Low-Dose Clozapine in Acute and Continuation Treatment of Severe Borderline Personality Disorder
J Clin Psychiatry 1998;59(3):103-107
© Copyright 2016 Physicians Postgraduate Press, Inc.
Purchase This PDF for $40.00
If you are not a paid subscriber, you may purchase the PDF.
(You'll need the free Adobe Acrobat Reader.)
Receive immediate full-text access to JCP. You can subscribe to JCP online-only ($86) or print + online ($156 individual).
With your subscription, receive a free PDF collection of the NCDEU Festschrift articles. Hurry! This offer ends December 31, 2011.
If you are a paid subscriber to JCP and do not yet have a username and password, activate your subscription now.
As a paid subscriber who has activated your subscription, you have access to the HTML and PDF versions of this item.
Click here to login.
Did you forget your password?
Still can't log in? Contact the Circulation Department at 1-800-489-1001 x4 or send email
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.