Low-dose clozapine in acute and continuation treatment of severe borderline personality disorder

Francesco Benedetti, Laura Sforzini, Cristina Colombo, Cesare Maffei, Enrico Smeraldi

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Abstract

Background: Psychotic-like symptoms in patients affected by borderline personality disorder (BPD) are usually treated with low-dose neuroleptics, which show controversial acute effects and lead to a worsening of affective- related symptoms and to severe neurologic side effects after prolonged administration. Clozapine lacks the neurologic side effects of traditional neuroleptics and has been shown to successfully treat psychotic-like symptoms in BPD patients at medium dose. We performed an open-label trial of low-dose clozapine in severe BPD patients. Method: Twelve BPD inpatients (DSM-IV criteria) with severe psychotic-like symptoms were studied. Exclusion criteria included comorbid Axis I and medical pathologies. All patients had followed a therapeutic program without improvement for at least 4 months before admission. The clozapine dose was titrated upward on an individual basis until the complete disappearance of psychotic-like symptoms was achieved. Clinician-rated scales were completed at the beginning of the study and after 4 and 16 weeks. Results: All patients completed the 16-week study. Individual clozapine doses ranged from 25 to 100 mg/day. Psychotic-like symptoms decreased within the first 3 weeks of treatment, as confirmed by a statistically significant decrease in Brief Psychiatric Rating Scale scores. This amelioration was coupled with an overall improvement, including a reduction in impulsive behaviors and in affective-related symptoms (Hamilton Rating Scale for Depression) and an increase in global functioning (Global Assessment of Functioning). Conclusion: Low-dose clozapine for acute and continuation treatment led to improvement in overall symptomatology in a small sample of severe BPD patients.

Original languageEnglish
Pages (from-to)103-107
Number of pages5
JournalJournal of Clinical Psychiatry
Volume59
Issue number3
Publication statusPublished - Mar 1998

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Borderline Personality Disorder
Clozapine
Affective Symptoms
Nervous System
Antipsychotic Agents
Therapeutics
Brief Psychiatric Rating Scale
Impulsive Behavior
Diagnostic and Statistical Manual of Mental Disorders
Inpatients
Depression
Pathology

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Low-dose clozapine in acute and continuation treatment of severe borderline personality disorder. / Benedetti, Francesco; Sforzini, Laura; Colombo, Cristina; Maffei, Cesare; Smeraldi, Enrico.

In: Journal of Clinical Psychiatry, Vol. 59, No. 3, 03.1998, p. 103-107.

Research output: Contribution to journalArticle

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