Symptomorientierte Pharmakotherapie bei Borderline-Persönlichkeitsstörung

Zusammenfassung:

Die Borderline-Persönlichkeitsstörung (BPS) gilt als schwerwiegendes psychiatrisches Störungsbild mit oft sehr heterogener Symptomatik. Obwohl psychotherapeutische Behandlungsverfahren derzeit im Zentrum der Interventionsmöglichkeiten stehen, erfordern schwerwiegende psychopathologische Symptome wie unkontrollierbare Impulsivität, depressive, dissoziative oder psychotische Symptomatik häufig den Einsatz von Psychopharmaka. Herkömmliche Übersichtsarbeiten zur Pharmakotherapie der BPS gliederten sich in der Regel nach Substanzgruppen. In dieser Arbeit wird die Literatur nach den klinisch relevanten Symptomgruppen depressive Symptomatik, Störungen der Affektregulation, Fremdaggressivität, Impulsivität, dissoziative Symptomatik, Selbstverletzungen, Suizidalität, psychotische und pseudopsychotische Symptomatik, Angst, Zwang und Schlafstörungen gegliedert dargestellt. Diese kritische Übersicht würdigt die Relevanz der Studienergebnisse anhand der jeweiligen statistischen Signifikanz. Im Anschluss daran werden aus der Datenlage abgeleitete Therapieempfehlungen zur Pharmakotherapie der Borderline-Persönlichkeitsstörung gegeben: So sollten etwa komorbide depressive Episoden möglichst mit einem Serotonin-Wiederaufnahmehemmer behandelt werden. Auch bei impulsivem und aggressivem Verhalten konnte die Wirksamkeit von Serotonin-Wiederaufnahmehemmern nachgewiesen werden. Bei intermittierender psychotischer Symptomatik sollte auf ein atypisches Neuroleptikum zurückgegriffen werden. Die Behandlung mit Benzodiazepinen ist als obsolet anzusehen.

Symptom-Focussed Pharmacotherapy in Borderline Personality Disorder:

Borderline Personality Disorder (BPD) is a common and serious psychiatric illness. Psychopathological symptoms often are heterogenous and difficult to influence. Psychotherapy stands in the core of treatment efforts. However, during the treatment of these patients often situations occur that make the use of drug treatment necessary. Symptoms such as depression, impulsivity, or dissociation can be difficult to deal with in this population. There appears to be no treatment of choice for the disorder as a whole.

Reviews so far have organized the literature by groups of pharmacological agents. In this review we give an overview over psychopathological symptoms in BPD, i.e. depression, affective dysregulation, aggression, impulsivity, dissociation, self-injuries, suicidality, psychotic symptoms, anxiety, obsessions and compulsions, and sleep disturbance. Effectivity of different drugs in influencing these symptoms is presented and significances of findings are used to assess the relevance of these findings. We conclude that certain symptoms such as depression or impulsivity can be successfully treated. Serotonin reuptake inhibitors play a decisive role in pharmacological treatment of Borderline Personality Disorder. Finally, recommendations for effective drug treatment of BPD symptoms are presented. Comorbid depression should be treated with Selective Serotonin Reuptake Inhibitors. These substances could also be shown to be effective in the treatment of impulsive and aggressive behavior. Intermittent psychotic symptoms are a target for atypical neuroleptics. Benzodiazepines are no longer viewed to be useful in the treatment of BPD.

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