Pharmacotherapy of Personality Disorders in German Speaking Countries: State and Changes in the Last Decade

Background: In many cases, patients with personality disorders currently receive psychopharmacological treatment as well as psychotherapy. Empirically oriented studies of outcome and efficacy are still rare, and clinical practice is still dominated by a symptomatic and rather pragmatic approach. Aim: This study provides empirical insight into the reality of psychopharmacological practice in psychiatric institutions in German speaking countries. Method: The use of psychotropic drugs in patients with personality disorders is demonstrated using the data base of the AMSP drug safety program. Recent changes are shown by comparing results from 1996 and 2003. Results: Our data show a symptom-driven, polypragmatic, and often off-label use of psychotropic drugs in personality disorders.

References

• 1 American Psychiatric A ssociation. Practice guideline for the treatment of patients with borderline personality disorder.  Am J Psychiatry. 2001;  158 (Suppl) 1-52
• 2 Benjamin L S. Special feature: personality disorders: models for treatment and strategies for treatment development.  J Personal Disord. 1997;  11 307-324
• 3 Cowdry R W, Gardner D L. Pharmacotherapy of borderline personality disorder: alprazolam, carbamazepine, trifluoperazine and tranylcyclopromine.  Arch Gen Psychiatry. 1988;  45 111-119
• 4 Cowdry R W. Psychopharmacology of borderline personality disorder.  J Clin Psychiatry. 1987;  48 15-25
• 5 Dulz B. Pharmakotherapie bei Borderlinestörungen. Eine Literaturübersicht.  Nervenarzt. 1994;  65 755-761
• 6 Frankenburg F R, Zanarini M C. Divalproex sodium treatment of women with borderline personality disorder and bipolar II disorder: a double-blind placebo-controlled pilot study.  J Clin Psychiatry. 2002;  63 442-446
• 7 Grohmann R, Engel R R, Geissler K H, Ruether E. Psychotropic drug use in psychiatric Impatiens: recent trends and changes over time - data from the AMSP study.  Pharmacopsychiatry. 2004;  37 (Suppl 1) S27-S38
• 8 Grohmann R, Engel R R, Ruether E, Hippius H. The AMSP drug safety program: methods and global results.  Pharmacopsychiatry . 2004;  37 (Suppl 1) S4-S11
• 9 Grohmann R, Hippius H, Helmchen H, Ruether E, Schmidt L G. The AMÜP study for drug surveillance in psychiatry - a summary of impatient data.  Pharmacopsychiatry. 2004;  37 (Suppl 1) S16-S26
• 10 Hollander E, Swann A C, Coccaro E F, Jiang P, Smith T B. Impact of trait impulsivity and state aggression on divalproex versus placebo response in borderline personality disorder.  Am J Psychiatry. 2005;  162 621-624
• 11 Kampfhammer H P, Hippius H. Special feature: pharmacotherapy in personality disorders.  J Personal Disord. 1998;  12 277-288
• 12 Links P S, Boggild A, Sarin N. Modeling the relationship between affective liability, Impulsivity, and suicidal behavior.  J Psychiatr Pract. 2000;  6 247-255
• 13 Links P S, Boggild A, Sarin N. Psychopharmacology of personality disorders: review and emerging issues.  Curr Psychiatry Rep. 2001;  3 70-76
• 14 Links P S, Heslegrave R, Villella J. Psychopharmacological management of personality disorders: an outcome-focused model. In Silk KR, editor Biology of Personality Disorders. Washington; American Psychiatric Press 1998: p 93-127
• 15 Markovitz P J. Recent trends in the pharmacotherapy of personality disorders.  J Personal Disord. 2004;  18 90-101
• 16 Montgomery S A. The psychopharmacology of borderline personality disorders.  Acta Psychiatr Belg. 2001;  87 260-266
• 17 Oldham J M, Bender D S, Skodol A E, Dyck I R, Sanislow C A, Yen S, Grilo C M, Shea M T, Zanarini M C, Gunderson E J, McGlashan T H. Testing an APA practice guideline: symptom-targeted medication utilization for patients with borderline personality disorder.  J Psychiatr Pract. 2004;  10 156-161
• 18 Pelissolo A, Lepine J P. Pharmacotherapy in personality disorders: methodological issues and resulte.  Encephale. 1999;  25 496-507
• 19 Soloff P H. Algorithms for psychopharmacological treatment of personality dimensions: symptom-specific treatments for cognitive-perceptual, affective, and impulsive-behavioral dysregulation.  Bull Menninger Clin. 1998;  62 195-214
• 20 Soloff P H. Psychopharmacology of borderline personality disorder.  Psychiatr Clin North Am. 2000;  23 169-192
• 21 Synder S. The interaction of psychopharmacology and psychoanalysis in the borderline patient.  Psychiatr Q. 1980;  52 240-250
• 22 Villalba R, Harrington C J. Repetitive self-injurious behaviour: a neuropsychiatric perspective and review of pharmacologic treatments.  Semin Clin Neuropsychiatry. 2000;  5 214-226
• 23 Zanarini M C, Frankenburg F R, Parachini E A. 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
• 24 Zanarini M C, Frankenburg F R. Olanzapine treatment of female borderline personality disorder patients: a double-blind, placebo-controlled pilot study.  J Clin Psychiatry. 2001;  62 849-854
• 25 Zanarini M C. Update on pharmacotherapy of borderline personality disorder.  Curr Psychiatry Rep. 2004;  6 66-70
• 26 Zisook S, Ricketts J E. Psychopharmacologic approaches to the borderline patient.  Hillside J Clin Psychiatry. 1988;  10 55-70