Arch Iranian Med 2006; 9 (4): 403 – 405

Brief Report

Treatment of Borderline Personality Disorder with Olanzapine
Saeed Shoja-Shafti MD *
Borderline personality disorder is one of the most problematic psychiatric disorders with aggressiveness and impulsivity as its two main characteristics. Our objective was to determine the efficacy of olanzapine on 20 patients with borderline personality disorder. Results were found to be affirmative in this respect.
Archives of Iranian Medicine, Volume 9, Number 4, 2006: 403 – 405.

Keywords: Borderline personality disorder • olanzapine • pharmacotherapy Introduction
orderline personality disorder (BPD) is a heterogeneous psychiatric disorder. Like any other kind of personality disorders, genetic, biologic, and psychoanalytic factors jointly compose its basis. The prevalence of the disease in the general population is estimated to be about 2%. In mental health settings, its prevalence is 10% in outpatient clinics and about 20% in inpatient units. BPD is much more common among women, who make up about 75% of the cases.1 The term “borderline” has historically been used to describe patients who were on a borderline between neurotic and psychotic disorders. Alterations of central neurotransmission systems, stressful childhood traumas, and genetic predisposition are major etiologic factors for this disorder. Affective unstableness, impulsiveness, and aggressiveness are the major presentations of such morbid personality. Also, recurrent suicidal treats and attempts, assaultiveness, substance abuse or dependence, and low tolerance for frustration are the remarkable characteristics of such patients. Both psychotherapeutic and pharmacologic
Author’s affiliation: *Department of Psychiatry, Razi Psychiatric Hospital, University of Social Welfare and Rehabilitation Sciences, Iran. •Corresponding author and reprints: Saeed Shoja-Shafti MD, Department of Psychiatry, Razi Psychiatric Hospital, University of Social Welfare and Rehabilitation Sciences, Amin Abad, Shahre Rey, Tehran, Iran. Telefax: +98-21-334-01604, E-mail: Accepted for publication: 15 March 2006


modalities have been used hitherto for extenuating these symptoms.2 Serotonin-selective reuptake inhibitors (SSRIs) have been proposed as the firstline treatments for impulsivity.3 Failure to respond to SSRIs should prompt consideration of low-dose neuroleptics.3, 4 On the other hand, long-term administration of neuroleptics to such patients can lead to important neurologic side effects like tardive dyskinesia. Lithium and anticonvulsant mood stabilizers have also been helpful with respect to impulsive aggression.5, 6 Atypical antipsychotic drugs with combined serotonergic and dopaminergic properties seem to offer a fine prospect for the treatment of BPD. In recent studies clozapine,7 olanzapine,8 and risperidone9 have been successfully employed for the management of BPD. The purpose of this study, also, was to determine whether olanzapine could moderate the impulsive-aggressive behavior of patients with BPD.

Patients and Methods
Twenty consecutive patients (all women) from one of the psychiatric wards of Razi Psychiatric Hospital in Tehran, who met the DSM-IV-TR diagnostic criteria for BPD, were enrolled in the study. They had a mean ± SD age of 24.7 ± 4.7 years. Their diagnoses had been certified by at least three psychiatrists, based on face to face interviews, history, observations, and the abovementioned diagnostic criteria. Patients were excluded from the trial if they suffered from any major medical or neurologic

