Download PDF
Fortschr Neurol Psychiatr 2009; 77(3): 133-138
DOI: 10.1055/s-0028-1109098
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Evidenz für den Einsatz von Antikonvulsiva bei Persönlichkeitsstörungen

Empirical Evidence for the Use of Anticonvulsants in Personality DisordersM. Sieberer1 , H. M. Emrich1
  • 1Zentrum Psychologische Medizin, Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie (Leiter: Prof. Dr. S. Bleich, vormals: Prof. Dr. Dr. phil. H. M. Emrich), Medizinische Hochschule Hannover
Further Information

Publication History

Publication Date:
12 March 2009 (online)

    Permissions and Reprints

Zusammenfassung

Anliegen: Der Einsatz von Psychopharmaka bei Persönlichkeitsstörungen (PKS) ist klinisch weit verbreitet. Diese Arbeit gibt eine systematische Übersicht über randomisierte kontrollierte Studien (RCTs) zum Einsatz von Antikonvulsiva bei PKS. Methode: Basierend auf einer Medline-Recherche wurden die zwischen 1970 und 2008 publizierten RCTs zum genannten Thema systematisch erfasst und ausgewertet. Ergebnisse: In den 12 erfassten RCTs ergab sich für den symptombezogenen Einsatz bei PKS die stärkste Evidenz für Valproat und Topiramat. Die Datenlage für den Einsatz anderer Antikonvulsiva bei Persönlichkeitsstörungen ist spärlich. Schlussfolgerungen: In klinischen Studien haben sich Valproinsäure und Topiramat, möglicherweise auch Lamotrigin, Carbamazepin und Oxcarbazepin zur symptomatischen Behandlung von affektiver Dysregulation und impulsiver Aggressivität bei PKS bewährt. Dennoch sind weitere RCTs dringend erforderlich, da sich die klinische Anwendungspraxis bisher nicht ausreichend auf eine wissenschaftliche Evidenz für die Wirksamkeit und Sicherheit von Antikonvulsiva bei PKS stützen kann.

Abstract

Objective: There is a common practice of polypharmacy and an increased use of mood stabilizers in personality disorders (PD). This paper reviews all randomized controlled trials (RCTs) of anticonvulsants to evaluate the evidence base supporting their use in treatment of PD. Methods: German and English language literature cited in Medline and published between 1970 and 2008 was searched using the following terms: Borderline/personality disorder, anticonvulsant, mood stabilizer, carbamazepine, felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, phenytoine, pregabalin, tiagabine, topiramate, and valproate. Results: Twelve RCTs were identified which included anticonvulsants in treatment of personality disorders. The anticonvulsants valproate and topiramate appeared to have the most empirical support for having a favorable effect on symptoms of borderline personality disorder. Evidence for the use of other anticonvulsants in patients with PD is sparse. Conclusions: Valproate and topiramate, probably also lamotrigine, carbamazepine, and oxcarbazepine as well, were useful in treating symptoms of affective dysregulation and impulsive aggression in PD. However, further RCTs of anticonvulsants are greatly needed as clinical use of these agents has risen without sufficient evidence supporting their efficacy and safety in personality disorders.

Schlüsselwörter

Persönlichkeitsstörung - Antikonvulsiva - mood stabilizer - Psychopharmakotherapie

