Abstract
Recent years have witnessed an important growth in the understanding and treatment of persons with Axis II disorders. Research into the biological bases of Axis II disorders increasingly suggests that these disorders ought to be regarded less as a discrete category and more as existing on a spectrum with their Axis I cohorts. This chapter summarizes these studies as well as the studies into what pharmacological agents can contribute to the amelioration of symptoms. Each section of the chapter takes up a different “dimension,” or grouping, of behavioral traits exhibited by persons with Axis II disorders. Each section first summarizes the studies to date into the psychobiology underlying these traits and then discusses the various psychopharmacological approaches to target these traits. The chapter's primary focus, however, is on the use of antidepressants to treat many of the common symptoms underlying personality disorders. Studies evaluating the use of selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants (TCAs), and monoamine oxidase inhibitors (MAOIs) in treating impulsivity, affective instability, and anxiety are described. Although the emphasis is on antidepressants, studies that have looked into the treatment of these traits with other medications, such as anticonvulsants, beta-blockers, and benzodiazepines, are also discussed. Many agents have shown promise in curbing the traits that often accompany personality disorders, although the results have often been mixed. The findings reported on in this chapter suggest potential interventions and point the way toward future avenues of research into the clinical psychopharmacological management of patients with personality disorders.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th ed. American Psychiatric Association, Washington, DC
Amies PL, Gelder MG, Shaw PM (1983) Social phobia: A comparative clinical study. Br J Psychiatry 142:174–179
Arango V, Ernsberger P, Marzuk PM, Chen JS, Tierney H, Stanley M, Reis DJ, Mann JJ (1990) Autoradiographic demonstration of increased serotonin 5-HT2 and beta-adrenergic receptors binding sites in the brain of suicide victims. Arch Gen Psychiatry 47:1038–1047
Aston-Jones G, Bloom FE (1981) Norepinephrine-containing locus coeruleus neurons in behaving rats exhibiting pronounced responses to non-noxious environmental stimuli. J Neurosci 1:887–890
Baron M, Gruen R, Rainer JD, Kane J, Asnis L, Lord S (1985) A family study of schizophrenic and normal control probands: Implications for the spectrum concept of schizophrenia. Am J Psychiatry 142:447–455
Battaglia M, Gasperini M, Sciuto G, Scherillo P, Diaferia G, Bellodi L (1991) Psychiatric disorders in the families of schizotypal subjects. Schizphr Bull 17:659–668
Baxter L, Edell W, Gerner R, Fairbanks L, Gwirtsman H (1984) Dexamethasone suppression test and Axis I diagnoses of inpatients with DSM-II borderline disorder. J Clin Psychiatry 45:150–153
Beeber AR, Kline MD, Pies RW, Manring JM Jr (1984) Dexamethasone suppression test in hospitalized depressed patients with borderline personality disorder. J Nerv Ment Dis 172:301–303
Berg E (1948) A simple objective technique for measuring flexibility in thinking. J Gen Psychol 39:15–22
Bergman AJ, Harvey PD, Roitman SL, Mohs RC, Marder D, Silverman JM, Siever LJ (1998) Verbal learning and memory in schizotypal personality disorder. Schizophr Bull 24:635–641
Biederman J, Newcorn J, Sprich S (1991) Comorbidity of attention deficit hyperactivity disorder (ADHD) with conduct, depressive, anxiety and other disorders. Am J Psychiatry 148:564–577
