Abstract
Progress with the development of models and general principles of psychopharmacologic management of personality disordered patients is reviewed. Recent research using mood stabilizers and novel antipsychotics are discussed. The effects of these medications on impulsive aggressiveness are supported and the effects are evident early and are independent of the effects on mood, including depression. Research is needed with other personality disorders beyond just borderline personality disorder. Future research must develop measurable outcomes and delineate the causal and temporal relationships between the psychopathologic features of personality disorders.
Similar content being viewed by others
References and Recommended Reading
Soloff PH: Algorithms for pharmacological treatment of personality dimensions: symptom-specific treatments for cognitive-perceptual, affective, and impulsive-behavioral dysregulation. Bull Menninger Clin 1998, 62:195–214. Based on available research evidence, the author develops first detailed algorithms for the pharmacologic management of personality disordered patients using a symptom-target approach.
Links PS, Heslegrave R, Villella J: Psychopharmacological management of personality disorders: an outcome-focused model. In Biology of Personality Disorders. Edited by Silk KR. Washington, DC: American Psychiatric Press; 1998:93–127. The authors reviewed existing models of the pharmacologic management of personality disorders and suggested an outcome-focused model based on using measurable outcomes.
Coccaro EF: Neurotransmitter function in personality disorders. In Biology of Personality Disorders. Edited by Silk KR. Washington, DC: American Psychiatric Press; 1998:1–25.
Coccaro EF: Neurotransmitter function in personality disorders. In Biology of Personality Disorders. Edited by Silk KR. Washington, DC: American Psychiatric Press; 1998:1–25.
Gunderson JG, Links PS: Borderline personality disorder. In Treatments of Psychiatric Disorders, edn 2. Edited by Gabbard GO. Washington, DC: American Psychiatric Press; 1995:2291–2309.
Soloff PH: Psychopharmacology of borderline personality disorder. Psychiatr Clin North Am 2000, 23:169–192. This paper updates Dr. Soloff’s 1998 article [1] specifically related to the psychopharmacologic management of borderline personality disorder. The appropriate use of antidepressant medication in this disorder is reviewed.
Links PS, Boggild A, Sarin N: Modeling the relationship between affective lability, impulsivity, and suicidal behavior. J Psychiatr Pract 2000, 6:247–255. The article refines the concept of affective lability and develops a model explaining depression and suicidal behavior in borderline personality disorder.
Guyatt G, Sackett D, Adachi J, et al.: A clinician’s guide for conducting randomized trials in individual patients. Can Med Assoc J 1988, 139:497–503.
Silk KR: Rational pharmacotherapy for patients with personality disorders. In Clinical Assessment and Management of Severe Personality Disorders. Edited by Links PS. Washington, DC: American Psychiatric Press; 1996:109–142.
Gitlin MJ: Pharmacotherapy of personality disorders. Conceptual framework and clinical strategies. J Clin Psychopharmacol 1993, 13:343–353.
Cowdry RW, Gardner DL: Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine and tranylcypromine. Arch Gen Psychiatry 1988, 45:111–119.
Links PS, Steiner M, Boiago I, Irwin D: Lithium therapy for borderline patients: preliminary findings. J Personal Disord 1990, 4:173–81.
Soloff PH, George A, Nathan RS, et al.: Progress in the pharmacotherapy of borderline disorders: a double-blind study of amitriptyline, haloperidol, and placebo. Arch Gen Psychiatry 1986, 43:691–697.
Gardner DL, Cowdry RW: Positive effects of carbamazepine on behavioral dyscontrol in borderline personality disorder. Am J Psychiatry 1986, 143:519–522.
De La Fuenta JM, Lotstra F: A trial of carbamazepine in borderline personality disorder. Eur Neuropsychopharmacol 1994, 4:479–86.
Stein DJ, Simeon D, Frenkel M, et al.: An open trial of valproate in borderline personality disorder. J Clin Psychiatry 1995, 56:506–510.
Wilcox JA: Divalproex sodium as a treatment for borderline personality disorder. Ann Clin Psychiatry 1995, 7:33–37.
Kavoussi Rj, Coccaro EF: Divalproex sodium for impulsive aggressive behavior in patients with personality disorders. J Clin Psychiatry 1998, 59:676–680.
Donovan SJ, Stewart JW, Nunes EV, et al.: Divalproex treatment for youth with explosive temper and mood lability: a doubleblind, placebo-controlled crossover design. Am J Psychiatry 2000, 157:818–820.
Hollander E: Impulsivity and aggression: borderline personality disorder and autism. Presented at the American Psychiatric Association 2000 Annual Meeting. Chicago: May 16, 2000.
Barratt ES, Stanford MS, Felthous AR, et al.: The effects of phenytoin on impulsive and premeditated aggression: a controlled study. J Clin Psychopharmacol 1997, 17:341–349.
Hegarty AM: Treatment of impulsive aggression with divalproex. Presented at the American Psychiatric Association 2000 Annual Meeting. Chicago: May 17, 2000.
Pinto OC, Akiskal HS: Lamotrigine as a promising approach to borderline personality. An open case series without concurrent DSM-IV major mood disorder. J Affect Disord 1998, 51:333–343.
Pazzaglia PJ, Post RM, Ketter TA, et al.: Nimodipine monotherapy and carbamazepine augmentation in patients with refractory recurrent affective illness. J Clin Psychopharmacol 1998, 18:404–413.
Frankenburg FR, Zanarini MC: Clozapine treatment of borderline patients: a preliminary study. Compr Psychiatry 1993, 34:402–405.
Chengappa KNR, Baker RW, Sirri C: The successful use of clozapine in ameliorating severe self mutilation in a patient with borderline personality disorder. J Pers Disord 1995, 9:76–82.
Benedetti F, Sforzini L, Colombo C, et al.: Low-dose clozapine in acute and continuation treatment of severe borderline personality disorder. J Clin Psychiatry 1998, 59:103–107.
Chengappa KNR, Ebeling T, Kang JS, et al.: Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder. J Clin Psychiatry 1999, 60:477–484.
Szigethy EM, Schulz SC: Risperidone in comorbid borderline personality disorder and dysthymia [letter]. J Clin Psychopharmacol 1997, 17:326–327.
Khouzam HR, Donnelly NJ: Remission of self-mutilation in a patient with borderline personality during risperidone therapy [letter]. J Nerv Ment Dis 1997, 195:348–349.
Koenigsberg HW, Goodman M, Mitropoulou V, et al.: Risperidone in the treatment of schizotypal personality. Presented at the American Psychiatric Association Annual Meeting 2000. Chicago: May 16, 2000.
Schulz SC, Camlin KL, Berry SA, et al.: Olanzapine safety and efficacy in patients with borderline personality disorder and comorbid dysthymia. Biol Psychiatry 1999, 46:1429–1435. The first published trial of novel antipsychotics, other than clozapine, in borderline personality disorder. Specific attention is given to the occurrence of side effects during exposure to olanzepine.
Koenigsberg HW, Anwunah I, New AS, et al.: Relationship between depression and borderline personality disorder. Depress Anxiety 1999, 10:158–167. An up-to-date review of the relationship between depression and borderline personality disorder.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Links, P.S., Boggild, A. & Sarin, N. Psychopharmacology of personality disorders: Review and emerging issues. Curr Psychiatry Rep 3, 70–76 (2001). https://doi.org/10.1007/s11920-001-0076-0
Issue Date:
DOI: https://doi.org/10.1007/s11920-001-0076-0