Abstract
Introduction: Atypical antipsychotics might become a new treatment option for patients with an impaired impulse regulation as seen in cluster B personality disorders (PD). The aim of the present study is to investigate the efficacy and tolerability of quetiapine in patients with cluster B PD.
Methods: Fifteen in-patients with a DSM-IV diagnosis of borderline, histrionic, or narcissistic PD were treated for 8 weeks with quetiapine at a dose of 400 mg/day in an open-label fashion. Effects on impulsivity (Barratt Impulsiveness Scale, BIS), depressive symptoms (Hamilton Depression Scale, HAMD, and Beck Depression Inventory, BDI) and side effects (Dosage Record and Treatment Emergent Symptom Scale, DOTES) were assessed.
Results: Twelve patients completed the study. No positive effect on impulsivity (BIS) was found, but a significant improvement on depression scores (HAM-D and BDI) was noted. Adverse effects that might have been due to study medication were mainly anticholinergic and mild-to-moderate.
Discussion: The data of our preliminary open-label study do not argue for a general recommendation of quetiapine for the treatment of impulsivity in cluster B PD, but indicate positive effects on depressive symptoms.
References
1
Adityanjee , Schulz SC.
Clinical use of quetiapine in disease states other than schizophrenia.
J Clin Psychiatry.
2002;
63
((Suppl 13))
32-38
2
American Psychiatric Association .
Practical guidelines for the treatment of patients with borderline personality disorder.
Am J Psychiatry.
2001;
158
1-52
3 Barratt ES. Impulsiveness substrates: Arousal and information processing. In: Spence JT and Izard CE Motivation, Emotion and personality . North-Holland: Elsevier Science 1985: 137-146
4
Barratt ES, Stanford MS, Kent TA, Felthous A.
Neuropsychological and cognitive psychophysiological substrates of impulsive aggression.
Biol Psychiatry.
1997;
41
1045-1061
5
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J.
An inventory of measuring depression.
Arch Gen Psychiatry.
1961;
4
561-571
6
Bellino S, Paradiso E, Bogetto F.
Efficacy and tolerability of quetiapine in the treatment of borderline personality disorder: A pilot study.
J Clin Psychiatry.
2006;
67
1042-1046
7
Bogenschutz MP, Nurnberg HG.
Olanzapine versus placebo in the treatment of borderline personality disorder.
J Clin Psychiatry.
2004;
65
104-109
8
Boileau I, Dagher A, Leyton M, Gunn RN, Baker GB, Diksic M, Benkelfat C.
Modeling sensitization to stimulants in humans: an [11 C]raclopride/positron emission tomography study in healthy men.
Arch Gen Psychiatry.
2006;
63
1386-1395
9
Chengappa KN, Ebeling T, Kang JS, Levine J, Parepally H.
Cloza-pine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder.
J Clin Psychiatry.
1999;
60
477-484
10
Dalley JW, Fryer TD, Brichard L, Robinson ES, Theobald DE, Laane K, Pena Y, Murphy ER, Shah Y, Probst K, Abakumova I, Aigbirhio FI, Richards HK, Hong Y, Baron JC, Everitt BJ, Robbins TW.
Nucleus accumbens D2/3 receptors predict trait impulsivity and cocaine reinforcement.
Science.
2007;
315
1267-1270
11
Davidson RJ, Putnam KM, Larson CL.
Dysfunction in the neural circuitry of emotion regulation: a possible prelude to violence.
Science.
2000;
289
591-594
12
Dougherty DM, Bjork JM, Huckabee HC, Moeller FG, Swann AC.
Laboratory measures of aggression and impulsivity in women with borderline personality disorder.
Psychiatr Res.
1999;
85
315-326
13
First MB, Gibbon M, Spitzer RL, Williams JBW.
Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II).
1996;
14
Fossati A, Barratt ES, Borroni S, Villa D, Grazioli F, Maffei C.
Impulsivity, aggressiveness, and DSM-IV personality disorders.
Psychiatr Res.
2007;
149
157-167
15
Frankenburg FR, Zanarini MC.
The association between borderline personality disorder and chronic medical illnesses, poor health-related lifestyle choices, and costly forms of health care utilization.
J Clin Psychiatry.
2004;
65
1660-1665
16
Gao K, Muzina D, Gajwani P, Calabrese JR.
Efficacy of typical and atypical antipsychotics for primary and comorbid anxiety symptoms or disorders: A review.
J Clin Psychiatry.
2006;
67
1327-1340
17
Guy W.
ECDEU Assessment Manual for Psychopharmacology (DHEW Publication No. ADM 76-338), U.S. Department of Health, Education & Welfare, Rockville, MD.
1976;
158-169
18
Hamilton A.
Diagnosis and rating of anxiety.
Br J Psychiatry.
1959;
3
67-69
19
Hamilton M.
Development of a rating scale for primary depressive illness.
Br J Soc Clin Psychol.
1967;
6
278-296
20
Links PS, Heslegrave R, Reekum R van.
Impulsivity: core aspect of borderline personality disorder.
J Personal Disord.
1999;
13
1-9
21
Linnoila M.
Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpulsive violent behavior.
Life Sci.
1983;
33
2609-2614
22
Looper KJ, Paris J.