Archives of Iranian Medicine, Volume 9, Number 4, October 2006 403

63 2. No concurrent psychotropic medication was allowed. Volume 9.6 ± 6. the DSM-IV global assessment of functioning (GAF).65 ± 0.86 Mean last observation 40. offered their informed consents.43 45.001 0.37 2.60 2. Statistical significance was set to 2-sided P value <0.8.5 somnolence. Data gathered from this study were compared using the Student’s t test.1 ± 14.54 ± 0. mood stabilizers.45 2. a substantial improvement in GAF was observed.21 1.93 ± 0. Changes in outcome measures within the study period are displayed in Table 1. and anxiety factors.50 20. Measure BPRS total BPRS anxiety BPRS tension BPRS depressive mood BPRS hostility BPRS suspiciousness BPRS uncooperativeness BPRS excitement GAF BDHI Mean baseline 49. which have been attributed to atypical antipsychotic drugs could be responsible for the improvements we observed in this regard. At the end of the study.52 ± 0. depressive mood.74 7.10 In addition to a decrease in BPD symptoms. in Iran) orally for eight weeks. in addition to the aforementioned BPD. excitement.63 mg /day. patients was 4.18 2. and then individually increased by 2.4 dyspepsia. All of their psychotropic drugs had been withdrawn for at least two weeks.001 BPRS = Brief Psychiatric Rating Scale.26 2. no patient dropped out for medication intolerance.15 52.63 ± 0. to be taken each evening.84 27. GAF = global assessment of functioning.58 3. before entering the study.85 60. Other BPRS factors failed to reach statistical significance.3 ± 7.001 0.001 0.76 ± 1. comparing with the baseline levels at the end of the study. hostility.8 ± 6. which had been prescribed for them included conventional neuroleptics. The dose established by week four was held constant up to the end of the study. Number 4. in weekly meetings. with an 11.30 2.5 mg increments.1 and constipation. during the course of this trial. Possible mood-stabilizing properties. the patients were receiving no specific psychotherapeutic approach and were only subjected to clinical management (a 30-min medication visit once a week and regular clinical visits twice per week).1 Since the side effects were mild and well-tolerated.74 ± 1.9 ± 4.59 1.23 ± 0.7 dizziness.001 0.87 25.41 2.02 point increase in the mean GAF score.93 ± 0. after a complete description of the treatment.05 0.56 27. The patients were treated with openlabel olanzapine (Sobhan Co.12 6.01 0.86 ± 0. The analysis of specific BPRS subscales revealed significantly lower scores in tension.95 ± 0. Previous pharmacologic treatments.57 2. October 2006 .85 3. suspiciousness. Principal scales in this research were the Brief Psychiatric Rating Scale (BPRS). and the self-rated Buss-Durkee Hostility Inventory (BDHI). Results All patients completed the entire eight weeks of the study. The mean score analysis revealed a significant improvement during the period of olanzapine administration. and benzodiazepines.005 0. to a maximum of 10 mg by week four. SSRIs. as needed or tolerated.82 ± 7.73 Percentage change 18.71 ± 0.20% improvement in BDHI total score. Substantial changes in GAF were also observed.12 ± 0.64 13.89 29.43 ± 1.05. The final mean ± SD olanzapine dose for Table 1.63% in comparison with the baseline scores.16 63. Mean ± SD of outcome measures before and after the study on 20 patients with borderline personality disorder. All patients. During the medication trial. 10 Treatment with olanzapine was followed by substantial improvement in scores assessing affective crisis. BPRS total scores showed a statistically significant reduction of 18. and also a trend towards amelioration in uncooperativeness factor. Therefore.001 0.Treatment of borderline personality disorder with olanzapine illness or if there was any comorbid remarkable mental disorders in axis I.5 0. BDHI = Buss-Durkee Hostility Inventory. This was started at a dose of 2.45 ± 1. All patients were assessed by the same psychiatrist at baseline and at the end of the eighth week of the treatment.5 mg/day.63 15.20 P value 0. Discussion Our results are similar to those of previous studies assessing the efficacy of olanzapine in BPD. Side effects included weight gain. There was also a 25. 404 Archives of Iranian Medicine.4 tremor.24 2.

Islam MN. 141: 1455 – 1458. Jesberger JA. Blumberg AG. Am J Psychiatry. this study must be interpreted with caution due to its small number of subjects and open method of treatment. 2000. 60 (suppl 15): 38 – 44. Ghaemi SN. Biol Psychiatry. Guille C. J Clin Psychiatry. J Clin Psychiatry. Nonetheless. Kang JS. 1972. 61: 638 – 642. Schultz SC. 9 2 10 3 Serban G. 17: 326 – 327. Number 4. Levine J. Lithium carbonate in emotionally unstable character disorder. 4 5 6 7 References 8 1 American Psychiatric Association. Schulz SC. J Clin Psychopharmacol. An open trial of valproate in borderline personality disorder. risperidone. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 60: 477 – 484. 2000. J Clin Psychiatry. Parepally H. Carrillo C. Berry SA. Soloff PH. 27: 519 – 523. Frenkel M. Shoja-Shafti this study offers encouraging evidence for the role of olanzapine in the management of this type of personality disorder. Washington. Response of borderline and schizotypal patients to small doses of thiothixene and haloperidol. Stein DJ. and olanzapine in the treatment of bipolar disorder. Simeon D. Quitkin F. Psychiatr Clin North Am. 1984. Sachs GS. Siegel S. 1995. Ebeling T. Rifkin A. Archives of Iranian Medicine. 1999. 46: 1429 – 1435. Chengappa KN. Risperidone in comorbid borderline personality disorder and dysthymia. 4th ed. Certainly. double-blind placebo-controlled studies are needed for better clarification of the efficacy of olanzapine in the improvement of different dimensions of BPD. Volume 9. ix. 1999. 1997. October 2006 405 . Klein DF. 1999.S. Hollander E. Olanzapine safety and efficacy in patients with borderline personality disorder and comorbid dysthymia. Hollander E. Arch Gen Psychiatry. 2000. 23: 169 – 192. J Clin Psychiatry. 56: 506 – 510. Managing aggressive behavior in patients with obsessive-compulsive disorder and borderline personality disorder. Camlin KL. A naturalistic comparison of clozapine. DC: American Psychiatric Association. Szigethy EM. Clozapine reduces severe self-mutilation and aggression in psychotic patients with borderline personality disorder. Psychopharmacology of borderline personality disorder.