Background: Acute dissociative states are common in patients with borderline personality disorder
(BPD). However, there are no established pharmacotherapeutic treatment options for
this severe clinical condition.
Methods: The effect of 0.4 mg naloxone administered intravenously in acute dissociative states
was examined as compared to placebo in a double-blind crossover study in nine patients
who met DSM-IV-criteria for BPD. Dissociative symptoms before and 15 min after a single
dose of naloxone or saline placebo were assessed using a self-rating instrument for
dissociation and aversive inner tension (DSS) and the observer-based items of the
Clinician Administered Dissociative States Scale (CADSS).
Results: Dissociative symptoms before treatment with naloxone or saline placebo were moderate
to severe. After injection of either naloxone or placebo, dissociative symptoms significantly
decreased on the DSS (p < 0.01) and the CADSS (p < 0.05). However, there were no significant
differences between naloxone and placebo in the reduction of symptoms. Patients who
showed the most prominent response to naloxone fulfilled the highest number of DSM-IV-criteria
for BPD.
Conclusions: Although it is difficult to draw definite conclusions from this small sample of patients,
this study does not support the assumption that naloxone in a single dose of 0.4 mg
is superior to placebo in acute dissociative states in patients with BPD. Further
studies will investigate whether patients benefit from naloxone in a higher dose or
whether subgroups of patients with BPD profit from naloxone in acute dissociative
states.
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Klaus LiebM.D.
Department of Psychiatry and Psychotherapy
University of Freiburg Medical School
Hauptstr. 5
D-79104 Freiburg
Germany
Phone: 0049-761-270-6681
Fax: 0049-761-270-6667
Email: klaus_lieb@psyallg.ukl.uni-freiburg.de