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Pharmacopsychiatry 2008; 41(5): 176-181
DOI: 10.1055/s-2008-1076730
Original Paper

© Georg Thieme Verlag KG Stuttgart · New York

Preliminary Evidence of Improvement of Depressive Symptoms but not Impulsivity in Cluster B Personality Disorder Patients Treated with Quetiapine: an Open Label Trial

S. Roepke 1 , A. Merkl 1 , A. Dams 1 , A. Ziegenhorn 1 , 2 , I. G. Anghelescu 1 , I. Heuser 1 , C. H. Lammers 1
  • 1Department of Psychiatry, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
  • 2Psychotraumatology Research Group, Douglas Hospital Research Centre, Montreal, QC, Canada
Further Information

Publication History

received 09.11.2007 revised 18.02.2008

accepted 04.03.2008

Publication Date:
01 September 2008 (online)

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Abstract

Introduction: Atypical antipsychotics might become a new treatment option for patients with an impaired impulse regulation as seen in cluster B personality disorders (PD). The aim of the present study is to investigate the efficacy and tolerability of quetiapine in patients with cluster B PD.

Methods: Fifteen in-patients with a DSM-IV diagnosis of borderline, histrionic, or narcissistic PD were treated for 8 weeks with quetiapine at a dose of 400 mg/day in an open-label fashion. Effects on impulsivity (Barratt Impulsiveness Scale, BIS), depressive symptoms (Hamilton Depression Scale, HAMD, and Beck Depression Inventory, BDI) and side effects (Dosage Record and Treatment Emergent Symptom Scale, DOTES) were assessed.

Results: Twelve patients completed the study. No positive effect on impulsivity (BIS) was found, but a significant improvement on depression scores (HAM-D and BDI) was noted. Adverse effects that might have been due to study medication were mainly anticholinergic and mild-to-moderate.

Discussion: The data of our preliminary open-label study do not argue for a general recommendation of quetiapine for the treatment of impulsivity in cluster B PD, but indicate positive effects on depressive symptoms.

