Pharmacological treatment of personality disorders
Past, present and future perspectives
It is beyond any doubt that only recently psychopharmacology gained acceptance as a therapeutic option in the treatment of Personality Disorders. This is a consequence of the increased appreciation of the important role that biological factors play in the pathogenesis of personality disorders. Pioneering studies of these patients showed that the pharmacological approach might be of benefit regarding affective instability, impassivity, aggressive behavior, cognitive distortions, and anxiety based on the DSM-IV classification which divides the 10 recognised Personality Disorders into 3 clusters, each one including disorders with common (prominent) characteristics, we reviewed the literature on the pharmacotherapy of Schizotypal, Borderline and Avoidant Personality Disorder with regard to the Schizotypal PD, in particular, researchers propose antipsychotics at low doses for limited periods. When depressive syndromes coexist, SSRIs, especially fluoxetine, are a reasonable choice. In the case of Borderline patients, SSRIs, such as fluoxetine and sertraline, remain the best-studied pharmacological option, although Lithium and Anticonvulsants, such as carbamazepine, valproate and lamotrigine, seem to be an alternative, especially when impulsivity and rage outbursts are prominent features. Low doses of antipsychotics are the best choise for borderline patients with psychotic-like symptoms. Even though there is a marked progress in the first and the second cluster the situation remains relatively unclear regarding the third one namely Anxious Personality Disorders. Whereas some clinicians propose the use of SSRIs. MAOIs, (â-adrenergic receptor antagonists and benzodiazepines (like alprazolam) as adjunctive therapy to the overall treatment of these patients, doubleblind, placebocontrolled studies are required to confirm the affectiveness of these agents. Finally we would like to point out that the psychotherapeutic approach remains the corner-stone for the treatment of Personality Disorders, and pharmacotherapy can only play and ancillary role.