What dimensions underlie Cluster B personality disorders?.
Comprehen Psychiatry.
2000;
41
432-437
23
Markovitz PJ.
Recent trends in the pharmacotherapy of personality disorders.
J Personal Disord.
2004;
18
90-101
24
MacGlashan TH, Grilo CM, Sanislow CA, Ralevski E, Morey LC, Gunderson JG, Skodol AE, Shea MT, Zanarini MC, Bender D, Stout RL, Yen S, Pagano M.
Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders.
Am J Psychiatry.
2005;
162
883-889
25
Mobascher A, Mobascher J, Schlemper V, Winterer G, Malevani J.
Aripiprazole pharmacotherapy of borderline personality disorder.
Pharmacopsychiatry.
2006;
39
111-112
26
Mulder RT, Joyce PR, Sullivan PF, Bulik CM, Carter FA.
The relationship among three models of personality psychopathology: DSM-II-R personality disorder, TCI scores and DSQ defences.
Psychol Med.
1999;
29
943-951
27
Nemeroff CB.
Use of atypical antipsychotics in refractory depression and anxiety.
J Clin Psychiatry.
2005;
66
13-21
28
New AS, Hazlett EA, Buchsbaum MS, Goodman M, Reynolds D, Mitropoulou V, Sprung L, Shaw RB, Koenigsberg H, Platholi J, Silverman J, Siever LJ.
Blunted prefrontal cortical 18fluorodeoxyglucose positron emission tomography response to meta-chlorophenylpiperazine in impulsive aggression.
Arch Gen Psychiatry.
2002;
59
621-629
29
Nickel MK, Muehlbacher M, Nickel C, Kettler C, Pedrosa GF, Bachler E, Buschmann W, Rother N, Fartacek R, Egger C, Anvar J, Rother WK, Loew TH, Kaplan P.
Aripiprazole in the treatment of patients with borderline personality disorder: a double-blind, placebo-controlled study.
Am J Psychiatry.
2006;
163
833-838
30
Pascual JC, Madre M, Soler J, Barrachina J, Campins MJ, Alvarez E, Pérez V.
Injectable atypical antipsychotics for agitation in borderline personality disorder.
Pharmacopsychiatry.
2006;
39
117-118
31
Patton JH, Stanfrod MS, Barratt ES.
Factor structure of the Barratt impulsiveness scale.
J Clin Psychol.
1995;
51
768-774
32
Perrella C, Carrus D, Costa E, Schifano F.
Quetiapine for the treatment of borderline personality disorder; an open-label study.
Prog Neuropsychopharmacol Biol Psychiatry.
2007;
31
158-163
33
Rocca P, Marchiaro L, Cocuzza F, Bogetto F.
Treatment of borderline personality disorder with risperidone.
J Clin Psychiatry.
2002;
63
241-244
34
Schulz SC.
The promise of atypical antipsychotics for borderline personality disorders. Presented at the 115th annual meeting of the American Psychiatric Association May 18–23 Philadelphia, Pa.
2002;
35
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC.
The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.
J Clin Psychiatry.
1998;
59
22-33
36
Skodol AE, Siever LJ, Livesly WJ, Gunderson JG, Pfohl B, Widiger TA.
The borderline diagnosis II: biology, genetics, and clinical course.
Biol Psychiatry.
2002;
51
951-963
37
Soler J, Pascual JC, Campins J, Barrachina J, Puigdemont D, Alvarez E, Perez V.
Double-blind, placebo-controlled study of dialectical behavior therapy plus olanzapine for borderline personality disorder.
Am J Psychiatry.
2005;
162
1221-1224
38
Soubrie P.
Serotonergic neurons and behaviour.
J Pharmacol.
1986;
17
107-112
39
Steel Z, Blaszczynski A.
Impulsivity, personality disorders and pathological gambling severity.
Addiction.
1998;
93
895-905
40
Villeneuve E, Lemelin S.
Open-label study of atypical neuroleptic quetiapine for treatment of borderline personality disorder: impulsivity as main target.
J Clin Psychiatry.
2005;
66
1298-1303
41
Walker C, Thomas J, Allen TS.
Treating impulsivity, irritability, and aggression of antisocial personality disorder with quetiapine.
Int J Offender Ther Comp Criminol.
2003;
47
556-567
42 Zanarini MC. Borderline personality as an impulse spectrum disorder. In Paris J (ed). Borderline Personality Disorder: Etiology and Treatment . Washington, DC: American Psychiatric Press 1993: 67-86
43
Zanarini M, Frankenburg FR.
Olanzapine treatment of female borderline personality disorder patients: a double-blind, placebo-controlled pilot study.
J Clin Psychiatry.
2001;
62
849-854
44
Zanarini M, Frankenburg FR, Parachini EA.
A preliminary, randomized trial of fluoxetine, olanzapine, and the olanzapine-fluoxetine combination in women with borderline personality disorder.
J Clin Psychiatry.
2004;
65
903-907
45
Zoccolillo M, Pickles A, Quinton D, Rutter M.
The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder.
Psychol Med.
1992;
22
971-986
Correspondence
S. Roepke
Department of Psychiatry
Charité-Universitätsmedizin Berlin
Campus Benjamin Franklin
Eschenallee 3
14050 Berlin
Germany
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