Evidenz für den Einsatz von Antikonvulsiva bei Persönlichkeitsstörungen

Zusammenfassung

Anliegen: Der Einsatz von Psychopharmaka bei Persönlichkeitsstörungen (PKS) ist klinisch weit verbreitet. Diese Arbeit gibt eine systematische Übersicht über randomisierte kontrollierte Studien (RCTs) zum Einsatz von Antikonvulsiva bei PKS. Methode: Basierend auf einer Medline-Recherche wurden die zwischen 1970 und 2008 publizierten RCTs zum genannten Thema systematisch erfasst und ausgewertet. Ergebnisse: In den 12 erfassten RCTs ergab sich für den symptombezogenen Einsatz bei PKS die stärkste Evidenz für Valproat und Topiramat. Die Datenlage für den Einsatz anderer Antikonvulsiva bei Persönlichkeitsstörungen ist spärlich. Schlussfolgerungen: In klinischen Studien haben sich Valproinsäure und Topiramat, möglicherweise auch Lamotrigin, Carbamazepin und Oxcarbazepin zur symptomatischen Behandlung von affektiver Dysregulation und impulsiver Aggressivität bei PKS bewährt. Dennoch sind weitere RCTs dringend erforderlich, da sich die klinische Anwendungspraxis bisher nicht ausreichend auf eine wissenschaftliche Evidenz für die Wirksamkeit und Sicherheit von Antikonvulsiva bei PKS stützen kann.

Abstract

Objective: There is a common practice of polypharmacy and an increased use of mood stabilizers in personality disorders (PD). This paper reviews all randomized controlled trials (RCTs) of anticonvulsants to evaluate the evidence base supporting their use in treatment of PD. Methods: German and English language literature cited in Medline and published between 1970 and 2008 was searched using the following terms: Borderline/personality disorder, anticonvulsant, mood stabilizer, carbamazepine, felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenytoine, pregabalin, tiagabine, topiramate, and valproate. Results: Twelve RCTs were identified which included anticonvulsants in treatment of personality disorders. The anticonvulsants valproate and topiramate appeared to have the most empirical support for having a favorable effect on symptoms of borderline personality disorder. Evidence for the use of other anticonvulsants in patients with PD is sparse. Conclusions: Valproate and topiramate, probably also lamotrigine, carbamazepine, and oxcarbazepine as well, were useful in treating symptoms of affective dysregulation and impulsive aggression in PD. However, further RCTs of anticonvulsants are greatly needed as clinical use of these agents has risen without sufficient evidence supporting their efficacy and safety in personality disorders.

Schlüsselwörter

Persönlichkeitsstörung - Antikonvulsiva - mood stabilizer - Psychopharmakotherapie

Key words

personality disorder - anticonvulsants - mood stabilizer - psychopharmacotherapy

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