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Grabitz P, Saksone L, Schorr SG, Schwietering J, Bittlinger M, Kimmelman J. Research encouraging off-label use of quetiapine: A systematic meta-epidemiological analysis. Clin Trials 2024; 21:418-429. [PMID: 38284364 DOI: 10.1177/17407745231225470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
BACKGROUND Researchers often conduct small studies on testing a drug's efficacy in off-label indications. If positive results from these exploratory studies are not followed up by larger, randomized, double-blinded trials, physicians cannot be sure of a drug's clinical value. This may lead to off-label prescriptions of ineffective treatments. We aim to describe the way clinical studies fostered off-label prescription of the antipsychotic drug quetiapine (Seroquel). METHODS In this systematic meta-epidemiological analysis, we searched EMBASE, MEDLINE, Cochrane CENTRAL and PsycINFO databases and included clinical studies testing quetiapine for unapproved indications between May 1995 and May 2022. We then assessed the frequency with which publications providing low-level evidence suggesting efficacy of quetiapine for off-label indications was not followed up by large, randomized and double-blinded trials within 5 years. RESULTS In total, 176 published studies were identified that reported potential efficacy of quetiapine in at least 26 indications. Between 2000 and 2007, publication of exploratory studies suggesting promise for off-label indications rapidly outpaced publication of confirmatory trials. In the 24 indications with a minimum of 5 years of follow-up from the first positive exploratory study, 19 (79%) were not followed up with large confirmatory trials within 5 years. At least nine clinical practice guidelines recommend the use of quetiapine for seven off-label indications in which published confirmatory evidence is lacking. CONCLUSION Many small, post-approval studies suggested the promise of quetiapine for numerous off-label indications. These findings generally went unconfirmed in large, blinded, randomized trials years after first being published. The imbalance of exploratory and confirmatory studies likely encourages ineffective off-label treatment.
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Affiliation(s)
- Peter Grabitz
- QUEST Center for Responsible Research, Berlin Institute of Health, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Lana Saksone
- QUEST Center for Responsible Research, Berlin Institute of Health, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Gabriele Schorr
- QUEST Center for Responsible Research, Berlin Institute of Health, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Schwietering
- QUEST Center for Responsible Research, Berlin Institute of Health, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Merlin Bittlinger
- Department of Equity, Ethics and Policy and Studies of Translation, Ethics and Medicine (STREAM), Biomedical Ethics Unit, McGill University, Montréal, QC, Canada
| | - Jonathan Kimmelman
- Department of Equity, Ethics and Policy and Studies of Translation, Ethics and Medicine (STREAM), Biomedical Ethics Unit, McGill University, Montréal, QC, Canada
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Herttua K, Crawford M, Paljarvi T, Fazel S. Associations between antipsychotics and risk of violent crimes and suicidal behaviour in personality disorder. EVIDENCE-BASED MENTAL HEALTH 2022; 25:e58-e64. [PMID: 36283800 PMCID: PMC9811101 DOI: 10.1136/ebmental-2022-300493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 09/29/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite uncertain benefits, people with personality disorder are commonly treated with antipsychotic medication. OBJECTIVE To investigate the association between antipsychotics and violent crimes and suicidal behaviour in individuals with personality disorder. METHODS We used nationwide Danish registries to identify all individuals with diagnosed personality disorder aged 18-64 years during 2007 to 2016. Antipsychotics were recorded in dispensed prescriptions, and individuals were followed up for police-recorded suspicions for violent crimes and healthcare presentations of suicidal behaviour. We applied a within-individual design where outcome rates for individuals with personality disorder during medicated periods were compared with rates during non-medicated periods. FINDINGS The cohort included 166 328 people with diagnosed personality disorder, of whom 79 253 were prescribed antipsychotics, presented at least one outcome and were thus included in the within-individual analyses. Compared with periods when individuals were not on antipsychotic medication, violent crime suspicions were 40% lower (incident rate ratio (IRR) 0.60, 95% CI 0.55 to 0.63) in men and 10% lower (IRR 0.90, 95% CI 0.79 to 1.01) in women, while rates of suicidal behaviour were 32% lower both in men (IRR 0.68, 95% CI 0.66 to 0.71) and in women (IRR 0.68, 95% CI 0.65 to 0.70). In subgroup analyses, the magnitude of the association varied across specific personality disorders for criminal outcomes but less for suicidal behaviour, with largest association in dissocial personality disorder for violent criminality (IRR 0.53, 95% CI 0.47 to 0.59). CONCLUSIONS Treatment with antipsychotics was associated with reduced risks for violent crime suspicions and suicidal behaviour among individuals with personality disorder. CLINICAL IMPLICATIONS Potential effects of antipsychotics on suicidal behaviour and violence should be taken into account when considering treatment options for people with personality disorders.
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Affiliation(s)
- Kimmo Herttua
- Public Health, University of Southern Denmark - Campus Esbjerg, Esbjerg, Denmark
| | - Mike Crawford
- Department of Brain Sciences, Imperial College London Faculty of Medicine, London, UK
| | - Tapio Paljarvi
- Psychiatry, Oxford University, Oxford, UK
- Psychiatry, Niuvanniemi Hospital, Kuopio, Finland
| | - Seena Fazel
- Psychiatry, University of Oxford, Oxford, UK
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3
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Hayes JF, Hardoon S, Deighton J, Viding E, Osborn DPJ. Association between quetiapine use and self-harm outcomes among people with recorded personality disorder in UK primary care: A self-controlled case series analysis. J Psychopharmacol 2022; 36:1218-1225. [PMID: 36317651 PMCID: PMC9643813 DOI: 10.1177/02698811221131990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Quetiapine is frequently prescribed to people with personality disorder diagnoses, but this is not supported by evidence or treatment guidelines. AIMS To examine associations between periods of quetiapine prescribing and self-harm events in people with personality disorder. METHOD Self-controlled case series using linked primary care and hospital records covering the period 2007-2017. We calculated incidence rates and incidence rate ratios (IRRs) for self-harm events during periods when people were prescribed (exposed to) quetiapine, as well as periods when they were unexposed or pre-exposed to quetiapine. RESULTS We analysed data from 1,082 individuals with established personality disorder diagnoses, all of whom had at least one period of quetiapine prescribing and at least one self-harm episode. Their baseline rate of self-harm (greater than 12 months before quetiapine treatment) was 0.52 episodes per year. Self-harm rates were elevated compared to the baseline rate in the month after quetiapine treatment was commenced (IRR 1.85; 95% confidence interval (CI) 1.46-2.34) and remained raised throughout the year after quetiapine treatment was started. However, self-harm rates were highest in the month prior to quetiapine initiation (IRR 3.59; 95% CI 2.83-4.55) and were elevated from 4 months before quetiapine initiation, compared to baseline. CONCLUSION Self-harm rates were elevated throughout the first year of quetiapine prescribing, compared to the baseline rate. However, rates of self-harm reduced in the month after patients commenced quetiapine, compared to the month before quetiapine was initiated. Self-harm rates gradually dropped over a year of quetiapine treatment. Quetiapine may acutely reduce self-harm. Longer-term use and any potential benefits need to be balanced with the risk of adverse events.
