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Arch Iranian Med 2006; 9 (4): 403 405
Archives of Iranian Medicine, Volume 9, Number 4, October 2006
403
Treatment of Borderline Personality Disorder with Olanzapine
Saeed Shoja-Shafti MD*
Borderline personality disorder is one of the most problematic
psychiatric disorders withaggressiveness and impulsivity as its tw
o main characteristics. Our objective was to determine theefficacy
of ol anzapine on 20 patients w ith borderline personality
disorder. Results were found to beaffirmative in this respect.
Archives of Iranian Medicine, Volume 9, Number 4, 2006: 403
405.
Keywords:Borderline personality disorder olanzapine
pharmacotherapy
Introduction
orderline personality disorder (BPD) isa heterogeneous
psychiatric disorder.
Like any other kind of personality
disorders, genetic, biologic, and psychoanalyticfactors jointly
compose its basis. The prevalence of
the disease in the general population is estimated to
be about 2%. In mental health settings, its
prevalence is 10% in outpatient clinics and about20% in
inpatient units. BPD is much more
common among women, who make up about 75%
of the cases.1
The term borderline has historically been
used to describe patients who were on a borderlinebetween
neurotic and psychotic disorders.
Alterations of central neurotransmission systems,
stressful childhood traumas, and genetic
predisposition are major etiologic factors for this
disorder. Affective unstableness, impulsiveness,and
aggressiveness are the major presentations of
such morbid personality. Also, recurrent suicidaltreats and
attempts, assaultiveness, substance abuse
or dependence, and low tolerance for frustration
are the remarkable characteristics of such patients.
Both psychotherapeutic and pharmacologic
modalities have been used hitherto for extenuating
these symptoms.2
Serotonin-selective reuptake
inhibitors (SSRIs) have been proposed as the first-line
treatments for impulsivity.3Failure to respond
to SSRIs should prompt consideration of low-dose
neuroleptics.3, 4
On the other hand, long-termadministration of neuroleptics to
such patients can
lead to important neurologic side effects like
tardive dyskinesia. Lithium and anticonvulsantmood stabilizers
have also been helpful with
respect to impulsive aggression.5, 6
Atypical antipsychotic drugs with combined
serotonergic and dopaminergic properties seem tooffer a fine
prospect for the treatment of BPD. In
recent studies clozapine,7 olanzapine,
8 and
risperidone9 have been successfully employed for
the management of BPD. The purpose of this
study, also, was to determine whether olanzapine
could moderate the impulsive-aggressive behaviorof patients with
BPD.
Patients and Methods
Twenty consecutive patients (all women) from
one of the psychiatric wards of Razi Psychiatric
Hospital in Tehran, who met the DSM-IV-TRdiagnostic criteria for
BPD, were enrolled in the
study. They had a mean SD age of 24.7 4.7years. Their diagnoses
had been certified by at
least three psychiatrists, based on face to face
interviews, history, observations, and the above-
mentioned diagnostic criteria.Patients were excluded from the
trial if they
suffered from any major medical or neurologic
Brief Report
B
Authors affiliation: *Department of Psychiatry, Razi
Psychiatric
Hospital, University of Social Welfare and Rehabilitation
Sciences, Iran.
Corresponding author and reprints: Saeed Shoja-Shafti MD,
Department of Psychiatry, Razi Psychiatric Hospital, University
ofSocial Welfare and Rehabilitation Sciences, Amin Abad, Shahre
Rey, Tehran, Iran.
Telefax: +98-21-334-01604, E-mail: [email protected].
Accepted for publication: 15 March 2006
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Treatment of borderline personality disorder with olanzapine
Archives of Iranian Medicine, Volume 9, Number 4, October
2006404
illness or if there was any comorbid remarkable
mental disorders in axis I, in addition to theaforementioned
BPD. All patients, after a complete
description of the treatment, offered their informed
consents. All of their psychotropic drugs had been
withdrawn for at least two weeks, before enteringthe study.
During the medication trial, the patients
were receiving no specific psychotherapeutic
approach and were only subjected to clinicalmanagement (a 30-min
medication visit once a
week and regular clinical visits twice per week).
Previous pharmacologic treatments, which hadbeen prescribed for
them included conventional
neuroleptics, SSRIs, mood stabilizers, and benzo-
diazepines. The patients were treated with open-
label olanzapine (Sobhan Co. in Iran) orally for
eight weeks. This was started at a dose of 2.5mg/day, to be
taken each evening, and then
individually increased by 2.5 mg increments, asneeded or
tolerated, in weekly meetings, to a
maximum of 10 mg by week four. The dose
established by week four was held constant up tothe end of the
study. No concurrent psychotropic
medication was allowed.
All patients were assessed by the samepsychiatrist at baseline
and at the end of the eighth
week of the treatment. Principal scales in this
research were the Brief Psychiatric Rating Scale
(BPRS), the DSM-IV global assessment offunctioning (GAF), and
the self-rated Buss-Durkee
Hostility Inventory (BDHI). Data gathered from
this study were compared using the Studentsttest.Statistical
significance was set to 2-sidedPvalue
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S. Shoja-Shafti
Archives of Iranian Medicine, Volume 9, Number 4, October 2006
405
this study offers encouraging evidence for the role
of olanzapine in the management of this type ofpersonality
disorder. Nonetheless, this study must
be interpreted with caution due to its small number
of subjects and open method of treatment.
Certainly, double-blind placebo-controlled studiesare needed for
better clarification of the efficacy of
olanzapine in the improvement of different
dimensions of BPD.
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