St Andrew's Academic Department, St Andrew's Healthcare, Northampton, NN1 5DG, UK.
Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK.
CNS Drugs. 2017 May;31(5):345-356. doi: 10.1007/s40263-017-0425-0.
Medicines are routinely prescribed to treat borderline personality disorder (BPD) despite a relative lack of high-quality evidence and in breach of some treatment guidelines. An earlier Cochrane review of pharmacotherapy in BPD underlined the lack of evidence, encouraged the replication of earlier studies, but also emphasised the pressing need for more randomised placebo-controlled trials, and for those studies to employ broadened inclusion criteria.
The authors searched bibliographic databases, reference lists of articles and trials registers. Records were screened to identify those that met the inclusion criteria. Full-text articles were screened and assessed for eligibility. On-going trials of pharmacotherapy in BPD were also identified.
Fifteen new studies of pharmacotherapy for BPD were identified since the earlier review. Eight of those examined second generation antipsychotics, two investigated mood stabilisers, three investigated antidepressants and two studied the effectiveness of opioid antagonists. Results for the effectiveness of antipsychotics appeared to be mixed. There has been little recent evidence to support the use of mood stabilisers. There is a lack of new placebo-controlled, randomised controlled trials investigating antidepressants and limited new evidence to support the use of opioid antagonists.
The review revealed that there remains a dearth of high-quality research evidence to help patients, carers and clinicians make sound and safe evidence-based decisions about medicines to treat BPD.
尽管缺乏高质量的证据，且有一些治疗指南与之相悖，医生仍会常规开处方药来治疗边缘型人格障碍（BPD）。之前 Cochrane 对 BPD 的药物治疗进行了综述，强调了证据不足的问题，鼓励对早期研究进行复制，同时也强调了进行更多随机安慰剂对照试验的迫切需要，并呼吁这些研究采用更广泛的纳入标准。
作者检索了文献数据库、文章的参考文献列表和试验登记处。对记录进行筛选，以确定符合纳入标准的记录。筛选全文文章并评估其纳入资格。还确定了正在进行的 BPD 药物治疗试验。
自上次综述以来，又确定了 15 项新的 BPD 药物治疗研究。其中 8 项研究了第二代抗精神病药，2 项研究了心境稳定剂，3 项研究了抗抑郁药，2 项研究了阿片类拮抗剂的疗效。抗精神病药疗效的结果似乎好坏参半。最近几乎没有证据支持使用心境稳定剂。缺乏新的安慰剂对照、随机对照试验来研究抗抑郁药，也缺乏新的证据来支持使用阿片类拮抗剂。
该综述表明，仍然缺乏高质量的研究证据，以帮助患者、护理人员和临床医生在治疗 BPD 的药物方面做出明智且安全的循证决策。