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Affiliation(s)
- Joseph F Hayes
- Division of Psychiatry, University
College London, London UK,Camden and Islington NHS Foundation
Trust, London, UK,Joseph F Hayes, Division of Psychiatry,
University College London, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Sarah Hardoon
- Division of Psychiatry, University
College London, London UK
| | - Jessica Deighton
- Anna Freud Centre, London, UK,Division of Psychology and Language
Sciences, University College London, London, UK
| | - Essi Viding
- Division of Psychology and Language
Sciences, University College London, London, UK
| | - David PJ Osborn
- Division of Psychiatry, University
College London, London UK,Camden and Islington NHS Foundation
Trust, London, UK
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Morozova M, Potanin S, Burminskiy D, Beniashvili A, Rupchev G, Lepilkina T, Sorokin M, Kasyanov E, Mazo G, Tarumov D, Trufanov A, Markin K, Beybalaeva T, Katok A, Tsapko D. Low doses of quetiapine (Seroquel) as an impulsivity corrector in patients with bipolar affective disorder in remission. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:120-127. [DOI: 10.17116/jnevro2022122081120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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5
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Grant JE, Valle S, Chesivoir E, Ehsan D, Chamberlain SR. A double-blind placebo-controlled study of brexpiprazole for the treatment of borderline personality disorder. Br J Psychiatry 2021; 220:1-6. [PMID: 35049469 PMCID: PMC7612273 DOI: 10.1192/bjp.2021.159] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Borderline personality disorder is associated with impaired quality of life and has a number of untoward public health associations. There is no established first-line pharmacological treatment for borderline personality disorder, and available options are not suitable for all individuals. AIMS To evaluate brexpiprazole, which has effects on the dopaminergic and serotonergic systems, for the reduction of borderline personality disorder symptoms. METHOD Eighty adults with borderline personality disorder were recruited for a randomised, double-blind placebo-controlled study. Participants received 12-week treatment with brexpiprazole (1 mg/day for 1 week, then increasing to 2 mg/day) or placebo in a parallel design. The primary efficacy outcome measure was the clinician-rated Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD). Safety data were collected. Effects of active versus placebo treatment were characterised with linear repeated measures models. RESULTS There was a significant interaction between treatment and time on the ZAN-BPD scale (P = 0.0031), solely because of differentiation specifically at week 12. Brexpiprazole was generally well tolerated. Secondary measures did not result in statistically significant differences from placebo. CONCLUSIONS Brexpiprazole appears to have some possible effect on borderline personality disorder symptoms, but further studies are needed because of the significant effects evident, specifically at the final time point. These findings also need to be viewed cautiously, given the small sample size, large drop-out rate and robust placebo response.
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Affiliation(s)
- Jon E. Grant
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL USA
| | - Stephanie Valle
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL USA
| | - Eve Chesivoir
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL USA
| | - Dustin Ehsan
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL USA
| | - Samuel R. Chamberlain
- Department of Psychiatry, Faculty of Medicine, University of Southampton, USA; and Southern Health NHS Foundation Trust, Southampton, USA
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6
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Wolkenstein L, Rombold-Bruehl F, Bingmann T, Sommer A, Kanske P, Plewnia C. Challenging control over emotions in borderline personality disorder - a tDCS study. Neuropsychologia 2021; 156:107850. [PMID: 33812945 DOI: 10.1016/j.neuropsychologia.2021.107850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Deficient cognitive control (CC) over emotional distraction is a central characteristic of borderline personality disorder (BPD). Reduced activation of the left dorsolateral prefrontal cortex (dlPFC) has been linked to this deficit. This study investigates whether it is possible to ameliorate CC deficits via anodal tDCS over the left dlPFC in BPD. Furthermore, we investigate whether the extent of CC impairment influences how well one responds to tDCS. METHODS The effect of a single-session tDCS (1 mA for 20 min, reference electrode on the contralateral mastoid bone) to the left dlPFC (F3) on the CC of patients with BPD (N = 20) and healthy control participants (HCs, N = 20) was examined in a double-blinded, balanced randomized, sham-controlled crossover trial. A delayed response working memory task with negative, neutral and positive pictures presented during the delay period was conducted to assess CC. Stimulation was applied simultaneously with the task. RESULTS Negative pictures caused prolonged response times as compared to a control condition in patients with BPD and HCs. Anodal tDCS to the left dlPFC did not significantly reduce this interference effect in the overall sample. Further analyses showed, however, that participants with impaired CC profited the most from anodal tDCS. In the subgroup of participants who actually showed an interference effect we found the expected significant amelioration of CC under tDCS. CONCLUSIONS The present study demonstrates that anodal tDCS applied to the left dlPFC improves deficient CC. Thereby, base-level performance moderates tDCS effects. Hence, tDCS might be suitable to support behavioral trainings to enhance CC specifically in people whose impairments in CC are comparably high.
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Affiliation(s)
- Larissa Wolkenstein
- Department of Psychology, Clinical Psychology and Psychotherapy, Ludwig-Maximilians-Universität München, Germany; Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Germany.
| | - Felicitas Rombold-Bruehl
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität, Humboldt-Universität zu Berlin, And Berlin Institute of Health, Campus Benjamin Franklin, Germany
| | - Tiffany Bingmann
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Germany
| | - Anja Sommer
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Tübingen, Germany; Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, Germany
| | - Philipp Kanske
- Department of Psychology, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany; Department of Social Neuroscience, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Christian Plewnia
- Department of Psychiatry and Psychotherapy, Neurophysiology & Interventional Neuropsychiatry, University of Tübingen, Germany
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Vai B, Cazzetta S, Scalisi R, Donati A, Bechi M, Poletti S, Sforzini L, Visintini R, Maffei C, Benedetti F. Neuropsychological deficits correlate with symptoms severity and cortical thickness in Borderline Personality Disorder. J Affect Disord 2021; 278:181-188. [PMID: 32961414 DOI: 10.1016/j.jad.2020.09.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/15/2020] [Accepted: 09/11/2020] [Indexed: 01/30/2023]
Abstract
BACKGROUND Neuropsychological abnormalities have been proposed to contribute to the development and maintenance of Borderline Personality Disorder (BPD). Previous meta-analyses and reviews confirmed deficits in a broad range of cognitive domains, including attention, cognitive flexibility, memory, executive functions, planning, information processing, and visuospatial abilities, often suggested to underlie brain abnormalities. However, no study directly explored the structural neural correlates of these deficits in BPD, also accounting for the possible confounding effect of pharmacological treatments, often used as adjunctive symptom-targeted therapy in clinical setting. METHODS In this study we compared the performance of 24 BPD patients to 24 healthy controls obtained at the neuropsychological battery "Brief Assessment and Cognition in Schizophrenia", exploring the relationship between the cognitive impairments and current symptomatology, brain grey matter volumes and cortical thickness, controlling for medications load. RESULTS Data revealed deficits in verbal memory and fluency, working memory, attention and speed of information processing and psychomotor speed and coordination when medication load was not in the model. Correcting for this variable, only the impairment in psychomotor abilities remained significant. A multiple regression confirmed the effect of this neuropsychological domain on the severity of BPD symptomatology (Borderline Evaluation of Severity Over Time). In BPD, the performance at psychomotor speed and coordination was also directly associated to cortical thickness in postcentral gyrus. LIMITATIONS Relatively small sample size, especially for neuroimaging. CONCLUSIONS Our study highlighted an influence of BPD neuropsychological impairments on symptomatology, and cortical thickness, prompting the potential clinical utility of a cognitive remediation program in BPD.
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Affiliation(s)
- Benedetta Vai
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Fondazione Centro San Raffaele, Milan, Italy.
| | - Silvia Cazzetta
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosalia Scalisi
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessia Donati
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Margherita Bechi
- Department of Clinical Neurosciences, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Poletti
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Laura Sforzini
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaele Visintini
- Division of Neuroscience, Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Cesare Maffei
- Vita-Salute San Raffaele University, Milan, Italy; Division of Neuroscience, Clinical Psychology and Psychotherapy Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy
| | - Francesco Benedetti
- Division of Neuroscience, Psychiatry and Clinical Psychobiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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8
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Del Casale A, Bonanni L, Bargagna P, Novelli F, Fiaschè F, Paolini M, Forcina F, Anibaldi G, Cortese FN, Iannuccelli A, Adriani B, Brugnoli R, Girardi P, Paris J, Pompili M. Current Clinical Psychopharmacology in Borderline Personality Disorder. Curr Neuropharmacol 2021; 19:1760-1779. [PMID: 34151763 PMCID: PMC8977633 DOI: 10.2174/1570159x19666210610092958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 02/11/2021] [Accepted: 05/05/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patients with Borderline Personality Disorder (BPD) manifest affective and behavioral symptoms causing personal distress, relationship difficulties, and reduced quality of life with global functioning impairment, mainly when the disease takes an unfavorable course. A substantial amount of healthcare costs is dedicated to addressing these issues. Many BPD patients receive medications, mostly those who do not respond to psychological interventions. OBJECTIVE Our aim was to assess the efficacy of the most used strategies of pharmacological interventions in BPD with a comprehensive overview of the field. METHODS We searched the PubMed database for papers focused on the most used psychotropic drugs for BPD. We included randomized controlled trials and open studies in adult patients with BPD, focusing on the efficacy and tolerability of single classes of drugs with respect to specific clinical presentations that may occur during the course of BPD. RESULTS Specific second-generation antipsychotics (SGAs) or serotonergic antidepressants can be effective for different core symptoms of BPD, mainly including mood symptoms, anxiety, and impulse dyscontrol. Some atypical antipsychotics can also be effective for psychotic and dissociative symptoms. Specific antiepileptics can be useful in some cases in treating different BPD symptoms, mainly including mood instability, impulsiveness, and anger. CONCLUSION No medication is currently approved for BPD, and clinicians should carefully assess the benefits and risks of drug treatment. Further studies are needed to identify specific personalized treatment strategies, also considering the clinical heterogeneity and possible comorbidities of BPD.