Key words

personality disorder - anticonvulsants - mood stabilizer - psychopharmacotherapy

Literatur

  • 1 Swartz M, Blazer D, George L. et al . Estimating the prevalence of borderline personality disorder in the community.  J Personal Disord. 1990;  4 257-272
    Google Scholar
  • 2 Grant B F, Chou S P, Goldstein R B. et al . Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions.  J Clin Psychiatry. 2008;  69 533-545
    Google Scholar
  • 3 Bender D S, Dolan R T, Skodol A E. et al . Treatment utilization by patients with personality disorders.  Am J Psychiatry. 2001;  158 295-302
    Google Scholar
  • 4 Zanarini M C, Frankenburg F R, Hennen J. et al . Mental health service utilization by borderline personality disorder patients and Axis II comparison subjects followed prospectively for 6 years.  J Clin Psychiatry. 2004;  65 28-36
    Google Scholar
  • 5 American Psychiatric Association . Practice guideline for the treatment of patients with borderline personality disorder.  Am J Psychiatry. 2001;  158 1-52
    Google Scholar
  • 6 Abraham P F, Calabrese J R. Evidenced-based pharmacologic treatment of borderline personality disorder: A shift from SSRIs to anticonvulsants and atypical antipsychotics?.  J Affect Disord. 2008;  111 21-30
    Google Scholar
  • 7 Gardner D L, Cowdry R W. Positive effects of carbamazepine on behavioral dyscontrol in borderline personality disorder.  Am J Psychiatry. 1986;  143 519-522
    Google Scholar
  • 8 Cowdry R W, Gardner D L. Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.  Arch Gen Psychiatry. 1988;  45 111-119
    Google Scholar
  • 9 De la Fuente J M, Lotstra F. A trial of carbamazepine in borderline personality disorder.  Eur Neuropsychopharmacol. 1994;  4 479-486
    Google Scholar
  • 10 De la Fuente J M, Bobes J, Vizuete C. et al . Effects of carbamazepine on dexamethasone suppression and sleep electroencephalography in borderline personality disorder.  Neuropsychobiology. 2002;  45 113-119
    Google Scholar
  • 11 Bellino S, Paradiso E, Bogetto F. Oxcarbazepine in the treatment of borderline personality disorder: A pilot study.  J Clin Psychiatry. 2005;  66 1111-1115
    Google Scholar
  • 12 Peris L, Szerman N, Ruíz M. Efficacy and safety of gabapentin in Borderline Personality Disorder: a six-month, open-label study.  Vertex. 2007;  18 418-422 (Abstract in Englisch)
    Google Scholar
  • 13 Tritt K, Nickel C, Lahmann C. et al . Lamotrigine treatment of aggression in female borderline-patients: a randomized, double-blind, placebo-controlled study.  J Psychopharmacol. 2005;  19 287-291
    Google Scholar
  • 14 Nickel M K, Nickel C, Mitterlehner F O. et al . Topiramate treatment of aggression in female borderline personality disorder patients: a double-blind, placebo-controlled study.  J Clin Psychiatry. 2004;  65 1515-1519
    Google Scholar
  • 15 Nickel M. Topiramate reduced aggression in female patients with borderline personality disorder.  Eur Arch Psychiatry Clin Neurosci. 2007;  257 432-433
    Google Scholar
  • 16 Nickel M K, Nickel C, Kaplan P. et al . Treatment of aggression with topiramate in male borderline patients: a double-blind, placebo-controlled study.  Biol Psychiatry. 2005;  57 495-499
    Google Scholar
  • 17 Nickel M K, Loew T H. Treatment of aggression with topiramate in male borderline patients, part II: 18-month follow-up.  Eur Psychiatry. 2008;  23 115-117
    Google Scholar
  • 18 Loew T H, Nickel M K, Mühlbacher M. et al . Topiramate treatment for women with borderline personality disorder: a double-blind, placebo-controlled study.  J Clin Psychopharmacol. 2006;  26 61-66
    Google Scholar
  • 19 Hollander E, Allen A, Lopez R P. et al . A preliminary double-blind, placebo-controlled trial of divalproex sodium in borderline personality disorder.  J Clin Psychiatry. 2001;  62 199-203
    Google Scholar
  • 20 Frankenburg F R, Zanarini M C. Divalproex sodium treatment of women with borderline personality disorder and bipolar II disorder: a double-blind placebo-controlled pilot study.  J Clin Psychiatry. 2002;  63 442-446
    Google Scholar
  • 21 Hollander E, Tracy K A, Swann A C. et al . Divalproex in the treatment of impulsive aggression: efficacy in cluster B personality disorders.  Neuropsychopharmacology. 2003;  28 1186-1197
    Google Scholar
  • 22 Hollander E, Swann A C, Coccaro E F. et al . Impact of trait impulsivity and state aggression on divalproex versus placebo response in borderline personality disorder.  Am J Psychiatry. 2005;  162 621-624
    Google Scholar
  • 23 Schmahl C, Bohus M. Symptomorientierte Pharmakotherapie bei Borderline-Persönlichkeitsstörungen.  Fortschr Neurol Psychiat. 2001;  69 310-321
    Google Scholar
  • 24 Gardner D L, Cowdry R W. Development of melancholia during carbamazepine treatment in borderline personality disorder.  J Clin Psychopharmacol. 1986;  6 236-239
    Google Scholar
  • 25 Loew T H, Nickel M K. Topiramate Treatment of Women With Borderline Personality Disorder, Part II: An Open 18-Month Follow-Up.  J Clin Psychopharmacol. 2008;  28 355-357
    Google Scholar
  • 26 Godt K. Personality disorders in 545 patients with eating disorders.  Eur Eat Disord Rev. 2008;  16 94-99
    Google Scholar
  • 27 Rosenvinge J H, Martinussen M, Ostensen E. The comorbidity of eating disorders and personality disorders: a meta-analytic review of studies published between 1983 and 1998.  Eat Weight Disord. 2000;  5 52-61
    Google Scholar
  • 28 Herzog T, Stiewe M, Sandholz A. et al . Borderline-Syndrom und Essstörungen. Literaturübersicht und Interview-Studien an 172 konsekutiven InanspruchnahmepatientInnen der Freiburger Essstörungsambulanz.  Psychother Psychosom Med Psychol. 1995;  45 97-108
    Google Scholar
  • 29 Mattes J A. Levetiracetam in patients with impulsive aggression: a double-blind, placebo-controlled trial.  J Clin Psychiatry. 2008;  69 310-315
    Google Scholar
  • 30 Mattes J A. Oxcarbazepine in patients with impulsive aggression: a double-blind, placebo-controlled trial.  J Clin Psychopharmacol. 2005;  25 575-579
    Google Scholar
  • 31 Leiberich P K, Nickel M K, Tritt K. et al . Lamotrigine treatment of aggression in female borderline patients, Part II: an 18-month follow-up.  J Psychopharmacol. 2008;  22 805-808
    Google Scholar

Dr. med. Marcel Sieberer

Klinik für Psychiatrie, Sozialpsychiatrie und Psychotherapie, Medizinische Hochschule

Carl-Neuberg-Str. 1

30625 Hannover

Email: Sieberer.Marcel@mh-hannover.de

      >