Soloff P H, Cornelius J, George A, Nathan S, Perel J M, Ulrich R F
Department of Psychiatry, University of Pittsburgh, Pa.
Arch Gen Psychiatry. 1993 May;50(5):377-85. doi: 10.1001/archpsyc.1993.01820170055007.
To compare the efficacy of a neuroleptic (haloperidol) to a monoamine oxidase inhibitor antidepressant (phenelzine sulfate) against the affective, cognitive, and impulsive-aggressive symptoms of criteria-defined borderline inpatients in an effort to dissect apart affective and schizotypal symptom patterns or subtypes using medication response.
Randomized, double-blind, placebo-controlled trial.
Inpatient unit of a tertiary care university psychiatric hospital serving a large public catchment area.
One hundred eight consecutively admitted borderline inpatients defined by Gunderson's Diagnostic Interview for Borderline Patients and DSM-III-R criteria, randomly assigned to 38 phenelzine, 36 haloperidol, and 34 placebo trials.
Following 1 week free of medication, haloperidol (average dose, 4 mg/d), phenelzine sulfate (average dose, 60 mg/d), or placebo were given for 5 weeks with weekly symptom ratings and plasma drug level determinations.
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 Psychiatric Scale [IMPS], Buss-Durkee Hostility Inventory), psychoticism (Schizotypal Symptom Inventory, SCL-90, IMPS), impulsivity (Ward Scale, Barratt Impulsiveness Scale, Self-Report Test of Impulse Control), and borderline psychotherapy (Borderline Syndrome Index).
Three-way comparisons between groups indicated superior efficacy for phenelzine, followed by placebo and haloperidol on measures of depression, borderline psychopathologic symptoms, and anxiety. Pairwise comparisons between medication and placebo revealed significant efficacy for phenelzine against anger and hostility but no efficacy against atypical depression or hysteroid dysphoria. We were unable to replicate prior reports of efficacy for the neuroleptic.
Pharmacologic dissection of borderline personality disorder patients into affective and schizotypal subtypes could not be demonstrated.
比较一种抗精神病药物（氟哌啶醇）与一种单胺氧化酶抑制剂抗抑郁药（硫酸苯乙肼）对符合标准的边缘性人格障碍住院患者的情感、认知及冲动攻击症状的疗效，以便通过药物反应剖析情感症状模式或亚型与分裂样症状模式或亚型。
随机、双盲、安慰剂对照试验。
一所服务于广大公共集水区的三级大学精神病医院的住院部。
108例连续入院的边缘性人格障碍住院患者，根据冈德森的边缘性人格障碍诊断访谈及《精神疾病诊断与统计手册》第三版修订版标准确定，随机分为38例接受硫酸苯乙肼治疗、36例接受氟哌啶醇治疗和34例接受安慰剂治疗。
在停药1周后，给予氟哌啶醇（平均剂量4mg/d）、硫酸苯乙肼（平均剂量60mg/d）或安慰剂，持续5周，每周进行症状评分并测定血浆药物水平。
通过抑郁（汉密尔顿评定量表、贝克抑郁量表）、总体严重程度（总体评估量表、症状自评量表90项[SCL-90]）、焦虑、愤怒敌意（SCL-90、住院多维精神病量表[IMPS]、巴斯-杜克敌意量表）、精神病性（分裂样症状量表、SCL-90、IMPS）、冲动性（病房量表、巴拉特冲动性量表、冲动控制自我报告测试）及边缘性心理治疗（边缘性综合征指数）来衡量疗效。
组间的三向比较表明，硫酸苯乙肼在抑郁、边缘性精神病理症状及焦虑测量指标上疗效更佳，其次是安慰剂和氟哌啶醇。药物与安慰剂之间的两两比较显示，硫酸苯乙肼对愤怒和敌意有显著疗效，但对非典型抑郁或类癔症性心境恶劣无效。我们无法重复之前关于该抗精神病药物疗效的报告。
无法证明将边缘性人格障碍患者通过药理学方法分为情感亚型和分裂样亚型是可行的。