References

  • 1 Adityanjee , Schulz SC. Clinical use of quetiapine in disease states other than schizophrenia.  J Clin Psychiatry. 2002;  63 ((Suppl 13)) 32-38
    PubMedGoogle Scholar
  • 2 American Psychiatric Association . Practical guidelines for the treatment of patients with borderline personality disorder.  Am J Psychiatry. 2001;  158 1-52
    CrossrefPubMedGoogle Scholar
  • 3 Barratt ES. Impulsiveness substrates: Arousal and information processing. In: Spence JT and Izard CE Motivation, Emotion and personality. North-Holland: Elsevier Science 1985: 137-146
    Google Scholar
  • 4 Barratt ES, Stanford MS, Kent TA, Felthous A. Neuropsychological and cognitive psychophysiological substrates of impulsive aggression.  Biol Psychiatry. 1997;  41 1045-1061
    CrossrefPubMedGoogle Scholar
  • 5 Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory of measuring depression.  Arch Gen Psychiatry. 1961;  4 561-571
    CrossrefPubMedGoogle Scholar
  • 6 Bellino S, Paradiso E, Bogetto F. Efficacy and tolerability of quetiapine in the treatment of borderline personality disorder: A pilot study.  J Clin Psychiatry. 2006;  67 1042-1046
    PubMedGoogle Scholar
  • 7 Bogenschutz MP, Nurnberg HG. Olanzapine versus placebo in the treatment of borderline personality disorder.  J Clin Psychiatry. 2004;  65 104-109
    PubMedGoogle Scholar
  • 8 Boileau I, Dagher A, Leyton M, Gunn RN, Baker GB, Diksic M, Benkelfat C. Modeling sensitization to stimulants in humans: an [11C]raclopride/positron emission tomography study in healthy men.  Arch Gen Psychiatry. 2006;  63 1386-1395
    CrossrefPubMedGoogle Scholar
  • 9 Chengappa KN, Ebeling T, Kang JS, Levine J, Parepally H. Cloza-pine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder.  J Clin Psychiatry. 1999;  60 477-484
    PubMedGoogle Scholar
  • 10 Dalley JW, Fryer TD, Brichard L, Robinson ES, Theobald DE, Laane K, Pena Y, Murphy ER, Shah Y, Probst K, Abakumova I, Aigbirhio FI, Richards HK, Hong Y, Baron JC, Everitt BJ, Robbins TW. Nucleus accumbens D2/3 receptors predict trait impulsivity and cocaine reinforcement.  Science. 2007;  315 1267-1270
    CrossrefPubMedGoogle Scholar
  • 11 Davidson RJ, Putnam KM, Larson CL. Dysfunction in the neural circuitry of emotion regulation: a possible prelude to violence.  Science. 2000;  289 591-594
    CrossrefPubMedGoogle Scholar
  • 12 Dougherty DM, Bjork JM, Huckabee HC, Moeller FG, Swann AC. Laboratory measures of aggression and impulsivity in women with borderline personality disorder.  Psychiatr Res. 1999;  85 315-326
    CrossrefPubMedGoogle Scholar
  • 13 First MB, Gibbon M, Spitzer RL, Williams JBW. Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). 1996; 
    PubMed
  • 14 Fossati A, Barratt ES, Borroni S, Villa D, Grazioli F, Maffei C. Impulsivity, aggressiveness, and DSM-IV personality disorders.  Psychiatr Res. 2007;  149 157-167
    CrossrefPubMedGoogle Scholar
  • 15 Frankenburg FR, Zanarini MC. The association between borderline personality disorder and chronic medical illnesses, poor health-related lifestyle choices, and costly forms of health care utilization.  J Clin Psychiatry. 2004;  65 1660-1665
    PubMedGoogle Scholar
  • 16 Gao K, Muzina D, Gajwani P, Calabrese JR. Efficacy of typical and atypical antipsychotics for primary and comorbid anxiety symptoms or disorders: A review.  J Clin Psychiatry. 2006;  67 1327-1340
    PubMedGoogle Scholar
  • 17 Guy W. ECDEU Assessment Manual for Psychopharmacology (DHEW Publication No. ADM 76-338), U.S. Department of Health, Education & Welfare, Rockville, MD. 1976;  158-169
    PubMed
  • 18 Hamilton A. Diagnosis and rating of anxiety.  Br J Psychiatry. 1959;  3 67-69
    PubMedGoogle Scholar
  • 19 Hamilton M. Development of a rating scale for primary depressive illness.  Br J Soc Clin Psychol. 1967;  6 278-296
    PubMedGoogle Scholar
  • 20 Links PS, Heslegrave R, Reekum R van. Impulsivity: core aspect of borderline personality disorder.  J Personal Disord. 1999;  13 1-9
    PubMedGoogle Scholar
  • 21 Linnoila M. Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpulsive violent behavior.  Life Sci. 1983;  33 2609-2614
    CrossrefPubMedGoogle Scholar
  • 22 Looper KJ, Paris J. What dimensions underlie Cluster B personality disorders?.  Comprehen Psychiatry. 2000;  41 432-437
    PubMedGoogle Scholar
  • 23 Markovitz PJ. Recent trends in the pharmacotherapy of personality disorders.  J Personal Disord. 2004;  18 90-101
    CrossrefPubMedGoogle Scholar
  • 24 MacGlashan TH, Grilo CM, Sanislow CA, Ralevski E, Morey LC, Gunderson JG, Skodol AE, Shea MT, Zanarini MC, Bender D, Stout RL, Yen S, Pagano M. Two-year prevalence and stability of individual DSM-IV criteria for schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders: toward a hybrid model of axis II disorders.  Am J Psychiatry. 2005;  162 883-889
    CrossrefPubMedGoogle Scholar