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Affiliation(s)
- Antonio Del Casale
- Address correspondence to this author at the Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University, Rome; E-mail:
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9
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Mungo A, Hein M, Hubain P, Loas G, Fontaine P. Impulsivity and its Therapeutic Management in Borderline Personality Disorder: a Systematic Review. Psychiatr Q 2020; 91:1333-1362. [PMID: 32989635 DOI: 10.1007/s11126-020-09845-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2020] [Indexed: 12/22/2022]
Abstract
No treatment has been approved and recognized as effective in borderline personality disorder (BPD). Impulsivity is a key dimension because it is a predictor of remission but also suicide. The purpose of this review is to establish an inventory on the management of impulsivity in BPD and determine the effective treatments. A systematic review on the PubMed and Ovid databases was conducted up to September 2019 to December 2019 using the PRISMA guidelines. The inclusion criteria were: studies with patients with borderline personality disorder, were published between 1989 and 2019, used English-language and evaluated impulsivity before and after treatment. 41 articles selected were included for pharmacological treatment. 24 articles were found for psychotherapeutic management and one randomized study of transcranial magnetic stimulation. Based on this review, we must focus on psychotherapy in BPD, particularly the schema therapy, dialectical behavioral therapy, psychoeducation, system training of emotional predictability and problem solving and psychotherapy using mentalisation. The use of neuroleptics and mood stabilizers appears to be more effective than antidepressants. Another approach, such as transcranial magnetic stimulation, may prove useful in the near future if this technique is studied further.
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Affiliation(s)
- Anaïs Mungo
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, Route de Lennik, 808-1070, Anderlecht, Belgium.
| | - Matthieu Hein
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, Route de Lennik, 808-1070, Anderlecht, Belgium
| | - Philippe Hubain
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, Route de Lennik, 808-1070, Anderlecht, Belgium
| | - Gwenolé Loas
- Erasme Hospital, Department of Psychiatry and Sleep Laboratory, Université libre de Bruxelles, Route de Lennik, 808-1070, Anderlecht, Belgium
| | - Philippe Fontaine
- Department of Psychiatry, CHC Liège - site Saint Vincent, Rocourt, Belgium
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10
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Yang CC, Mauer L, Völlm B, Khalifa N. The Effects of Non-invasive Brain Stimulation on Impulsivity in People with Mental Disorders: a Systematic Review and Explanatory Meta-Analysis. Neuropsychol Rev 2020; 30:499-520. [PMID: 33009976 DOI: 10.1007/s11065-020-09456-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 09/20/2020] [Indexed: 01/03/2023]
Abstract
Impulsivity is a multi-faceted construct that underpins various mental health disorders. Impulsive behavior exacts a substantial health and economic burden, hence the importance of developing specific interventions to target impulsivity. Two forms of non-invasive brain stimulation, namely transcranial direct current stimulation (tDCS) and repetitive transcranial magnetic stimulation (rTMS), have been used to modulate impulsivity. To date, no reviews have systematically examined their effects on modulating impulsivity in people with mental health disorders. We conducted a systematic review and meta-analysis of the literature from AMED, Embase, Medline and PsycINFO databases on the use of rTMS and tDCS to modulate impulsivity in people with mental health disorders. Results from 11 tDCS and 18 rTMS studies indicate that tDCS has a significant, albeit small, effect on modulating impulsivity (g = 0.29; 95% CI, 0.09 to 0.48; p = .004) whereas rTMS has no significant effect on impulsivity (g = -0.08; 95% Cl, -0.35 to 0.19; p = .550). Subgroup analyses identified the key parameters required to enhance the effects of tDCS and rTMS on impulsivity. Gender and stimulation intensity acted as significant moderators for effects of rTMS on impulsivity. There is insufficient evidence to support the use of tDCS or rTMS in clinical practice to reduce impulsivity in people with mental health disorders. The use of standardized non-invasive brain stimulation protocols and outcome measures in patients with the same diagnosis is advised to minimize methodological heterogeneity.
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Affiliation(s)
- Cheng-Chang Yang
- Department of Neurology, Shuang Ho Hospital, Taipei Medical University, No 291 ZhongZheng Road, Zhonghe District, New Taipei City, Taiwan. .,Brain and Consciousness Research Center, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan.
| | - Laura Mauer
- Institute of Clinical Psychology and Psychotherapy, Dresden University of Technology, Dresden, Germany
| | - Birgit Völlm
- Klinik und Poliklinik für Forensische Psychiatrie, Universitat Rostock, Rostock, Germany
| | - Najat Khalifa
- Division of Forensic Psychiatry, Department of Psychiatry, School of Medicine, Queen's University, Kingston, Canada
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Jeon N, Bortolato M. What drugs modify the risk of iatrogenic impulse-control disorders in Parkinson's disease? A preliminary pharmacoepidemiologic study. PLoS One 2020; 15:e0227128. [PMID: 31910240 PMCID: PMC6946157 DOI: 10.1371/journal.pone.0227128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 12/12/2019] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Parkinson's disease (PD) patients treated with pramipexole (PPX) and ropinirole (ROP) exhibit a higher risk of developing impulse control disorders (ICDs), including gambling disorder, compulsive shopping, and hypersexuality. The management of ICDs in PD is challenging, due to the limited availability of effective therapeutic alternatives or counteractive strategies. Here, we used a pharmacoepidemiological approach to verify whether the risk for PPX/ROP-associated ICDs in PD patients was reduced by drugs that have been posited to exert therapeutic effects on idiopathic ICDs-including atypical antipsychotics (AAs), selective serotonin reuptake inhibitors (SSRIs), and glutamatergic modulators (GMs). METHODS To quantify the strength of the associations between PPX/ROP and other medications with respect to ICD risk, odds ratios (ORs) were calculated by multivariable logistic regression, adjusting for age, gender, marital status race, psychiatric comorbidities, and use of cabergoline and levodopa. RESULTS A total of 935 patients were included in the analysis. Use of GMs, SSRIs, and AAs was not associated with a decreased ICD risk in PD patients treated with PPX/ROP; conversely, ICD risk was significantly increased in patients treated with either GMs (Adjusted Odds Ratio, ORa: 14.00 [3.58-54.44]) or SSRIs (ORa: 3.67 [1.07-12.59]). Results were inconclusive for AAs, as available data were insufficient to compute a reliable ORa. CONCLUSIONS These results suggest that some of the key pharmacological strategies used to treat idiopathic ICD may not be effective for ICDs associated with PPX and ROP in PD patients. Future studies with larger cohorts are needed to confirm, validate, and extend these findings.
