II) was carried out. The subjects were randomly assigned to topiramate (n = 22) or placebo (n = 20).. Significant changes on four STAXI scales (State Anger, p < .01; Trait Anger, p < .05; Anger Out, p < .01; Anger Control, p < .01) were observed in the subjects treated with topiramate. A nonsignificant difference was found on the Anger In scale (p = .86). Additional significant weight loss was observed (difference in weight loss between the both groups was 5.0 kg, p < .01, 95% confidence interval = [-6.5 to 3.4]). All subjects tolerated topiramate relatively well.. Topiramate appears to be an effective agent in the treatment of anger in men with BPD. Mild weight loss can be expected.

Topics: Adult; Aggression; Body Weight; Borderline Personality Disorder; Double-Blind Method; Follow-Up Studies; Fructose; Humans; Male; Mood Disorders; Neuroprotective Agents; Personality Inventory; Placebos; Psychiatric Status Rating Scales; Statistics, Nonparametric; Topiramate

The goal of this study was to compare the efficacy and safety of topiramate versus placebo in the treatment of aggression in women who meet the criteria for borderline personality disorder.. We conducted a double-blind, placebo-controlled study of topiramate in 29 female subjects (response rate 93.5%) meeting SCID (Structured Clinical Interview for DSM-IV) criteria for borderline personality disorder. The subjects were randomly assigned in a 2:1 ratio to topiramate (N = 21, analysis based on N = 19) or placebo (N = 10). Treatment lasted 8 weeks (November 2003-January 2004). Primary outcome measures were self-reported changes on the anger subscales of the State-Trait Anger Expression Inventory (STAXI).. Significant improvements on 4 subscales of the STAXI (state-anger, trait-anger, anger-out, anger-control) were observed in the topiramate-treated subjects after 8 weeks, in comparison with the placebo group. The difference in improvement in score between the 2 groups for state-anger, trait-anger, and anger-out ranged from 21% to 24%, and the difference for anger-control was -13%. As an exception, a difference of only 8.5% (p < .2) was found on the anger-in subscale. Significantly greater weight loss was observed in the topiramate-treated group than in those treated with placebo (difference in weight loss between the 2 groups: 2.3 kg [5.1 lb] [3.2%]; 95% CI = 1.3% to 4.4%, p < .01). All patients tolerated topiramate well.. Topiramate appears to be a safe and effective agent in the treatment of anger in women with borderline personality disorder as defined by SCID criteria. Additionally, significant weight loss can be expected.

Topics: Adult; Aggression; Anger; Anticonvulsants; Borderline Personality Disorder; Double-Blind Method; Female; Fructose; Humans; Placebos; Psychiatric Status Rating Scales; Topiramate; Treatment Outcome; Weight Loss

Topics: Adolescent; Anti-Anxiety Agents; Borderline Personality Disorder; Emergency Medical Services; Female; Fructose; Humans; Lorazepam; Neuroprotective Agents; Panic Disorder; Topiramate

Topiramate is an anticonvulsant which has been used more and more in recent years in psychiatry as well. The undesirable effects that have been observed remain relatively mild under conditions of slow titration. Psychotic symptoms have been described in connection with the use of topiramate in individual cases, however. It is not known which concomitant circumstances favour the appearance of this side-effect, though. This is a report about a psychotic attack that happened for the first time and lasted for one night in a borderline patient who was treated with topiramate 250 mg/day shortly after the start of a febrile infection. After the infection had gone, topiramate was given again and titrated to 300 mg/day. No further psychotic symptoms were observed.

Topics: Adult; Anticonvulsants; Borderline Personality Disorder; Dose-Response Relationship, Drug; Drug Administration Schedule; Fever of Unknown Origin; Fructose; Hallucinations; Humans; Male; Psychoses, Substance-Induced; Respiratory Tract Infections; Topiramate

We report on a woman with borderline personality disorder and a history of childhood trauma that showed significant clinical response with low dosage of topiramate. We propose that topiramate changed some of the main features of this disorder, such as catastrophic reaction to real or imaginary abandonment or rejection, improving adaptive functioning. We hypothesize that topiramate might facilitate memory extinction, therefore decreasing emotional and behavioural reactivity.

Topics: Borderline Personality Disorder; Child; Child Abuse; Female; Fructose; Humans; Middle Aged; Neuroprotective Agents; Topiramate

Topics: Adult; Bipolar Disorder; Borderline Personality Disorder; Comorbidity; Drug Overdose; Feeding and Eating Disorders; Female; Fructose; Humans; Substance-Related Disorders; Topiramate; Weight Gain

Topics: Adult; Anticonvulsants; Borderline Personality Disorder; Female; Fructose; Humans; Self-Injurious Behavior; Topiramate