Clinical outcome of psychopharmacologic treatment of borderline and schizotypal personality disordered subjects.

This paper reviews the biological and psychopharmacologic nature of personality disordered subjects, specifically those with borderline (BPD) and schizotypal (ScPD) personality disorder. Generally speaking, there is no agent of choice for the treatment of either BPD or ScPD. Many agents of different classes appear to offer some benefit to selected subjects depending upon their symptom presentation. For example, ScPD or BPD subjects with prominent cognitive/perceptual distortion may respond to neuroleptic agents, while some BPD subjects with depressed mood may respond best to antidepressants. The hypothesis that biological and behavioral dimensions underlie the psychopharmacologic response to treatment in personality disordered subjects, proposed over the past decade, is now being tested. The most salient example of this is the testing of serotonin-specific agents (e.g., fluoxetine) for potential antiaggressive efficacy in personality disordered subjects with prominent histories of impulsive aggressive behavior and putative reduced serotonin system function.