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Affiliation(s)
- Nakyung Jeon
- College of Pharmacy, Chonnam National University, Gwang-ju, Republic of Korea
| | - Marco Bortolato
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, Utah, United States of America
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12
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Bozzatello P, Rocca P, De Rosa ML, Bellino S. Current and emerging medications for borderline personality disorder: is pharmacotherapy alone enough? Expert Opin Pharmacother 2019; 21:47-61. [DOI: 10.1080/14656566.2019.1686482] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Paola Rocca
- Department of Neuroscience, University of Turin, Turin, Italy
| | | | - Silvio Bellino
- Department of Neuroscience, University of Turin, Turin, Italy
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Abstract
Loneliness impacts both physical and psychological health and is associated with increases of all-cause mortality and suicidal behavior. Because loneliness may result from a variety of developmental, interpersonal, and intrapersonal factors, distinguishing its components, origins, and sustaining factors as it manifests in various psychopathological states are important steps in formulating interventions to alleviate these conditions. To date, loneliness has not been widely studied in relation to complex posttraumatic stress disorder (PTSD), which is newly delineated in the International Classification of Diseases, characterized by PTSD symptoms in the context of significant early trauma, as well as "disturbances in self-organization" marked by affective dysregulation, negative self-concept, and disturbances in relationships. In this article, illustrating with case material, we suggest that loneliness plays a major role in the development of complex PTSD and in the preservation of its symptoms. Consequently, therapies for complex PTSD should include interventions that address loneliness.
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Tzagarakis C, Thompson A, Rogers RD, Pellizzer G. The Degree of Modulation of Beta Band Activity During Motor Planning Is Related to Trait Impulsivity. Front Integr Neurosci 2019; 13:1. [PMID: 30705624 PMCID: PMC6344424 DOI: 10.3389/fnint.2019.00001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 01/03/2019] [Indexed: 11/23/2022] Open
Abstract
Impulsivity is a prominent personality trait, and a key modulating component of neurologic and psychiatric disorders. How impulsivity is related to the brain mechanisms associated with action planning is poorly understood. Here, we investigated the relation between impulsivity and the modulation of beta band oscillatory activity associated with action planning and execution. Given that beta power decreases during action planning and decreases further during action execution, we hypothesized that during planning the level of beta band power of more impulsive individuals would be closer to the level reached during execution than that of less impulsive individuals. This could explain the tendency to "jump the gun" (commission errors) in high impulsivity. To test this hypothesis, we recruited healthy volunteers (50 participants analyzed) and used the Barratt Impulsiveness Scale questionnaire to evaluate their impulsivity as high or low. We then recorded their brain neuromagnetic signals while they performed an instructed-delay task that induced different levels of action planning by varying the number of spatial cues, hence the uncertainty, about the location of the upcoming target. During the early cue period of the task, we found a posterior (source localized in the occipito-parietal areas) and a left fronto-central group of channels (source localized in the left sensorimotor areas) where beta power was modulated by number of cues, whereas during the late cue period only the left fronto-central group was modulated. We found that the decrease of relative beta band power during action planning in the left fronto-central group of channels was more pronounced in the high impulsivity group than in the low impulsivity group. In addition, we found that the beta band-mediated functional connectivity between the posterior and the left fronto-central groups of channels was weaker in the high impulsivity group than in the low impulsivity group during the early cue period. Furthermore, high impulsives made more commission and movement errors in the task than low impulsives. These results reveal neural mechanisms through which impulsivity affects action planning and open the way for further study of the role of beta band activity in impulsivity, especially in the context of disease and therapeutics.
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Affiliation(s)
- Charidimos Tzagarakis
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
- Brain Sciences Center, Minneapolis VA Health Care System, Minneapolis, MN, United States
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Andrew Thompson
- College of Biological Sciences, University of Minnesota, Minneapolis, MN, United States
| | - Robert D. Rogers
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- School of Psychology, Bangor University, Bangor, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Giuseppe Pellizzer
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, United States
- Brain Sciences Center, Minneapolis VA Health Care System, Minneapolis, MN, United States
- Department of Neurology, University of Minnesota, Minneapolis, MN, United States
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Barkus C, Ferland JMN, Adams WK, Churchill GC, Cowen PJ, Bannerman DM, Rogers RD, Winstanley CA, Sharp T. The putative lithium-mimetic ebselen reduces impulsivity in rodent models. J Psychopharmacol 2018; 32:1018-1026. [PMID: 29986609 DOI: 10.1177/0269881118784876] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Deficits in impulse control feature in many psychiatric conditions including bipolar disorder, suicidality and addictions. Lithium lowers impulsivity in clinical populations and decreases pathological gambling in experimental medicine studies, but suffers from adverse effects, poor compliance and a low therapeutic index. AIMS Recently we identified that the neuroprotective agent ebselen, which is reportedly safe in humans, inhibited inositol monophosphatase (IMPase), a candidate lithium mechanism. Ebselen also reduced 5-HT receptor (5-HT2A) function which predicts impulsivity lowering properties. Here we investigated the effect of ebselen in rat models of impulsive behaviour. METHODS Ebselen was tested in two models of impulsivity with human analogues: the five-choice serial reaction time task (5-CSRTT) and rodent gambling task (rGT). The main outcome measures were premature responses (5-CSRTT and rGT) and choice behaviour (rGT), which model motor impulsivity and choice impulsivity, respectively. RESULTS At doses that decreased 5-HT2A receptor function (DOI-induced wet dog shakes), ebselen decreased premature responding in the 5-CSRTT both in the absence and presence of cocaine. The 5-HT2A receptor antagonist MDL 100,907 also reduced premature responding in the 5-CSRTT although not in the presence of cocaine. In the rGT ebselen showed a tendency to reduce premature responding but had no effect on choice behaviour. CONCLUSIONS These findings suggest that ebselen preferentially reduces motor impulsivity over choice impulsivity, and that inhibition of 5-HT2A receptor function is a contributing mechanism. Collectively, these data support the repurposing of ebselen as an anti-impulsive treatment and fast-tracking to clinical trials in patient groups characterised by poor impulse control.
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Affiliation(s)
- Chris Barkus
- 1 Department of Pharmacology, University of Oxford, UK
- 2 Department of Psychology, University of British Columbia, Vancouver, Canada
| | | | - Wendy K Adams
- 2 Department of Psychology, University of British Columbia, Vancouver, Canada
| | | | | | | | | | | | - Trevor Sharp
- 1 Department of Pharmacology, University of Oxford, UK
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Gilmore CS, Dickmann PJ, Nelson BG, Lamberty GJ, Lim KO. Transcranial Direct Current Stimulation (tDCS) paired with a decision-making task reduces risk-taking in a clinically impulsive sample. Brain Stimul 2018; 11:302-309. [DOI: 10.1016/j.brs.2017.11.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/27/2017] [Accepted: 11/13/2017] [Indexed: 12/28/2022] Open
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Bozzatello P, Ghirardini C, Uscinska M, Rocca P, Bellino S. Pharmacotherapy of personality disorders: what we know and what we have to search for. FUTURE NEUROLOGY 2017. [DOI: 10.2217/fnl-2017-0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Pharmacotherapy for personality disorders is in the early stage of development because the evidence base for effective drug treatment is insufficient, biased toward borderline personality disorder and rampant with methodological issues. In this paper, we reviewed randomized, placebo-controlled trials of drugs efficacy in patients with personality disorders published between 1990 and 2016. Overwhelming majority of studies focused on borderline personality disorder, and the accumulation of evidence resulted in seven meta-analyses, which are interpreted into better strategies for evidence-based practice. Little research attention was given to schizotypal and antisocial personality disorders, with only indirect treatment efficacy evidence for the obsessive–compulsive and avoidant personality disorders. Some avenues for future efficacy research are indicated.
