Anwendung von Moodstabilizern in der Psychopharmakotherapie der Borderline-Persönlichkeitsstörung

Zusammenfassung

Die Borderline-Persönlichkeitsstörung (BPS) ist charakterisiert durch ein instabiles Muster tiefgreifender Schwierigkeiten in den Bereichen der Perzeption, der interpersonellen Beziehungsgestaltung, der Affektregulation und der Impulskontrolle. In der Behandlung dieser komplexen Störung spielt neben anderen die Psychopharmakotherapie eine zentrale stützende Rolle und erfolgt, ausgerichtet auf die psychopathologisch führende Kerndimension, mit atypischen Antipsychotika, Antidepressiva oder Stimmungsstabilisatoren (Moodstabilizern). Oft ergibt sich aufgrund der Mehrschichtigkeit der Symptome eine Polypsychopharmazie aus mehreren Substanzklassen. In dieser Arbeit soll eine Übersicht über die Ergebnisse der Gesamtstudienlage an Moodstabilizern in der Pharmakotherapie der BPS gegeben werden; speziell wurde der Einsatz von Lithium, Carbamazepin, Valproat, Topiramat und Lamotrigin untersucht. Mit Hinblick auf das überwiegend junge, weibliche Patientenkollektiv ist wegen der teratogenen Risiken eine kritische Abwägung erforderlich. In der Auswertung zeigten sich ein signifikanter Wirkeffekt auf Kernsymptome der BPS für alle untersuchten Substanzen, jedoch auch deutliche Einschränkungen in der Vergleichbarkeit und Aussagekraft aufgrund der Heterogenität von Untersuchungskollektiv, Studiendesign, Begleitmedikation und Messinventar. Trotz bisher fehlender Zulassung spiegeln die Ergebnisse den mittlerweile klinisch etablierten Einsatz der Moodstabilizer in dieser Indikation wider und unterstreichen die spezifische Relevanz von Moodstabilizern in der gezielten Behandlung von Kernsymptomen der BPS.

Abstract

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.

Borderline-Persönlichkeitsstörung - Moodstabilizer - Psychopharmakotherapie - Affektinstabilität - Schwangerschaft

Borderline Personality Disorder - moodstabilizer - psychopharmacotherapy - affective dysregulation - pregnancy

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