title: Addition of methylphenidate to intensive dialectical behaviour therapy for patients suffering from comorbid borderline personality disorder and ADHD: a naturalistic study.
abstract: Attention deficit hyperactivity disorder (ADHD) is frequently comorbid with borderline personality disorder (BPD). However, few studies have examined how comorbid BPD-ADHD patients, treated or not with methylphenidate (MPH), respond to psychotherapy compared to non-comorbid BPD patients. In this perspective, we used a naturalistic study to compare, during a month-long intensive dialectical behaviour therapy (DBT), the clinical course of BPD patients and comorbid BPD-ADHD patients who were treated or untreated with MPH. Out of the 158 BPD patients recruited, 59 had adult ADHD as a comorbidity; among these, 29 underwent a treatment with MPH or des-methylphenidate, while the 30 others did not. MPH treatment was given non-randomly and only when ADHD was considered to be hampering the capacity of the subjects to follow the therapy. Patients completed the following forms upon admission and after 1 month of treatment: the adult ADHD Self-Report Scale (ASRS v.1.1), the Barratt Impulsiveness Scale (BIS-10), the State-Trait Anger Expression (STAXI), the Beck Depression Inventory II (BDI-II), and the Beck Hopelessness Scale. At baseline, comorbid BPD-ADHD patients showed significantly higher impulsiveness than BPD patients. In the entire sample, there was a significant decrease in all dimensions ranging from small to large effect sizes during the 4-week intensive DBT. BPD-ADHD patients who were undergoing MPH treatment showed a significantly improved response to DBT treatment for Trait-State Anger scores, motor impulsiveness, depression severity, and ADHD severity, when compared to those without stimulant medication. This study outlines the importance of systematically screening BPD patients for ADHD, since a MPH-based treatment will improve the symptoms of patients who are comorbid for BPD and ADHD. Due to the non-random allocation of subjects, more severely affected patients were more readily placed on MPH; this suggests that the more severe the ADHD symptoms, the greater the chance for the patient of being treated.
authors: TRE Program, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospital of Geneva, 20 rue de Lausanne, 1201, Geneva, Switzerland, paco.prada@hcuge.ch.
authors: Paco
authors: P
authors: Prada
authors: Rosetta
authors: R
authors: Nicastro
authors: Julien
authors: J
authors: Zimmermann
authors: Roland
authors: R
authors: Hasler
authors: Jean-Michel
authors: JM
authors: Aubry
authors: Nader
authors: N
authors: Perroud
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D001521:Behavior Therapy / Q000379:methods; D001883:Borderline Personality Disorder / Q000188:drug therapy / Q000453:epidemiology* / Q000628:therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D010352:Patient Dropouts / Q000706:statistics & numerical data
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate