EFFICACY OF PHENELZINE AND HALOPERIDOL IN BORDERLINE PERSONALITY-DISORDER

Objective: To compare the efficacy of a neuroleptic (haloperidol) to a monoamine oxidase inhibitor antidepressant (phenelzine sulfate) again st the affective, cognitive, and impulsive-aggressive symptoms of crit eria-defined borderline inpatients in an effort to dissect apart affec tive and schizotypal symptom patterns or subtypes using medication res ponse. Design: Randomized, double-blind, placebo-controlled trial. Set ting: Inpatient unit of a tertiary care university psychiatric hospita l serving a large public catchment area. Patients: One hundred eight c onsecutively admitted borderline inpatients defined by Gunderson's Dia gnostic Interview for Borderline Patients and DSM-III-R criteria, rand omly assigned to 38 phenelzine, 36 haloperidol, and 34 placebo trials. Interventions: Following 1 week free of medication, haloperidol (aver age dose, 4 mg/d), phenelzine sulfate (average dose, 60 mg/d), or plac ebo were given for 5 weeks with weekly symptom ratings and plasma drug level determinations. Main Outcome Measures: Efficacy was measured on depression (Hamilton Rating Scale, Beck Depression Inventory), global severity (Global Assessment Scale, Symptom Checklist-90 items [SCL-90 ]), anxiety, anger-hostility (SCL-90, Inpatient Multidimensional Psych iatric Scale [IMPS], Buss-Durkee Hostility Inventory), psychoticism (S chizotypal Symptom Inventory, SCL-90, IMPS), impulsivity (Ward Scale, Barratt Impulsiveness Scale, Self-Report Test of Impulse Control), and borderline psychotherapy (Borderline Syndrome Index). Results: Three- way comparisons between groups indicated superior efficacy for phenelz ine, followed by placebo and haloperidol on measures of depression, bo rderline psychopathologic symptoms, and anxiety. Pairwise comparisons between medication and placebo revealed significant efficacy for phene lzine against anger and hostility but no efficacy against atypical dep ression or hysteroid dysphoria. We were unable to replicate prior repo rts of efficacy for the neuroleptic. Conclusions: Pharmacologic dissec tion of borderline personality disorder patients into affective and sc hizotypal subtypes could not be demonstrated.