Braff DL (1986) Impaired speed of information processing in non-medicated schizotypal patients. Schizophr Bull 7:499–508
Brown GL, Ebert MH, Goyer PF, Jimerson DC, Klein WJ, Bunney WE, Goodwin FK (1982) Aggression, suicide, and serotonin relationships to CSF metabolites. Am J Psychiatry 139:741–745
Bunney WE Jr, Bunney-Garland BL (1987) Mechanism of action of lithium in affective illness: Basic and clinical implications. In: Meltzer HY (ed) Psychopharmacology: Third generation of progress. Raven Press, New York, pp 553–563
Cazzulo C, Vita A, Giobbio G, Dieci M, Saccheti E (1991) Cerebral structural abnormalities in schizophreniform disorder and in schizophrenia spectrum personality disorders. In Schizophrenia Research: Advances in neuropsychiatry and psychopharmacology, vol 1. Edited by Tamminga C, Schultz S. New York, Raven Press, pp 209–217
Coccaro EF (1989) Central serotonin in impulsive aggression. Br J Psychiatry 155(suppl 8):52–62
Coccaro EF (1993) Psychopharmacologic studies in patients with personality disorder: Review and perspective. Journal of Personality Disorders (Spring suppl):181–192
Coccaro EF, Bergeman CS (1993) Heritability of irritable impulsiveness: A study of twins reared together and apart. Psychiatry Res 48:229–242
Coccaro EF, Kavoussi RJ (1995) Fluoxetine in aggression in personality disorders [New Research Abstracts]. Presented at the American Psychiatric Association 148th annual meeting, Miami, Florida, May 20-25
Coccaro EF, Siever LJ, Klar HM, Maurer G, Cochrane K, Cooper TB, Mohs RC, Davis KL (1989) Serotonergic studies in patients with affective and personality disorders: Correlates with suicidal and impulsive aggressive behavior. Arch Gen Psychiatry 46:587–599
Coccaro EF, Astill JL, Herbert JL, Schut AG (1990a) Fluoxetine treatment of impulsive aggression in DSM-III-R personality disorder patients. J Clin Pharmacol 10:373–375
Coccaro EF, Gabriel S, Siever LJ (1990b) Buspirone challenge: Preliminary evidence for a role for 5-HT1a receptors in impulsive aggressive behavior in humans. Psychopharmacol Bull 26:393–405
Coccaro EF, Lawrence T, Trestman R, Gabriel S, Klar HM, Siever LJ (1991) Growth hormone responses to intravenous clonidine challenge correlates with behavioral irritability in psychiatric patients and in healthy volunteers. Psychiatry Res 39:129–139
Cornblatt BA, Lenzenweber MF, Dworkin RH, Erlenmeyer-Kimling L (1992) Childhood attention dysfunctions predict social deficits in unaffected adults at risk for schizophrenia. Br J Psychiatry 161(suppl 18):59–64
Cornelius JR, Brenner RP, Soloff PH, Schulz SC, Tumuluru RV (1986) EEG abnormalities in borderline personality disorder patients: Specific or non-specific. Biol Psychiatry 21:977–980
Cornelius JR, Soloff PH, Perel JM, Ulrich RF (1990) Fluoxetine trial in borderline personality disorder. Psychopharmacol Bull 26:151–154
Cornelius JR, Soloff PH, Perel JM, Ulrich RF (1991)A preliminary trial of fluoxetine in refractory borderline patients. J Clin Pharmacol 11:116–120
Cowdry RW, Gardner DL (1988) Pharmacotherapy of borderline personality disorder: Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine. Arch Gen Psychiatry 45:111–119
Cowdry RW, Pickar D, Davies R (1985-86) Symptoms and EEG findings in the borderline syndrome. Int J Psychiatry Med 15:201–211
Davidson JRT, Potts NLS, Richichi EA, Ford SM, Krishnan KR, Smith RD, Wilson W (1991) The brief social phobia scale. J Clin Psychiatry 52( suppl 11):48–51
Davis KL, Berger PA, Hollister LE, Defraites E (1978) Physostigmine in mania. Arch Gen Psychiatry 35:119–122