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Affiliation(s)
- Paola Bozzatello
- Centre or Personality Disorders, Department of Neuroscience, University of Turin, via Cherasco 11, 10126, Turin, Italy
| | - Camilla Ghirardini
- Centre or Personality Disorders, Department of Neuroscience, University of Turin, via Cherasco 11, 10126, Turin, Italy
| | - Maria Uscinska
- Centre or Personality Disorders, Department of Neuroscience, University of Turin, via Cherasco 11, 10126, Turin, Italy
| | - Paola Rocca
- Department of Neuroscience, University of Turin, via Cherasco 11,10126, Turin, Italy
| | - Silvio Bellino
- Centre or Personality Disorders, Department of Neuroscience, University of Turin, via Cherasco 11, 10126, Turin, Italy
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Shaikh U, Qamar I, Jafry F, Hassan M, Shagufta S, Odhejo YI, Ahmed S. Patients with Borderline Personality Disorder in Emergency Departments. Front Psychiatry 2017; 8:136. [PMID: 28824467 PMCID: PMC5543278 DOI: 10.3389/fpsyt.2017.00136] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Abstract
Borderline personality disorder (BPD) patients, when in crisis, are frequent visitors of emergency departments (EDs). When these patients exhibit symptoms such as aggressiveness, impulsivity, intense anxiety, severe depression, self-harm, and suicidal attempts or gestures, diagnosis, and treatment of the BPD becomes challenging for ED doctors. This review will, therefore, outline advice to physicians and health-care providers who face this challenging patient population in the EDs. Crisis intervention should be the first objective of clinicians when dealing with BPD in the emergency. For the patients with agitation, symptom-specific pharmacotherapy is usually recommended, while for non-agitated patients, short but intensive psychotherapy especially dialectical behavior therapy (DBT) has a positive effect. Although various psychotherapies, either alone or integrated, are preferred modes of treatment for this group of patients, the effects of psychotherapies on BPD outcomes are small to medium. Proper risk management along with developing a positive attitude and empathy toward these patients will help them in normalizing in an emergency setting after which treatment course can be decided.
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Affiliation(s)
- Untara Shaikh
- Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Iqra Qamar
- Nassau University Medical Center, East Meadow, NY, United States
| | | | | | | | | | - Saeed Ahmed
- Kings County Hospital Center, Brooklyn, NY, United States
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Wasylyshen A, Williams AM. Second-generation antipsychotic use in borderline personality disorder: What are we targeting? Ment Health Clin 2016; 6:82-88. [PMID: 29955452 PMCID: PMC6007581 DOI: 10.9740/mhc.2016.03.82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Borderline personality disorder (BPD) is a personality disorder plagued with high rates of psychotropic polypharmacy. Estimates show that second-generation antipsychotics (SGAs) are used in most of these patients; however, they are being prescribed off label. Methods: A literature review was conducted via PubMed in search for studies evaluating SGA use in BPD. Results: There are available data investigating 8 of 11 SGAs and their use in BPD. Of N = 269 potential articles, N = 34 evaluating the use of SGAs in BPD were included. Discussion: Strong evidence supporting SGAs in BPD is lacking. Potential target symptoms in which a SGA may be useful include depression, anxiety, anger, impulsivity, and paranoia/dissociative behavior.
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Affiliation(s)
- Adrian Wasylyshen
- PharmD Candidate, Loma Linda University School of Pharmacy, Loma Linda, California
| | - Andrew M Williams
- Assistant Professor of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, California,
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Soeiro-DE-Souza MG, Dias VV, Missio G, Balanzá-Martinez V, Valiengo L, Carvalho AF, Moreno RA. Role of quetiapine beyond its clinical efficacy in bipolar disorder: From neuroprotection to the treatment of psychiatric disorders (Review). Exp Ther Med 2015; 9:643-652. [PMID: 25667608 PMCID: PMC4316978 DOI: 10.3892/etm.2015.2213] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Accepted: 12/05/2014] [Indexed: 02/06/2023] Open
Abstract
The aim of the present review was to discuss the following aspects of treatment with quetiapine in psychiatric disorders: i) Neurocognition and functional recovery in bipolar disorder (BD); ii) neuroprotective profile in different models; and iii) potential off-label indications. A PubMed search was conducted of articles published in English between 2000 and 2012 on quetiapine, cross-referenced with the terms ‘anxiety’, ‘attention deficit disorder’, ‘borderline personality disorder’, ‘dementia’, ‘insomnia’, ‘major depressive disorder’ (MDD), ‘obsessive-compulsive disorder’, ‘post-traumatic stress disorder’, ‘remission’, ‘cognition’, ‘neurobiology’, ‘neuroprotection’, ‘efficacy’ and ‘effectiveness’. Articles were selected from meta-analyses, randomized clinical trials and open trials, and the results were summarized. Quetiapine, when studied in off-label conditions, has shown efficacy as a monotherapy in MDD and general anxiety disorder. Quetiapine also appears to exhibit a small beneficial effect in dementia. The review of other conditions was affected by methodological limitations that precluded any definitive conclusions on the efficacy or safety of quetiapine. Overall, the present review shows evidence supporting a potential role for quetiapine in improving cognition, functional recovery and negative symptoms in a cost-effective manner in BD. These benefits of quetiapine are potentially associated with its well-described neuroprotective effects; however, further studies are clearly warranted.
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Affiliation(s)
- Márcio G Soeiro-DE-Souza
- Mood Disorders Unit (GRUDA), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Vasco Videira Dias
- Mood Disorders Unit (GRUDA), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Giovanni Missio
- Mood Disorders Unit (GRUDA), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Vicent Balanzá-Martinez
- University Hospital Doctor Peset and Section of Psychiatry, University of Valencia, Valencia, Spain ; CIBER Mental Health (CIBERSAM), Carlos III Health Institute, Madrid, Spain
| | - Leandro Valiengo
- Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - André F Carvalho
- Psychiatry Research Group and Department of Clinical Medicine, Federal University of Ceará, Fortaleza, Brazil
| | - Ricardo Alberto Moreno
- Mood Disorders Unit (GRUDA), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
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21
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Abstract
Drug treatment of patients with borderline personality disorder (BPD) is common but mostly not supported by evidence from high-quality research. This review summarises the current evidence up to August 2014 and also aims to identify research trends in terms of ongoing randomised controlled trials (RCTs) as well as research gaps. There is some evidence for beneficial effects by second-generation antipsychotics, mood stabilisers and omega-3 fatty acids, while the overall evidence base is still unsatisfying. The dominating role SSRI antidepressants usually play within the medical treatment of BPD patients is neither reflected nor supported by corresponding evidence. Any drug treatment of BPD patients should be planned and regularly evaluated against this background of evidence. Research trends indicate increasing attention to alternative treatments such as dietary supplementation by omega-3 fatty acids or oxytocin.
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Abstract
The best available evidence for psychopharmacologic treatment of borderline personality disorder (BPD) is outlined here. BPD is defined by disturbances in identity and interpersonal functioning, and patients report potential medication treatment targets such as impulsivity, aggression, transient psychotic and dissociative symptoms, and refractory affective instability Few randomized controlled trials of psychopharmacological treatments for BPD have been published recently, although multiple reviews have converged on the effectiveness of specific anticonvulsants, atypical antipsychotic agents, and omega-3 fatty acid supplementation. Stronger evidence exists for medication providing significant improvements in impulsive aggression than in affective or other interpersonal symptoms. Future research strategies will focus on the potential role of neuropeptide agents and medications with greater specificity for 2A serotonin receptors, as well as optimizing concomitant implementation of evidence-based psychotherapy and psychopharmacology, in order to improve BPD patients' overall functioning.
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Affiliation(s)
- Luis H Ripoll
- Assistant Professor, Dept of Psychiatry, The Mount Sinai School of Medicine, New York, New York, USA
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23
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Carney AC. Efficacy of Quetiapine Off-Label Uses: Data Synthesis. J Psychosoc Nurs Ment Health Serv 2013; 51:11-8. [DOI: 10.3928/02793695-20130709-01] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 07/02/2013] [Indexed: 12/16/2022]
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Sebastian A, Jacob G, Lieb K, Tüscher O. Impulsivity in borderline personality disorder: a matter of disturbed impulse control or a facet of emotional dysregulation? Curr Psychiatry Rep 2013; 15:339. [PMID: 23424747 DOI: 10.1007/s11920-012-0339-y] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Impulsivity is regarded as a clinical, diagnostic and pathophysiological hallmark of borderline personality disorder (BPD). Self-report measures of impulsivity consistently support the notion of higher impulsive traits in BPD patients as compared to healthy control subjects. Laboratory tests of impulsivity, i.e. neuropsychological tests of impulse control render weak and inconsistent results both across different cognitive components of impulse control and within the same cognitive component of impulse control. One important factor worsening impulsive behaviors and impulse control deficits in BPD is comorbid attention-deficit/hyperactivity disorder (ADHD). In addition, emotional dysregulation interacts with impulse control especially for BPD salient emotions. In sum, although basic mechanisms of impulse control seem not to be disturbed in BPD, clinically well observed impulsive behaviors may be explained by comorbid ADHD or may be the consequence of dysregulation of BPD salient emotions.
