Low-Dose Clozapine in Acute and Continuation Treatment of Severe Borderline Personality Disorder
J Clin Psychiatry 1998;59(3):103-107
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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
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.