De la Fuente JM, Lotstra F (1994). A trial of carbamazepine in borderline personality disorder. Euro Neuropsychopharmacol 4:479–486
Deltito J, Stam M (1989) Psychopharmacological treatment of avoidant personality disorder. Compr Psychiatry 30:498–504
Elphick M, Yang JD, Cowen PJ (1990) Effects of carbamazepine on dopamine-and serotonin-mediated neuroendocrine responses. Arch Gen Psychiatry 47:135–140
Faltus F, Janeckova E (1985) The antidepressant effect of deprenyl. Jesenik, Czechoslovakia, 27th Annual Psychopharmacology Meeting
Fish B (1987) Infants predictors of the longitudinal course of schizophrenic development. Schizophren Bull 13:395–409
Fritze J, Sofic E, Muller T, Pfuller H, Lanczik M, Riederer P (1990) Cholinergic-adrenergic balance: Part 2, relationship between drug sensitivity and personality. Psychiatry Res 34:271–279
Garbutt JC, Loosen PT, Tipermas A, Prange AJ Jr (1983) The TRH test in patients with borderline personality disorder. Psychiatry Res 9:107–113
Gardner DL, Cowdry RW (1986) Alprazolam induced dyscontrol in borderline personality disorder. Am J Psychiatry 142:98–100
Goldberg SC, Schulz SC, Schulz PM, Resnick RJ, Hamer RM, Friedel RO (1986) Borderline and schizotypal personality disorders treated with low-dose thiothixine versus placebo. Arch Gen Psychiatry 43:680–686
Gottesman II, Shields J (1982) Schizophrenia: The epigenetic puzzle. Cambridge University Press, New York
Gottschalk LA, Gleser GC, Wylie HW Jr, Kaplan SM (1965) Effects of imipramine on anxiety and hostility levels. Psychopharmacology (Berlin) 7:303–310
Gunderson JG, Siever LJ, Spaulding E (1983) The search for the schizotypy: Crossing the border again. Arch Gen Psychiatry 40:15–22
Guy W (1976) ECDEU assessment manual for psychopharmacology-revised (DHEW Publ No ADM 76-338). Rockville, MD, U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs, pp 218–222
Hall RCW, Zisook S (1981) Paradoxical reactions to benzodiazepines. Br J Clin Pharmacol 11:99S–194S
Hedberg DC, Hauch JH, Glueck BC (1971) Tranylcypromine-trifluoperazine combination in the treatment of schizophrenia. Am J Psychiatry 127:1141–1146
Higley JD, Mehlman PT, Taub DM, Higley SB, Suomi SJ, Vickers JH, Linnoila M (1992b) Cerebrospinal fluid monoamine and adrenal correlates of aggression in free-ranging rhesus monkeys. Arch Gen Psychiatry 49:436–441
Janowsky DS, Risch CS (1987) Role of acetylcholine mechanisms in the affective disorders. In: Meltzer HY (ed) Psychopharmacology: The third generation of progress. Raven Press, New York
Janowsky DS, El-Yousef MK, Davis JM, Sekerke HJ (1972) Cholinergic antagonism of methylphenidate-induced stereotyped behavior. Psychopharmacology 27:297–314
Janowsky DS, El-Yousef MK, Davis JM (1974) Acethylcoline and depression. Psychosom Med 36:248–257
Kagan J, Reznick JS, Snidman N, Gibbons J, Johnson MO (1988) Childhood derivatives inhibition and lack of inhibition to the unfamiliar. Child Dev 59:1580–1589
Kavoussi RJ, Coccaro EF (1993) The amphetamine challenge test correlates with affective lability in healthy volunteers. Psychiatry Res 48:219–228
Kendler K (1985) Diagnostic approaches to schizotypal personality disorder: A historical perspective. Schizophren Bull 11:538–553
Kendler KS, Gruenberg AM (1984) An independent analysis of the Copenhagen sample of the Danish study of schizophrenia. VI. The relationship between psychiatric disorders as defined by DSM III in the relatives and adoptees. Arch Gen Psychiatry 41:555–564