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Affiliation(s)
- Alexandra Sebastian
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Strasse 8, 55131 Mainz, Germany
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25
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Low-dose quetiapine for adolescents with autistic spectrum disorder and aggressive behavior: open-label trial. Clin Neuropharmacol 2012; 34:216-9. [PMID: 21996644 DOI: 10.1097/wnf.0b013e31823349ac] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Atypical antipsychotics may be useful in treating aggression associated with autistic spectrum disorder (ASD). We evaluated the effectiveness of low-dose quetiapine treatment in ASD adolescent patients with aggressive behavior. METHOD Eleven adolescent patients (8 boys and 3 girls) diagnosed with ASD, aged 13 to 17 years, were treated with quetiapine in an open-label study over an 8-week period. The severity of ASD, aggressive behavior, and sleep disturbances were assessed using the Clinical Global Impression-Severity (CGI-S), Overt Aggression Scale, and Child Sleep Habits Questionnaire, respectively. RESULTS Nonsignificant changes were obtained in autistic behavior after quetiapine treatment (CGI-S: 4.0 ± 0.6 vs CGI-S after: 3.1 ± 1.1; 2-tailed paired t = 1.93; df = 10; P = 0.08). Severity of aggressive behavior decreased significantly after quetiapine treatment (Overt Aggression Scale: 2.1 ± 0.94 vs 1.3 ± 0.64, respectively; 2-tailed paired t = 2.37; df =10; P = 0.028). Sleep disturbances improved significantly (Child Sleep Habits Questionnaire: 49.0 ± 12 vs 44.1 ± 9.6; 2-tailed paired t = 2.98; df =10; P = 0.014) and a positive correlation was found between the improvements in aggression and sleep (Spearman correlation: r = 0.43; N = 11; P = 0.013). Quetiapine was well tolerated. CONCLUSION Short-term low-dose quetiapine treatment may reduce aggression levels and improve sleep quality in adolescents with ASD.
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27
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Oldershaw A, Simic M, Grima E, Jollant F, Richards C, Taylor L, Schmidt U. The effect of cognitive behavior therapy on decision making in adolescents who self-harm: a pilot study. Suicide Life Threat Behav 2012; 42:255-65. [PMID: 22435932 DOI: 10.1111/j.1943-278x.2012.0087.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Research shows poor decision making in adolescents who self-harm and a positive correlation between decision-making abilities and duration since last self-harm episode. This exploratory study investigated whether decision making in self-harming adolescents could be improved through treatment with a novel cognitive behavior therapy (CBT). It also investigated whether improvement in decision making following treatment was linked to self-harm cessation. Adolescent self-harmers receiving CBT (n = 24) or no treatment (n = 9) and healthy controls (n = 22) were longitudinally compared on the Iowa gambling task (IGT). Significant IGT improvements were only observed for adolescents who self-harm following CBT. CBT may benefit adolescent self-harmers and generate decision-making improvements.
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Affiliation(s)
- Anna Oldershaw
- King's College London, Institute of Psychiatry, London, UK.
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28
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Dalley JW, Roiser JP. Dopamine, serotonin and impulsivity. Neuroscience 2012; 215:42-58. [PMID: 22542672 DOI: 10.1016/j.neuroscience.2012.03.065] [Citation(s) in RCA: 290] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 03/08/2012] [Accepted: 03/10/2012] [Indexed: 12/17/2022]
Abstract
Impulsive people have a strong urge to act without thinking. It is sometimes regarded as a positive trait but rash impulsiveness is also widely present in clinical disorders such as attention deficit hyperactivity disorder (ADHD), drug dependence, mania, and antisocial behaviour. Contemporary research has begun to make major inroads into unravelling the brain mechanisms underlying impulsive behaviour with a prominent focus on the limbic cortico-striatal systems. With this progress has come the understanding that impulsivity is a multi-faceted behavioural trait involving neurally and psychologically diverse elements. We discuss the significance of this heterogeneity for clinical disorders expressing impulsive behaviour and the pivotal contribution made by the brain dopamine and serotonin systems in the aetiology and treatment of behavioural syndromes expressing impulsive symptoms.
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Affiliation(s)
- J W Dalley
- Behavioural and Clinical Neuroscience Institute and Department of Experimental Psychology, University of Cambridge, Downing Street, Cambridge CB2 3EB, UK. jwd20@cam. ac. uk
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Impaired decision making in adolescent suicide attempters. J Am Acad Child Adolesc Psychiatry 2012; 51:394-403. [PMID: 22449645 PMCID: PMC3314230 DOI: 10.1016/j.jaac.2012.01.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 01/04/2012] [Accepted: 01/10/2012] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Decision-making deficits have been linked to suicidal behavior in adults. However, it remains unclear whether impaired decision making plays a role in the etiopathogenesis of youth suicidal behavior. The purpose of this study was to examine decision-making processes in adolescent suicide attempters and never-suicidal comparison subjects. METHOD Using the Iowa Gambling Task, the authors examined decision making in 40 adolescent suicide attempters, 13 to 18 years old, and 40 never-suicidal, demographically matched psychiatric comparison subjects. RESULTS Overall, suicide attempters performed significantly worse on the Iowa Gambling Task than comparison subjects. This difference in overall task performance between the groups persisted in an exact conditional logistic regression analysis that controlled for affective disorder, current psychotropic medication use, impulsivity, and hostility (adjusted odds ratio = 0.96, 95% confidence interval = 0.90-0.99, p < 0.05). A two-way repeated-measures analysis of variance revealed a significant group-by-block interaction, demonstrating that attempters failed to learn during the task, picking approximately the same proportion of disadvantageous cards in the first and final blocks of the task. In contrast, comparison subjects picked proportionately fewer cards from the disadvantageous decks as the task progressed. Within the attempter group, overall task performance did not correlate with any characteristic of the index attempt or with the personality dimensions of impulsivity, hostility, and emotional lability. CONCLUSIONS Similar to findings in adults, impaired decision making is associated with suicidal behavior in adolescents. Longitudinal studies are needed to elucidate the temporal relationship between decision-making processes and suicidal behavior and to help frame potential targets for early identification and preventive interventions to reduce youth suicide and suicidal behavior.
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Moallem N, Ray LA. Quetiapine improves response inhibition in alcohol dependent patients: a placebo-controlled pilot study. Pharmacol Biochem Behav 2011; 100:490-3. [PMID: 22037407 DOI: 10.1016/j.pbb.2011.10.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/12/2011] [Accepted: 10/14/2011] [Indexed: 10/16/2022]
Abstract
RATIONALE Quetiapine has been shown to be a promising medication for the treatment of alcoholism. As an atypical antipsychotic medication with antagonist activity at D1 and D2, 5-HT(1A) and 5-HT(2A), H(1) and α1 and α2 receptors, quetiapine has been found to decrease impulsivity in other psychiatric disorders but its effects on impulsivity have not been studied in alcohol dependent patients. OBJECTIVE This study seeks to test the effects of quetiapine on a specific dimension of impulsivity, namely response inhibition. This pilot study seeks to further elucidate the mechanisms of action of quetiapine for alcohol use disorders. METHOD A total of 20 non-treatment seeking alcohol dependent individuals were randomized to one of the following conditions in a double-blind, placebo-controlled design: (1) quetiapine (400 mg/day); or (2) matched placebo. Participants completed two counterbalanced intravenous placebo-alcohol administration sessions as well as behavioral measure of response inhibition (i.e. stop signal task) pre and post placebo-alcohol administration sessions. RESULTS Analyses revealed a significant effect of quetiapine in improving response inhibition as measured by the stop signal task. These results provide preliminary evidence suggesting that quetiapine improves response inhibition in alcohol dependent patients, as compared to placebo. CONCLUSION This pilot study contributes a novel putative mechanism of action of quetiapine in alcoholism, namely an improvement in response inhibition.
