Pharmacotherapy boosts psychotherapy for borderline personality disorder

Patients with borderline personality disorder who are treated both psychotherapeutically and pharmacologically appear to have lower dropout rates and improved outcomes in comparison with those given just psychotherapeutic management, Spanish scientists have discovered.

While atypical antipsychotic agents have shown improved outcomes in the treatment of borderline personality disorder compared with typical antipsychotics, they are still associated with high dropout rates that can be as high as 68%.

As dialectical behavior therapy has proven efficacy, Victor PĂ©rez and colleagues from Sta Creu and St Pau Hospital in Barcelona sought to examine the effects of adding pharmacological therapy.

Sixty patients with borderline personality disorder were given dialectical behavior therapy for 12 weeks, alongside either olanzapine or placebo treatment, after an initial 1-month baseline selection phase. Drug doses ranged from 5-20 mg per day, at an average of 8.83 mg per day.

A total of 70% of the participants completed the trial, with both treatment groups showing overall improvements in most of the symptoms studied. However, patients given olanzapine demonstrated significant improvements in depression, anxiety, and impulsivity/aggressive behavior.

The team concludes in the American Journal of Psychiatry: "A combined psychotherapeutic/pharmacological approach for patients with borderline personality disorder appears to lower dropout rates and constitutes an effective treatment."

Am J Psychiatry 2005; 162: 1221-1224