Kendler KS, Gruenberg AM, Strauss JS (1981) An independent analysis of the Copenhagen sample of the Danish adoption study of schizophrenia. Arch Gen Psychiatry 38:982–984
Kendler KS, Ochs AL, Gorman AM, Hewitt JK, Ross DE, Mirsky AF (1991)The structure of schizotypy: A pilot multitrait twin study. Psychiatry Res 36:19–36
Kety SS (1988) Schizophrenic illness in the families of schizophrenic adoptees: Findings from the Danish national sample. Schizophr Bull 14:217–222
Kety SS, Rosenthal D, Wender PH (1975) Mental illness in the biological and adoptive families of adopted individuals who have become schizophrenics: a preliminary report based on psychiatric interviews. E. Fieve, D. Rosenthal and H. Brill (eds) Genetic research in psychiatry. John Hopkins University Press, Baltimore, pp 147–165
Kirrane RM, Siever LJ (2000) New perspectives on schizotypal personality disorder. Curr Psychiatry Rep 2:62–66
Kirrane RM, Mitropoulou V, Nunn M, New AS, Harvey PD, Schopick F, Silverman J, Siever LJ (2000) Effects of amphetamine on visuospatial working memory performance in schizophrenia spectrum personality disorder. Neuropsychopharmacology 22(1):14–18
Klein DF (1968) Psychiatric diagnosis and a typology of clinical drug effects. Psychopharmacology 13:359–386
Klein DF, Greenberg IM (1967) Behavioral effects of diphenylhydantoin in severe psychiatric disorders. Am J Psychiatry 124:847–849
Koenigsberg HW, Reynolds D, Goodman M, New A, Mitropoulou V, Trestman R, Silverman J, Siever LJ (2003) Risperidone in the treatment of schizotypal personality disorder. J Clin Psychiatry 64:628–634
Korzekwa M, Steiner M, Links P, Eppel A (1991) The dexamethasone suppression test in borderlines: Is it useful? Can J Psychiatry 36:26–28
Krishnan KR, Davidson JR, Rayasam K, Shope F (1984) The dexamethasone suppression test in borderline personality disorder. Biol Psychiatry 19:1149–1153
Lahmeyer HW, Val E, Gaviria FM, Prasad RB, Pandey GN, Rodgers P, Weiler MA, Altman EG (1988) EEG sleep, lithium transport, dexamethasone suppression, and monoamineoxidase activity in borderline personality disorder. Psychiatry Res 25:19–30
Lamprecht F, Eichelman B, Thoa NB, Williams RB, Kopin IJ (1972) Rat fighting behavior: Serum dopamine-B-hydroxylase and hypothalamic tyrosine hydroxylase. Science 177:1214–1215
Leone NF (1982) Response of borderline patients to loxapine and chlorpromazine. J Clin Psychiatry 43:148–150
Levine ES, Litto WJ, Jacobs BL (1990) Activity of cat locus coeruleus noradrenergic neurons during the defense reaction. Brain Res 531:189–195
Liebowitz, MR (1987) Social phobia. Modern Problems in Pharmacopsychiatry 22:141–173
Liebowitz MR (1989) Phenelzine versus atenolol in social phobia: A placebo controlled study. J Clin Psychiatry 49:498–504
Liebowitz MR (1992) Reversible MAO inhibitors in social phobia, bulimia and other disorders. Clin Neuropharmacol (suppl 1):434A–435A
Liebowitz MR, Klein DF (1981) Interrelationship of hysteroid dysphoria and borderline personality disorder. Psychiatr Clin North Am 4:67–87
Liebowitz MR, Fyer AJ, Gorman JM, Dillon D, Davies S, Stein JM, Cohen BS, Klein DF (1985) Specificity of lactate infusions in social phobia versus panic disorders. Am J Psychiatry 142:947–950
Liebowitz MR, Hollander E, Schneier F, Campeas R, Welkowitz L, Hatterer J, Fallon B (1990a) Reversible and irreversible monoamine oxidase inhibitors in other psychiatric disorders. Acta Psychiatr Scand Suppl 360:29–34
Liebowitz MR, Schneier F, Campeas R, Gorman J, Fyer A, Hollander E, Hatterer J, Papp L (1990b) Phenelzine and atenolol in social phobia. Psychopharmacol Bull 26:123–125