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Affiliation(s)
- Nathasha Moallem
- Department of Psychology, University of California, Los Angeles, CA 90095-1563, USA
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Antipsychotics, antidepressants, anticonvulsants, and placebo on the symptom dimensions of borderline personality disorder: a meta-analysis of randomized controlled and open-label trials. J Clin Psychopharmacol 2011; 31:613-24. [PMID: 21869691 DOI: 10.1097/jcp.0b013e31822c1636] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to quantitatively review randomized controlled trials (RCTs) and open-label trials analyzing the efficacy of antidepressants, mood stabilizers, and antipsychotics for the treatment of the core symptoms of borderline personality disorder (BPD). Using a similar meta-analytic approach, the efficacy of placebo on the same core symptoms of BPD was evaluated. The risk of discontinuation of each of the medication classes reported in the studies was also analyzed to establish the major causes of discontinuation. MEDLINE (1966 to June 2010) and EMBASE (1980 to June 2010) databases were systematically searched to identify relevant RCTs and open studies. The primary outcome was improvement in the specific core symptoms of the disorder: affective dysregulation, impulsive-behavioral dyscontrol, and cognitive-perceptual symptoms. Evidence from RCTs and open studies suggests that drug treatment, especially with mood stabilizers and antipsychotics, may be effective for treating affective dysregulation and impulsive-behavioral dyscontrol. Antipsychotics were also effective in reducing cognitive-perceptual symptoms. Antidepressants failed to show efficacy in treating BPD symptom dimensions other than affective dysregulation. Our analyses of the placebo arm of RCTs showed a significant improvement of symptomatology in these patients also. There were no significant differences in overall dropout rates between patients on medications and those on placebo. In conclusion, the efficacy of pharmacological treatment on the symptom dimensions of BPD has been shown by various independent meta-analyses, with a positive effect of drug treatment on the core symptoms of BPD and some documentable differences in terms of efficacy between different drug classes in each of the symptom domains.
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A human laboratory study of the effects of quetiapine on subjective intoxication and alcohol craving. Psychopharmacology (Berl) 2011; 217:341-51. [PMID: 21487653 DOI: 10.1007/s00213-011-2287-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 03/25/2011] [Indexed: 01/08/2023]
Abstract
RATIONALE The available treatments for alcoholism are only modestly effective, and patients vary widely in their treatment response. Quetiapine, an atypical antipsychotic medication with antagonist activity at D1 and D2, 5-HT(1A) and 5-HT(2A), H(1), and α1 and α2 receptors was shown to promote abstinence, reduce drinking days, and reduce heavy drinking days in a 12-week double-blind placebo-controlled trial. OBJECTIVE Although quetiapine represents one of the promising pharmacotherapies for the treatment of alcoholism, its mechanisms of action are poorly understood. The objective of this study is to elucidate the biobehavioral mechanisms of action of quetiapine for alcoholism, by examining its effects on subjective intoxication and craving. METHOD A total of 20 non-treatment-seeking alcohol-dependent individuals were randomized to one of the following conditions in a double-blind, placebo-controlled design: (1) quetiapine (400 mg/day); or (2) matched placebo. Participants were on the target medication dose (or matched placebo) for 4 weeks during which they completed weekly assessments of drinking, sleep, mood, and anxiety. Participants completed two counterbalanced intravenous placebo-alcohol administration sessions as well as cue-reactivity assessments. RESULTS Analyses revealed a significant effect of quetiapine in reducing craving during the alcohol administration, the alcohol cue-exposure, and the weekly reports of alcohol craving. Quetiapine was also found to reduce subjective intoxication and alcohol-induced sedation during the alcohol administration paradigm. CONCLUSIONS This study contributes critical new information about mechanisms of response to quetiapine for alcoholism, which, in turn, can inform larger-scale studies and ultimately, clinical practice.
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Rosenbluth M, Sinyor M. Off-label use of atypical antipsychotics in personality disorders. Expert Opin Pharmacother 2011; 13:1575-85. [DOI: 10.1517/14656566.2011.608351] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bellino S, Bozzatello P, Rinaldi C, Bogetto F. Paliperidone ER in the Treatment of Borderline Personality Disorder: A Pilot Study of Efficacy and Tolerability. DEPRESSION RESEARCH AND TREATMENT 2011; 2011:680194. [PMID: 21826264 PMCID: PMC3151513 DOI: 10.1155/2011/680194] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 06/15/2011] [Indexed: 11/17/2022]
Abstract
Antipsychotics are recommended for the treatment of impulsive dyscontrol and cognitive perceptual symptoms of borderline personality disorder (BPD). Three reports supported the efficacy of oral risperidone on BPD psychopathology. Paliperidone ER is the metabolite of risperidone with a similar mechanism of action, and its osmotic release reduces plasmatic fluctuations and antidopaminergic effects. The aim of this study is to evaluate efficacy and safety of paliperidone ER in BPD patients. 18 outpatients with a DSM-IV-TR diagnosis of BPD were treated for 12 weeks with paliperidone ER (3-6 mg/day). They were assessed at baseline, week 4, and week 12, using the CGI-Severity item, the BPRS, the HDRS, the HARS, the SOFAS, the BPD Severity Index (BPDSI), and the Barratt Impulsiveness Scale (BIS-11). Adverse events were evaluated with the DOTES. Paliperidone ER was shown to be effective and well tolerated in reducing severity of global symptomatology and specific BPD symptoms, such as impulsive dyscontrol, anger, and cognitive-perceptual disturbances. Results need to be replicated in controlled trials.
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Affiliation(s)
- Silvio Bellino
- Centre for Personality Disorders, Unit of Psychiatry 1, Department of Neurosciences, University of Turin, via Cherasco 11, 10126 Turin, Italy
| | - Paola Bozzatello
- Centre for Personality Disorders, Unit of Psychiatry 1, Department of Neurosciences, University of Turin, via Cherasco 11, 10126 Turin, Italy
| | - Camilla Rinaldi
- Centre for Personality Disorders, Unit of Psychiatry 1, Department of Neurosciences, University of Turin, via Cherasco 11, 10126 Turin, Italy
| | - Filippo Bogetto
- Centre for Personality Disorders, Unit of Psychiatry 1, Department of Neurosciences, University of Turin, via Cherasco 11, 10126 Turin, Italy
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Archer T, Oscar-Berman M, Blum K. Epigenetics in Developmental Disorder: ADHD and Endophenotypes. JOURNAL OF GENETIC SYNDROMES & GENE THERAPY 2011; 2:1000104. [PMID: 22224195 PMCID: PMC3250517 DOI: 10.4172/2157-7412.1000104] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Heterogeneity in attention-deficit/hyperactivity disorder (ADHD), with complex interactive operations of genetic and environmental factors, is expressed in a variety of disorder manifestations: severity, co-morbidities of symptoms, and the effects of genes on phenotypes. Neurodevelopmental influences of genomic imprinting have set the stage for the structural-physiological variations that modulate the cognitive, affective, and pathophysiological domains of ADHD. The relative contributions of genetic and environmental factors provide rapidly proliferating insights into the developmental trajectory of the condition, both structurally and functionally. Parent-of-origin effects seem to support the notion that genetic risks for disease process debut often interact with the social environment, i.e., the parental environment in infants and young children. The notion of endophenotypes, markers of an underlying liability to the disorder, may facilitate detection of genetic risks relative to a complex clinical disorder. Simple genetic association has proven insufficient to explain the spectrum of ADHD. At a primary level of analysis, the consideration of epigenetic regulation of brain signalling mechanisms, dopamine, serotonin, and noradrenaline is examined. Neurotrophic factors that participate in the neurogenesis, survival, and functional maintenance of brain systems, are involved in neuroplasticity alterations underlying brain disorders, and are implicated in the genetic predisposition to ADHD, but not obviously, nor in a simple or straightforward fashion. In the context of intervention, genetic linkage studies of ADHD pharmacological intervention have demonstrated that associations have fitted the "drug response phenotype," rather than the disorder diagnosis. Despite conflicting evidence for the existence, or not, of genetic associations between disorder diagnosis and genes regulating the structure and function of neurotransmitters and brain-derived neurotrophic factor (BDNF), associations between symptoms-profiles endophenotypes and single nucleotide polymorphisms appear reassuring.
