Schmahl C, Bohus M
Abteilung für Psychiatrie und Psychotherapie mit Poliklinik, Universitätsklinik für Psychiatrie und Psychosomatik, Freiburg.
Fortschr Neurol Psychiatr. 2001 Jul;69(7):310-21. doi: 10.1055/s-2001-15305.
Borderline Personality Disorder (BPD) is a common and serious psychiatric illness. Psychopathological symptoms often are heterogenous and difficult to influence. Psychotherapy stands in the core of treatment efforts. However, during the treatment of these patients often situations occur that make the use of drug treatment necessary. Symptoms such as depression, impulsivity, or dissociation can be difficult to deal with in this population. There appears to be no treatment of choice for the disorder as a whole. Reviews so far have organized the literature by groups of pharmacological agents. In this review we give an overview over psychopathological symptoms in BPD, i.e. depression, affective dysregulation, aggression, impulsivity, dissociation, self-injuries, suicidality, psychotic symptoms, anxiety, obsessions and compulsions, and sleep disturbance. Effectivity of different drugs in influencing these symptoms is presented and significances of findings are used to assess the relevance of these findings. We conclude that certain symptoms such as depression or impulsivity can be successfully treated. Serotonin reuptake inhibitors play a decisive role in pharmacological treatment of Borderline Personality Disorder. Finally, recommendations for effective drug treatment of BPD symptoms are presented. Comorbid depression should be treated with Selective Serotonin Reuptake Inhibitors. These substances could also be shown to be effective in the treatment of impulsive and aggressive behavior. Intermittent psychotic symptoms are a target for atypical neuroleptics. Benzodiazepines are no longer viewed to be useful in the treatment of BPD.
边缘型人格障碍（BPD）是一种常见且严重的精神疾病。其精神病理症状往往具有异质性且难以干预。心理治疗是治疗工作的核心。然而，在治疗这些患者的过程中，常常会出现需要使用药物治疗的情况。诸如抑郁、冲动或分离症状等在这类患者中可能难以处理。对于整个这种疾病似乎没有一种首选的治疗方法。迄今为止的综述都是按照药物类别对文献进行整理的。在本综述中，我们概述了边缘型人格障碍的精神病理症状，即抑郁、情感失调、攻击性、冲动性、分离症状、自我伤害行为、自杀倾向、精神病性症状、焦虑、强迫观念和强迫行为以及睡眠障碍。介绍了不同药物对这些症状的影响效果，并利用研究结果的意义来评估这些发现的相关性。我们得出结论，某些症状如抑郁或冲动性能够得到成功治疗。5-羟色胺再摄取抑制剂在边缘型人格障碍的药物治疗中起决定性作用。最后，针对边缘型人格障碍症状的有效药物治疗提出了建议。共病性抑郁应使用选择性5-羟色胺再摄取抑制剂进行治疗。这些药物在治疗冲动和攻击行为方面也已被证明是有效的。间歇性精神病性症状是使用非典型抗精神病药物的治疗靶点。苯二氮䓬类药物在边缘型人格障碍的治疗中不再被认为是有用的。
