Efficacy of phenelzine and haloperidol in borderline personality disorder.
OBJECTIVE
To compare the efficacy of a neuroleptic (haloperidol) to a monoamine oxidase inhibitor antidepressant (phenelzine sulfate) against the affective, cognitive, and impulsive-aggressive symptoms of criteria-defined borderline inpatients in an effort to dissect apart affective and schizotypal symptom patterns or subtypes using medication response.


METHODS
Randomized, double-blind, placebo-controlled trial.


METHODS
Inpatient unit of a tertiary care university psychiatric hospital serving a large public catchment area.


METHODS
One hundred eight consecutively admitted borderline inpatients defined by Gunderson's Diagnostic Interview for Borderline Patients and DSM-III-R criteria, randomly assigned to 38 phenelzine, 36 haloperidol, and 34 placebo trials.


METHODS
Following 1 week free of medication, haloperidol (average dose, 4 mg/d), phenelzine sulfate (average dose, 60 mg/d), or placebo were given for 5 weeks with weekly symptom ratings and plasma drug level determinations.


METHODS
Efficacy was measured on depression (Hamilton Rating Scale, Beck Depression Inventory), global severity (Global Assessment Scale, Symptom Checklist-90 items [SCL-90]), anxiety, anger-hostility (SCL-90, Inpatient Multidimensional Psychiatric Scale [IMPS], Buss-Durkee Hostility Inventory), psychoticism (Schizotypal Symptom Inventory, SCL-90, IMPS), impulsivity (Ward Scale, Barratt Impulsiveness Scale, Self-Report Test of Impulse Control), and borderline psychotherapy (Borderline Syndrome Index).


RESULTS
Three-way comparisons between groups indicated superior efficacy for phenelzine, followed by placebo and haloperidol on measures of depression, borderline psychopathologic symptoms, and anxiety. Pairwise comparisons between medication and placebo revealed significant efficacy for phenelzine against anger and hostility but no efficacy against atypical depression or hysteroid dysphoria. We were unable to replicate prior reports of efficacy for the neuroleptic.


CONCLUSIONS
Pharmacologic dissection of borderline personality disorder patients into affective and schizotypal subtypes could not be demonstrated.
Soloff
P H
PH
Department of Psychiatry, University of Pittsburgh, Pa.
Cornelius
J
J
George
A
A
Nathan
S
S
Perel
J M
JM
Ulrich
R F
RF
D000328:Adult; D001883:Borderline Personality Disorder / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D015897:Comorbidity; D003866:Depressive Disorder / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D006220:Haloperidol / Q000627:therapeutic use*; D006760:Hospitalization; D006801:Humans; D008297:Male; D010555:Personality Inventory; D010624:Phenelzine / Q000627:therapeutic use*; D010919:Placebos; D011569:Psychiatric Status Rating Scales; D015203:Reproducibility of Results
D010919:Placebos; D006220:Haloperidol; D010624:Phenelzine