Liebowitz MR, Schneier FR, Hollander E, Welkowitz LA, Saoud JB, Feerick J, Campeas R, Fallon BA, Street L, Gitow A (1991) Treatment for social phobia with drugs other than benzodiazepines. J Clin Psychiatry 52(suppl 11):10–15
Liebowitz MR, Schneier F, Campeas R, Hollander E, Hatterer J, Fyer A, Gorman J, Papp L, Davies S, Gully R, et al. (1992) Phenelzine vs atenolol in social phobia: A placebo-controlled comparison. Arch Gen Psychiatry 49:290–300
Links PS, Steiner M, Boiago I, Irwin D (1990) Lithium therapy for borderline patients: Preliminary findings. Journal of Personality Disorders 4:173–181
Linnoila M, Virkkunen M, Sheinin M Nuutila A, Rimon R, Goodwin FK (1983) Low cerebrospinal fluid 5-hydroxyindolacetic acid concentration differentiates impulsive from nonimpulsive violent behavior. Life Sci 33:2609–2614
Loosen PT, Prange AJ (1982) Serum thyrotropin response to thyrotropin-release hormone in psychiatric patients. Am J Psychiatry 139:405–415
Lyons MJ, Merla ME, Young L, Kremen WS (1991) Impaired neuropsychological functioning in symptomatic volunteers with schizotypy: Preliminary findings. Biol Psychiatry 30:424–426
Mann JJ, Arango V (1992) Integration of neurobiology and psychopathology in a unified model of suicidal behavior. J Clin Psychopharmacol 12(suppl 2):2S–7S
Mann JJ, Aarons SF, Wilner PJ, Keilp JG, Sweeney JA, Pearlstein T, Frances AJ, Kocsis JH, Brown RP (1989) A controlled study of the antidepressant efficacy and side-effects of L-deprenyl: A selective monoamine oxidase inhibitor. Arch Gen Psychiatry 46:45–50
Marazziti D, De Leo D, Conti L (1989) Further evidence supporting the role of serotonin system in suicidal behavior: A preliminary study of suicide attempters. Acta Psychiatr Scand 80:322–324
Markovitz PJ, Calabrese JR, Schulz SC, Meltzer HY (1991) Fluoxetine treatment of borderline and schizotypal personality disorder. Am J Psychiatry 148:1064–1067
Marshall JR (1994) Practical approaches to the treatment of social phobia. J Clin Psychiatry 55:367–374
McKinney WT, Moran EC, Kraemer GW (1984) Separation in nonhuman primates as a model for human depression: neurobiological implications. In: Post RM, Ballenger JC (eds) Neurobiology of mood disorders. Williams and Wilkins, Baltimore, pp 393–406
Meltzer HY, Arora RC (1986) Platelet markers of suicidality. Ann N YAcad Sci 487:271–280
Merritt RD, Baloh DW (1989) Backward masking spatial frequency effects among hypothetically schizotypal individuals. Schizophr Bull 15:573–583
Norden MJ (1989) Fluoxetine in borderline personality disorder. Prog Neuropsychopharmacol Biol Psychiatry 13:885–893
Nuechterlein KH (1991) Vigilance in schizophrenia and related disorders. In: Handbook of schizophrenia, Vol 5: Neuropsychology, psychophysiology and information processing, Steinhauer SR, Gruzelier JH, Zubin J, eds. New York, Elsevier, 397–443
Onstad S, Skre I, Edvardsen J, Torgersen S, Kringlen E (1991) Mental disorders in first degree relatives of schizophrenics. Acta Psychiatr Scand 83:463–467
Pandey GN, Pandey SC, Janicak PG, Marks RC, Davis JM (1990) Platelet serotonin-2 receptor binding sites in depression and suicide. Biol Psychiatry 28:215–222
Parsons B, Quitkin FM, McGrath PJ, Stewart JW, Tricamo E, Ocepek-Welikson K, Harrison W, Rabkin JG, Wager SG, Nunes E (1989) Phenelzine, imipramine, and placebo in borderline patients meeting criteria for atypical depression. Psychopharmacol Bull 25:524–534
Pinto OC, Akiskal HS (1998). Lamotrigine as a promising approach to borderline personality: an open case series without concurrent DSM-IV major mood disorder. J Affect Disord 51:333–343.
