Cornelius J R, Soloff P H, Perel J M, Ulrich R F
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, PA 15213.
Am J Psychiatry. 1993 Dec;150(12):1843-8. doi: 10.1176/ajp.150.12.1843.
The aim of this study was to assess the effectiveness of low-dose neuroleptic medication and monoamine oxidase inhibitor (MAOI) antidepressant medication in continuation pharmacotherapy of patients with borderline personality disorder.
The authors conducted a double-blind, placebo-controlled study comparing continuation therapy with a neuroleptic (up to 6 mg/day of haloperidol), an MAOI antidepressant (up to 90 mg/day of phenelzine), and placebo in 14 men and 40 women with borderline personality disorder. Continuation medication trials lasted 16 weeks, following 5 weeks of acute therapy.
Continuing haloperidol demonstrated efficacy only for the treatment of irritability. Higher levels of depression, hypersomnia, and leaden paralysis were noted in the patients who received haloperidol than in those who received phenelzine and those who received placebo. The dropout rate during the first 8 weeks of the continuation study was significantly higher for the patients receiving haloperidol (64%) than for those receiving placebo (28%). Continued phenelzine demonstrated only modest efficacy for the treatment of depression and irritability. An activating effect of phenelzine was shown on measures of excitement and reactivity.
No evidence of efficacy was found for continuation therapy with haloperidol in the treatment of borderline personality disorder other than in the treatment of irritability. Little evidence of efficacy was found for continuation therapy with phenelzine for borderline personality disorder other than modest improvements in irritability and depressive symptoms. There is currently no clear pharmacological treatment of choice for the continuation therapy of borderline personality disorder.
本研究旨在评估低剂量抗精神病药物和单胺氧化酶抑制剂（MAOI）抗抑郁药物在边缘性人格障碍患者持续药物治疗中的有效性。
作者进行了一项双盲、安慰剂对照研究，比较了14名男性和40名女性边缘性人格障碍患者使用抗精神病药物（最多6毫克/天氟哌啶醇）、MAOI抗抑郁药物（最多90毫克/天苯乙肼）和安慰剂进行持续治疗的效果。在5周的急性治疗后，持续药物试验持续16周。
持续使用氟哌啶醇仅在治疗易怒方面显示出疗效。接受氟哌啶醇治疗的患者比接受苯乙肼治疗的患者和接受安慰剂治疗的患者出现更高水平的抑郁、嗜睡和铅样麻痹。在持续研究的前8周，接受氟哌啶醇治疗的患者（64%）的脱落率显著高于接受安慰剂治疗的患者（28%）。持续使用苯乙肼仅在治疗抑郁和易怒方面显示出适度疗效。苯乙肼对兴奋和反应性测量显示出激活作用。
除了治疗易怒外，未发现氟哌啶醇持续治疗边缘性人格障碍有疗效证据。除了易怒和抑郁症状有适度改善外，未发现苯乙肼持续治疗边缘性人格障碍有疗效证据。目前对于边缘性人格障碍的持续治疗尚无明确的药理学治疗选择。
