Clonidine improves hyperarousal in borderline personality disorder with or without comorbid posttraumatic stress disorder: a randomized, double-blind, placebo-controlled trial.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition borderline personality disorder (BPD) seems to constitute a very heterogeneous category. Therefore, pharmacological therapy is symptom-oriented or targets comorbid conditions. A high comorbidity exists between BPD and posttraumatic stress disorder (PTSD). In a double-blind, randomized, placebo-controlled crossover study, we sought to determine whether the antinoradrenergic agent clonidine was effective in reducing hyperarousal and measures of BPD-specific and general psychopathology in a sample of 18 patients with BPD, with or without comorbid PTSD, and with a prominent hyperarousal syndrome. Hyperarousal as measured by the Clinician Administered PTSD scale improved significantly compared with placebo (P = 0.003) irrespective of PTSD comorbidity. Improvements in general and BPD-typical psychopathology were mainly seen in the PTSD-positive subgroup, whereas the subjective sleep latency (P = 0.005) and the restorative qualities of the sleep (P = 0.014) improved in the whole sample. Improvements, despite the small sample size of this pilot study, lead us to conclude that clonidine might be a useful adjunct to pharmacotherapy in patients with BPD who have marked hyperarousal and/or sleep problems and, in particular, in patients with BPD who have a PTSD comorbidity.
Ziegenhorn
Andreas A
AA
Departments of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. andreas.ziegenhorn@charite.de
Roepke
Stefan
S
Schommer
Nicole C
NC
Merkl
Angela
A
Danker-Hopfe
Heidi
H
Perschel
Frank H
FH
Heuser
Isabella
I
Anghelescu
Ion G
IG
Lammers
Claas H
CH
D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use*; D000328:Adult; D001143:Arousal / Q000187:drug effects; D001883:Borderline Personality Disorder / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D003000:Clonidine / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011594:Psychometrics; D012720:Severity of Illness Index; D012893:Sleep Wake Disorders / Q000188:drug therapy / Q000209:etiology; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D055815:Young Adult
D000316:Adrenergic alpha-Agonists; D003000:Clonidine