Price LH, Charney DS, Delgado PL, Heninger GR (1989) Lithium treatment and serotonergic function. Br J Psychiatry 46:13–19
Raine A, Sheard C, Reynolds GP, Lemcz T (1992) Pre-frontal structural and functional deficits associated with individual differences in schizotypal personality. Schizophr Res 7:237–247
Rampling D (1978) Aggression: a paradoxical response to tricyclic antidepressants. Am J Psychiatry 135:117–118
Ratey JJ, Sorgi P, O'Driscoll GA, Sands S, Daehler ML, Fletcher JR, Kadish W, Spruiell G, Polakoff S, Lindem KJ, et al. (1992) Nadolol to treat aggression and psychiatric symptomatology in chronic psychiatric inpatients: A double-blind, placebo-controlled study. J Clin Psychopharmacol 53:41–46
Reich JH (1989) Familiarity of DSM-III dramatic and anxious personality clusters. J Nerv Ment Dis 177:96–100
Reich JH (1991) Avoidant and dependent personality traits in relatives of patients with panic disorder, patients with dependent personality disorder, and normal controls. Psychiatr Res 39:89–98
Rickles K, Downing RW. Chlordiazepoxide and hostility in anxious outpatients. Am J Psychiatry 1974; 131:442–444
Rifkin A, Quitkin F, Carrillo C, Blumberg AG, Klein DF (1972) Lithium carbonate in emotionally unstable character. disorder. Arch Gen Psychiatry 27:519–523
Risch SC, Cohen RM, Janowsky DS, Kalin NH, Sitaram N, Gillin JC, Murphy DL (1981) Physostigmine induction of depressive symptomatology in normal human subjects. Psychiatr Res 4:89–94
Rosenbaum JF, Biederman J, Hirshfeld DR, Bolduc EA, Chaloff J (1991) Behavioral inhibition in children: A possible precursor to panic disorder or social phobia. J Clin Psychiatry 52(suppl 1):5–9
Rotter M, Kalus O, Losonczy M, Guo L, Trestman RL, Coccaro E Davidson M, Davis KL, Siever LJ (1991) Lateral ventricle enlargement in schizotypal personality disorder. Biol Psychiatry 29:43a–185a
Salzman C, Wolfson AN, Miyawaki, E: Fluoxetine treatment of anger in borderline personality disorder. Proceedings of the American College of Neuropharmacol 1992, p. 24
Sawaguchi T, Goldman-Rakic PS (1991) D1 dopamine receptors in prefrontal cortex: Involvement in working memory. Science 251:947–950
Schiff HB, Sabin TD, Geller A, Alexander L, Mark V (1982) Lithium in aggressive behavior. Am J Psychiatry 139:1346–1348
Schneier FR, Spitzer RL, Gibbon M, Fyer AJ, Liebowitz MR (1991) The relationship of social phobia subtypes and avoidant personality disorders. Compr Psychiatry 32:496–502
Schulz PM, Schulz SC, Goldberg SC, Ettigi P, Resnick RJ, Friedel RO (1986) Diagnoses of the relatives of schizotypal outpatients. J Nerv Ment Dis 174:457–463
Schulz SC, Cornelius J, Schulz PM, Soloff PH (1988) The amphetamine challenge test in patients with borderline personality disorder. Am J Psychiatry 145:809–814
Sheard M, Marini J, Bridges C, Wapner A (1976) The effect of lithium on impulsive aggressive behavior in man. Am J Psychiatry 133:1409–1413
Siegel BV, Trestman RL, O'Flaithbheartaigh SO, Mitropoulou V, Amin F, Kirrane R, Silverman JM, Schmeidler J, Keefe RSE, Siever LJ (1996) D-Amphetamine challenge effects on Wisconsin Card Sort Test performance in schizotypal personality disorder. Schizophr Res 20:29–32
Siever LJ (1987) The role of noradrenergic mechanisms in the etiology of the affective disorders. In: Meltzer HY (ed) Psychopharmacology: The third generation of progress. Raven Press, New York, pp 493–504
Siever LJ, Davis KL (1991) A psychobiological perspective of the personality disorders. Am J Psychiatry 148:1647–1658
Siever LJ, Klar H, Coccaro EF (1985) Psychobiological substrates of personality. In: Klar H, Siever LJ (eds) Biological response styles: Clinical implications. American Psychiatric Press, Washington DC, pp 38–66
Siever LJ, Silverman JM, Horvath TB, Klar H, Coccaro E, Keefe RS, Pinkham L, Rinaldi P, Mohs RC, Davis KL (1990) Increased morbid risk for schizophrenia-related disorders in relatives of schizotypal personality disorder patients. Arch Gen Psychiatry 47:634–640
Siever LJ, Amin F, Coccaro EF, Bernstein D, Kavoussi RJ, Kalus O, Horvath TB, Warne P, Davidson M, Davis KL (1991) Plasma homovalinic acid in schizotypal personality disorder patients and controls. Am J Psychiatry 148:1246–1248.
