PHARMACOTHERAPY OF PERSONALITY-DISORDERS - CONCEPTUAL-FRAMEWORK AND CLINICAL STRATEGIES

This article delineates the conceptual models used when medications ar e prescribed for patients with personality disorders and reviews the d ata on the efficacy of these medications. Studies before 1980 are diff icult to interpret because of changes in diagnostic criteria. Nonethel ess, early studies on non-DSM-III disorders such as pseudoneurotic sch izophrenia, emotionally unstable character disorder, hysteroid dysphor ia, and subaffective disorders indicated the potential utility of phar macotherapy for treating personality disorders. Models to consider in evaluating the possible use of medications for treating personality di sorders are: (1) treating the disorder itself, (2) treating symptom cl usters within and across disorders; and (3) treating associated axis I disorders. Among the current personality disorders, borderline person ality disorder has been the most extensively studied, with antipsychot ic agents being the most well-documented treatment. Monoamine oxidase inhibitors, fluoxetine, and carbamazepine show promise. Schizotypal di sorders may respond to low-dose antipsychotic drugs. Although heuristi cally valuable, the symptom cluster approach to treatment has not yet been validated. Axis I disorders, especially depression, are frequentl y associated with all personality disorders. Dependent personality dis order is linked to panic disorder with agoraphobia, whereas avoidant p ersonality disorder is associated with social phobia and panic. In gen eral, pharmacotherapy for axis I disorders is less effective in the pr esence of a comorbid personality disorder. Despite the modest benefits seen in many studies, pharmacotherapy can add significantly to the ov erall treatment of those with personality disorders. Future research m ust carefully assess the effect of comorbid axis I disorders on respon ses. The symptom cluster/psychobiologic dimension approach should be i nvestigated in clinical studies.