Treatment of borderline personality disorder with risperidone.
BACKGROUND
Of the various Axis II disorders, borderline personality disorder (BPD) is among the more critical to treat. There are at present few results in terms of clinical outcome with the psychotropic agents available. Possible targets for pharmacotherapy are affective symptoms, cognitive disturbances, and impulsive, self-injurious behaviors. In previous studies, atypical antipsychotics at low-to-moderate doses provided symptom reduction with good tolerability. Our purpose was to assess the efficacy of risperidone in BPD, focusing on its effects on impulsive-aggressive behavior.


METHODS
Fifteen BPD outpatients (DSM-IV diagnosis) with prominent histories of aggressive behavior were included in an 8-week open-label study with risperidone at low-to-moderate doses. Axis II codiagnoses included antisocial personality disorder (N = 4). Exclusion criteria included current Axis I diagnosis or any major medical or neurologic illness. Efficacy measures were the 21-item Hamilton Rating Scale for Depression, the Brief Psychiatric Rating Scale, the DSM-IV Global Assessment of Functioning, and the self-rated Aggression Questionnaire. Evaluations were carried out at baseline and at the end of the treatment.


RESULTS
Thirteen patients completed the trial; 2 patients dropped out because of lack of compliance. Final mean dose of risperidone was 3.27 mg/day. There was a significant (p = .0057) reduction in aggression based on Aggression Questionnaire scores. This amelioration was coupled with an overall improvement, including a reduction in depressive symptoms and an increase in energy and global functioning.


CONCLUSIONS
Risperidone at low-to-moderate doses can improve BPD symptomatology. Further studies are needed to explore the efficacy of risperidone versus placebo as well as in comparison to other potential treatments for BPD.
Rocca
Paola
P
Department of Neuroscience, University of Turin, Italy. bogetto@molinette.unito.it
Marchiaro
Livio
L
Cocuzza
Elena
E
Bogetto
Filippo
F
D000328:Adult; D000374:Aggression / Q000187:drug effects; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001883:Borderline Personality Disorder / Q000188:drug therapy* / Q000523:psychology*; D018492:Dopamine Antagonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007175:Impulsive Behavior; D008297:Male; D018967:Risperidone / Q000627:therapeutic use*; D012702:Serotonin Antagonists / Q000627:therapeutic use; D016896:Treatment Outcome
D014150:Antipsychotic Agents; D018492:Dopamine Antagonists; D012702:Serotonin Antagonists; D018967:Risperidone