  • 25 Mobascher A, Mobascher J, Schlemper V, Winterer G, Malevani J. Aripiprazole pharmacotherapy of borderline personality disorder.  Pharmacopsychiatry. 2006;  39 111-112
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Mulder RT, Joyce PR, Sullivan PF, Bulik CM, Carter FA. The relationship among three models of personality psychopathology: DSM-II-R personality disorder, TCI scores and DSQ defences.  Psychol Med. 1999;  29 943-951
    CrossrefPubMedGoogle Scholar
  • 27 Nemeroff CB. Use of atypical antipsychotics in refractory depression and anxiety.  J Clin Psychiatry. 2005;  66 13-21
    PubMedGoogle Scholar
  • 28 New AS, Hazlett EA, Buchsbaum MS, Goodman M, Reynolds D, Mitropoulou V, Sprung L, Shaw RB, Koenigsberg H, Platholi J, Silverman J, Siever LJ. Blunted prefrontal cortical 18fluorodeoxyglucose positron emission tomography response to meta-chlorophenylpiperazine in impulsive aggression.  Arch Gen Psychiatry. 2002;  59 621-629
    CrossrefPubMedGoogle Scholar
  • 29 Nickel MK, Muehlbacher M, Nickel C, Kettler C, Pedrosa GF, Bachler E, Buschmann W, Rother N, Fartacek R, Egger C, Anvar J, Rother WK, Loew TH, Kaplan P. Aripiprazole in the treatment of patients with borderline personality disorder: a double-blind, placebo-controlled study.  Am J Psychiatry. 2006;  163 833-838
    CrossrefPubMedGoogle Scholar
  • 30 Pascual JC, Madre M, Soler J, Barrachina J, Campins MJ, Alvarez E, Pérez V. Injectable atypical antipsychotics for agitation in borderline personality disorder.  Pharmacopsychiatry. 2006;  39 117-118
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Patton JH, Stanfrod MS, Barratt ES. Factor structure of the Barratt impulsiveness scale.  J Clin Psychol. 1995;  51 768-774
    CrossrefPubMedGoogle Scholar
  • 32 Perrella C, Carrus D, Costa E, Schifano F. Quetiapine for the treatment of borderline personality disorder; an open-label study.  Prog Neuropsychopharmacol Biol Psychiatry. 2007;  31 158-163
    CrossrefPubMedGoogle Scholar
  • 33 Rocca P, Marchiaro L, Cocuzza F, Bogetto F. Treatment of borderline personality disorder with risperidone.  J Clin Psychiatry. 2002;  63 241-244
    CrossrefPubMedGoogle Scholar
  • 34 Schulz SC. The promise of atypical antipsychotics for borderline personality disorders. Presented at the 115th annual meeting of the American Psychiatric Association May 18–23 Philadelphia, Pa. 2002; 
    PubMed
  • 35 Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10.  J Clin Psychiatry. 1998;  59 22-33
    Google Scholar
  • 36 Skodol AE, Siever LJ, Livesly WJ, Gunderson JG, Pfohl B, Widiger TA. The borderline diagnosis II: biology, genetics, and clinical course.  Biol Psychiatry. 2002;  51 951-963
    CrossrefPubMedGoogle Scholar
  • 37 Soler J, Pascual JC, Campins J, Barrachina J, Puigdemont D, Alvarez E, Perez V. Double-blind, placebo-controlled study of dialectical behavior therapy plus olanzapine for borderline personality disorder.  Am J Psychiatry. 2005;  162 1221-1224
    CrossrefPubMedGoogle Scholar
  • 38 Soubrie P. Serotonergic neurons and behaviour.  J Pharmacol. 1986;  17 107-112
    PubMedGoogle Scholar
  • 39 Steel Z, Blaszczynski A. Impulsivity, personality disorders and pathological gambling severity.  Addiction. 1998;  93 895-905
    CrossrefPubMedGoogle Scholar
  • 40 Villeneuve E, Lemelin S. Open-label study of atypical neuroleptic quetiapine for treatment of borderline personality disorder: impulsivity as main target.  J Clin Psychiatry. 2005;  66 1298-1303
    CrossrefPubMedGoogle Scholar
  • 41 Walker C, Thomas J, Allen TS. Treating impulsivity, irritability, and aggression of antisocial personality disorder with quetiapine.  Int J Offender Ther Comp Criminol. 2003;  47 556-567
    CrossrefPubMedGoogle Scholar
  • 42 Zanarini MC. Borderline personality as an impulse spectrum disorder. In Paris J (ed). Borderline Personality Disorder: Etiology and Treatment. Washington, DC: American Psychiatric Press 1993: 67-86
    Google Scholar
  • 43 Zanarini M, Frankenburg FR. Olanzapine treatment of female borderline personality disorder patients: a double-blind, placebo-controlled pilot study.  J Clin Psychiatry. 2001;  62 849-854
    CrossrefPubMedGoogle Scholar
  • 44 Zanarini M, Frankenburg FR, Parachini EA. A preliminary, randomized trial of fluoxetine, olanzapine, and the olanzapine-fluoxetine combination in women with borderline personality disorder.  J Clin Psychiatry. 2004;  65 903-907
    CrossrefPubMedGoogle Scholar
  • 45 Zoccolillo M, Pickles A, Quinton D, Rutter M. The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder.  Psychol Med. 1992;  22 971-986
    CrossrefPubMedGoogle Scholar

Correspondence

S. Roepke

Department of Psychiatry

Charité-Universitätsmedizin Berlin

Campus Benjamin Franklin

Eschenallee 3

14050 Berlin

Germany

Phone: +49/30/8445 87 96

Fax: +49/30/8445 83 65

Email: stefan.roepke@charite.de

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