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Affiliation(s)
- Trevor Archer
- Department of Psychology, University of Gothenburg, Box 500, SE-40530 Gothenburg, Sweden
| | - Marlene Oscar-Berman
- Departments of Psychiatry, Neurology, and Anatomy & Neurobiology, Boston University School of Medicine, and Boston VA Healthcare System, Boston, MA, USA
| | - Kenneth Blum
- Department of Psychiatry, University of Florida College of Medicine, and McKnight Brain Institute, Gainesville, FL, USA
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Feurino L, Silk KR. State of the art in the pharmacologic treatment of borderline personality disorder. Curr Psychiatry Rep 2011; 13:69-75. [PMID: 21140245 DOI: 10.1007/s11920-010-0168-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article reviews the most recent studies of the pharmacologic treatment of borderline personality disorder (BPD). Although research continues using randomized controlled trials with a placebo arm as well as active medication, meta-analyses and systematic reviews have revealed that the use of any specific medication or medication class in BPD remains at best uncertain and inconclusive. Studies indicate that the selective serotonin reuptake inhibitors have fallen out of favor, and researchers have turned their attention to the study of mood stabilizers and atypical antipsychotics. Thus, it is not surprising that trends in prescribing appear to be shifting toward the use of these two classes over the selective serotonin reuptake inhibitors; yet we remain without any medication that has a specific indication for treatment of BPD or an indication for any symptom that is seen as part of the BPD syndrome.
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Affiliation(s)
- Louis Feurino
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109-2700, USA.
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Abstract
This review examined aggressive behavior in Borderline Personality Disorder (BPD) and its management in adults. Aggression against self or against others is a core component of BPD. Impulsiveness is a clinical hallmark (as well as a DSM-IV-TR diagnostic criterion) of BPD, and aggressive acts by BPD patients are largely of the impulsive type. BPD has high comorbidity rates with substance use disorders, Bipolar Disorder, and Antisocial Personality Disorder; these conditions further elevate the risk for violence. Treatment of BDP includes psychodynamic, cognitive behavioral, schema therapy, dialectic behavioral, group and pharmacological interventions. Recent studies indicate that many medications, particularly atypical antipsychotics and anticonvulsants, may reduce impulsivity, affective lability as well as irritability and aggressive behavior. But there is still a lack of large, double blind, placebo controlled studies in this area.
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Affiliation(s)
- K Látalová
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic.
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Bellino S, Paradiso E, Bozzatello P, Bogetto F. Efficacy and tolerability of duloxetine in the treatment of patients with borderline personality disorder: a pilot study. J Psychopharmacol 2010; 24:333-9. [PMID: 18719047 DOI: 10.1177/0269881108095715] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Guidelines of the American Psychiatric Association for borderline personality disorder (BPD) indicate selective serotonin reuptake inhibitors and the serotonin and noradrenaline reuptake inhibitor (SNRI) venlafaxine for treating affective dysregulation and impulsive behavioural dyscontrol symptoms. The SNRI duloxetine has been studied in patients with major depression, generalized anxiety disorder and fibromyalgia, showing particular efficacy on somatic complaints. This study investigates duloxetine in the treatment of patients with BPD. Eighteen outpatients with a DSM-IV-TR diagnosis of BPD were treated with open-label duloxetine, 60 mg/day, for 12 weeks. Patients were assessed at baseline, week 4 and 12 with the CGI Severity item, the BPRS, the HAM-D, the HAM-A, the SOFAS, the BPD Severity Index (BPDSI) and the HSCL-90-Somatization Subscale (HSCL-90 SOM). Adverse effects were evaluated using the Dosage Record Treatment Emergent Symptom Scale. Statistics were performed with the analysis of variance. Significant P values were <or=0.05. Fourteen patients completed the study. Four patients (22.2%) discontinued treatment in the first 4 weeks because of non-compliance. A significant change was found for: BPRS, HAM-D, SOFAS, BPDSI total score and items 'impulsivity', 'outbursts of anger' and 'affective instability' and HSCL-90 SOM. Adverse effects were mild headache and nausea. Initial results suggest that duloxetine is an effective and well-tolerated treatment for BPD, with positive effects on somatic symptoms.
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Affiliation(s)
- S Bellino
- Service for Personality Disorders, Unit of Psychiatry, Department of Neurosciences, University of Turin, Turin, Italy.
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Van den Eynde F, De Saedeleer S, Naudts K, Day J, Vogels C, van Heeringen C, Audenaert K. Quetiapine treatment and improved cognitive functioning in borderline personality disorder. Hum Psychopharmacol 2009; 24:646-9. [PMID: 19946934 DOI: 10.1002/hup.1075] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We aimed to assess whether executive functioning improved over time in a sample of borderline personality disorder (BPD) subjects that took part in a quetiapine treatment trial. METHODS Performance on the following neurocognitive tasks was assessed at enrolment and at the end of the 12 weeks quetiapine treatment: Trail Making Task, Word Fluency Task and Tower of London Task. Forty-one BPD patients were recruited, of whom 32 completed the trial. An intention-to-treat analysis with a mixed linear model was applied. RESULTS The data show that participants significantly improved on most executive functioning measures. Patients' scores decreased significantly (mean [SD] difference; p-value) on the Trail Making Task Part A (11.7 [2.3]; p < 0.0001), Part B (51.8 [9.2]; p < 0.0001) and 'B minus A' (40.1 [8.2]; p < 0.0001), on a Phonological (15.9 [1.6]; p < 0.0001) and Semantic (9.8 [1.1]; p < 0.0001) Verbal Fluency tasks, and on the Tower of London total correct score (2.5 [0.4]; p < 0.0001), total move score (29.5 [4.5]; p < 0.0001) and total time (172.9 [35.8]; p < 0.0001). CONCLUSIONS In this study we have demonstrated that executive functioning in BPD is improved after treatment with quetiapine. Neurocognitive measures of executive functioning should be considered as valuable outcomes in the study of treatment efficacy in BPD.
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Alexander J. De novo induction of obsessive-compulsive symptoms with quetiapine in a patient with borderline personality disorder. Aust N Z J Psychiatry 2009; 43:1185. [PMID: 20001420 DOI: 10.3109/00048670903279903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Jacob Alexander
- Central Northern Adelaide Health Service, Adelaide, South Australia, Australia
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Prado-Lima PASD. Tratamento farmacológico da impulsividade e do comportamento agressivo. BRAZILIAN JOURNAL OF PSYCHIATRY 2009; 31 Suppl 2:S58-65. [DOI: 10.1590/s1516-44462009000600004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A impulsividade aumentada e o comportamento agressivo ocorrem frequentemente em uma série de transtornos psiquiátricos e de doenças neurológicas. Duas abordagens de tratamento podem ser empregadas: o tratamento do transtorno ou da doença em que esses sintomas ocorrem ou o tratamento da impulsividade e do comportamento agressivo. Este segundo enfoque considera que há similaridades neurobiológicas subjacentes independentemente dos diagnósticos "primários" a que elas estejam associadas. O desequilíbrio entre os impulsos límbicos ascendentes, exercidos por estruturas como a amígdala, e os mecanismos de controle pré-frontais descendentes poderiam ser a razão última de um comportamento agressivo-impulsivo. Os papéis da serotonina, da noradrenalina e da dopamina foram amplamente investigados com relação ao comportamento impulsivo e agressivo e esses dados neuroquímicos foram ainda integrados ao modelo neuroanatômico, fornecendo as bases para a intervenção farmacológica sobre esses comportamentos.
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Kapoor S. Management of borderline personality disorder: emerging, new pharmacological and non-pharmacological strategies. Acta Psychiatr Scand 2009; 119:85-6; author reply 86. [PMID: 18983629 DOI: 10.1111/j.1600-0447.2008.01290.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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