Antipsicotici atipici nel trattamento farmacologico del disturbo borderline di personalità: una revisione sistematica

Introduction

Diagnosis and treatment of Borderline Personality Disorder (BPD) are a matter of great clinical interest and research. Nowadays the atypical antipsychotic drugs (AAP) are frequently prescribed even though their use in the BPD is still off-label.

The aim of this paper is to perform a systematic review of studies focusing on the efficacy and tolerability of AAP in the BPD.

Materials and methods

A comprehensive search from PubMed, Emabse, PsycLIT and Cochrane Library, was conducted from January 1980 to April 2009. Only randomized controlled trials (RCTs) were included in the final analysis.

Results

Nine RCTs were selected from the analyzed studies. Olanzapine is by far the most investigated drug; its efficacy over placebo was well documented in the treatment of anxiety, anger, impulsivity and paranoia, as well as in improving interpersonal relationships. Aripiprazole has been associated with a significant improvement of symptoms like hostility, anger, anxiety and paranoid ideation. For ziprasidone, no significant advantage over placebo was reported. The efficacy of quetiapine, risperidone and clozapine has been supported only by open studies.

Conclusions

AAP are frequently prescribed in BPD, even though RCTs on their efficacy are still scarce. More studies are needed to better assess not only the efficacy of such drugs but also their effectiveness in a long-term treatment.