Siever LJ, Trestman RL, Coccaro EF, Bernstein D, Gabriel SM, Owen K, Moran M, Lawrence T, Rosenthal J, Horvath TB (1992) The growth hormone response to clonidine in acute and remitted depressed male patients. Neuropsychopharmacology 6:165–177
Siever LJ, Kalus O, Keefe RSE (1993a). The boundaries of schizophrenia. Psychiatr Clin North Am 16:217–244
Siever LJ, Rotter M, Trestman RL, Coccaro EF, Losconzy MF, Davis KL (1993b) Increased ventricular brain ratio in schizotypal personality disorder. 146th Annual Meeting of the American Psychiatric Association, NR335
Siever LJ, Buchsbaum MS, New AS, Spiegel-Cohen J, Wei T, Hazlett EA, Sevin E, Nunn M Mitropoulou V (1999) d,l-fenfluramine response in impulsive personality disorder assessed with [18F]flourodeoxyglucosepositron emission tomography. Neuropsychopharmacology 20:413–423
Silverman JM, Pinkham L, Horvath TB, Coccaro EF, Klar H, Schear S, Apter S, Davidson M, Mohs RC, Siever LJ (1991) Affective and impulsive personality disorder traits in the relatives of borderline personality disorder. Am J Psychiatry 148:1378–1385
Silverman JM, Keefe RSE, Losonczy MF, LI G, O'Brian V. Mohs RC, Siever LJ (1992) Schizotypal and neuro-imaging factors in relatives of schizophrenic probands. Society of Biological Psychiatry Annual Meeting 31:70a, April 1992
Snyder S, Pitts WM (1984) Electroencephalography of DSM-III borderline personality disorder. Acta Psychiatr Scand 69:129–134
Soloff PH, George A, Nathan RS (1982) The dexamethasone suppression test in patients with borderline personality disorder. Am J Psychiatry 139:1621–1623
Soloff PH, George A, Nathan RS, Schulz PM, Perel JM (1986a) Paradoxical effects of amitriptyline in borderline patients. Am J Psychiatry 143:1603–1605
Soloff PH, George A, Nathan RS, Schulz PM, Ulrich RF, Perel JM (1986b) Progress in the psychopharmacotherapy of borderline disorders: A double-blind study of amitriptyline, haloperidol, and placebo. Arch Gen Psychiatry 43:691–697
Soloff PH, George A, Nathan S, Schulz PM, Cornelius JR, Herring J, Perel JM (1989) Amitriptyline versus haloperidol in borderlines: Final outcomes and predictors to response. J Clin Psychopharmacol 9:238–246
Soloff PH, Cornelius J, George A, Nathan S, Perel JM, Ulrich RF (1993) Efficacy of phenelzine and haloperidol in borderline personality disorder. Arch Gen Psychiatry 50:377–385
Stark P, Fuller RW, Wong DT (1985) The pharmacologic profile of fluoxetine. J Clin Psychiatry 46:1647–1658
Stein DJ, Simeon D, Frenkel M, Islam M, Hollander E (1995) An open trial of valproate in borderline personality disorder. J Clin Psychiatry 56:506–510
Stein MB, Chartier MJ, Hazen AL, Kroft CD, Chale RA, Cote D, Walker JR (1996). Paroxetine in the treatment of generalized social phobia: Open-label treatment and double-blind placebo-controlled discontinuation. J Clin Psychopharmacol 16:218–222
Stein DJ, Berk M, Els C, Emsley RA, Gittelson L, Wilson D, Oakes R, Hunter B (1999) A double-blind placebo controlled trial of paroxetine in the management of social phobia (social anxiety disorder) in South Africa. S Afr Med J 89:402–6.
Steinberg BJ, Trestman RL, Siever LJ (1994) The cholinergic and noradrenergic neuro-transmitter systems in affective instability in borderline personality disorder. In: Silk KR (ed) Biological and neurobehavioral studies in borderline personality disorder. American Psychiatric Press, Washington DC, pp 57–63
Steinberg BJ, Trestman R, Mitropolous V, Serby M, Coccaro E, Weston S, DeVegvar M, Siever LJ (1997) Depressive response to physostigmine challenge in borderline personality disorder patients. Neuropsychopharmacology 17:264–273
Stephens JH, Schaffer JW (1970) A controlled study of the effects of diphenylhydantoin on anxiety, irritability, and anger in neurotic outpatients. Psychopharmacologia (Berlin) 17:169–181
Sternbach HA, Fleming J, Extein I, Pottash AL, Gold MS (1983) The dexamethasone suppression and thyrotropin-releasing hormone tests in depressed borderline patients. Psychoneuroendocrinology 8:459–462
Stolk JM, Conner RL, Levine S, Barchas JD (1974) Brain norepinephrine metabolism and shock-induced fighting behavior in rats: Differential effects of shock and fighting on the neurochemical response to a common footshock stimulus. J Pharmacol Exp Ther 190:193–209
Tancer ME (1993) Neurobiology of social phobia. J Clin Psychiatry 54(suppl 12):26–30
Tancer ME, Golden RN (1993) A neuropharmacologic test of the tridimensional personality questionnaire in social phobia. Biol Psychiatry 33:48A
Tancer ME, Stein MB, Gelernter CS, Uhde TW (1990) The hypothalamic-pituitary-thyroid axis in social phobia. Am J Psychiatry 147:929–933
Tellegen A, Lykken DT, Bouchard TJ Jr, Wilcox KJ, Segal NL, Rich S (1988) Personality similarity in twins reared apart and together. J Pers Soc Psychol 54:1031–1039
Torgerson S (1984) Genetic and nosological aspects of schizotypal and borderline personality disorders. Arch Gen Psychiatry 41:546–554
Torgerson AM, Kringlen E (1978) Genetic aspects of temperamental differences in infants: A study of same-sexed twins. J Am Acad Child Psychiatry 17:438–444
Trestman RL, Coccaro EF, Weston S, Mitropoulou V, Ramella F, Gabriel S, Siever LJ (1992) Impulsivity, suicidal behavior, and major depression in personality disorder: Differential correlates with noradrenergic and serotonergic function. Biol Psychiatry 31:68A
Trestman RL, Keefe RS, Mitropoulou V, Harvey PD, deVegvar ML, Lees-Roitman S, Davidson M, Aronson A, Silverman J, Siever LJ (1995) Cognitive function and biological correlates of cognitive performance in schizotypal personality disorder. Psychiatry Res 59:127–136
Uhde TW (1994) A review of biological studies in social phobia. J Clin Psychiatry 55(suppl 6): 17–27
Uhde TW, Tancer ME, Black B, Brown TM (1991) Phenomenology and neurobiology of social phobia: comparison with panic disorder. J Clin Psychiatry 52(suppl 11):31–40
Van der Kolk BA (1986) Uses of lithium in patients without major affective illness. Hosp Community Psychiatry 37:675
Versiani M, Nardi AE, Mundim FD, Alves AB, Liebowitz MR, Amrein R (1992) Pharmacotherapy of social phobia: A controlled study with moclobemide and phenelzine. Br J Psychiatry 161:353–360
Volavka J (1988) Can aggressive behavior in humans be modified by beta-blockers? Postgrad Med Feb 29:163–168
Wainberg ML, Trestman RL, Keefe RS, Cornblatt B, deVegvar M, Siever LJ (1993) CPT in schizotypal personality disorder. American Psychiatric Association Annual Meeting 1993, San Francisco, CA
Wechsler D (1981) Wechsler adult intelligence scale-revised. New York: Psychological Corporation.
Widiger TA (1992) Generalized social phobia versus avoidant personality disorder: A commentary on three studies. J Abnorm Psychol 101:340–343
Yudofsky SC, Silver JM, Schneider SE (1987) Pharmacological treatment of aggression. Psychiatric Annals 17:397–406
Zanarini MC, Gunderson JG, Marino MF, Schwartz EO, Frankenburg FR (1988) DSM-III disorders in the families of borderline outpatients. Journal of Personality Disorders 2:292–302
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2004 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Wainberg, M.L., Kolodny, A.J., Siever, L.J. (2004). Personality Disorders. In: Preskorn, S.H., Feighner, J.P., Stanga, C.Y., Ross, R. (eds) Antidepressants: Past, Present and Future. Handbook of Experimental Pharmacology, vol 157. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-18500-7_17
Download citation
DOI: https://doi.org/10.1007/978-3-642-18500-7_17
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-62135-2
Online ISBN: 978-3-642-18500-7
eBook Packages: Springer Book Archive