The use of pharmacological treatments for people with personality disorder: A systematic review of randomized controlled trials

Abstract

Background This is a companion paper to our earlier review of psychological treatments for people with personality disorder that examined the evidence from randomized controlled trials (RCTs). Here, we report on the evidence of pharmacological treatments from RCTs for people with personality disorder. As in the previous report, this paper incorporates information from an earlier review that examined the evidence to 2002, and extends it to December 2006. As in the previous paper, this review restricts itself to the findings from RCTs, and excludes evidence from other study designs; however, details of these other studies will be posted in the National Personality Disorder Institute Website (http://www.pdinstitute.org.uk). Aim This study aimed to examine the evidence from RCTs to justify intervening with pharmacological treatments in people with personality disorder. Method Fifteen electronic databases (including MEDLINE, EMBASE and PsycINFO) were searched to the end of December 2006 for any RCT of a pharmacological intervention for participants meeting DSM or ICD criteria for personality disorder. Outcomes were grouped using a similar symptomological categorization to that suggested by Soloff in 1998. Results This methodology identified 35 trials for inclusion. The main positive findings were those favouring the use of anticonvulsants to reduce aggression, and of anti-psychotics to reduce cognitive perceptual and mental state disturbance. However, there were major methodological deficiencies in the trial designs, including small numbers of participants and limited duration of treatment and follow-up. Conclusion This review identifies a very limited evidence base to justify intervening with drugs in this group. Reasons why this should be so are examined that relate to fundamentally differing conceptualizations of how any intervention might impact in an individual with personality disorder. Copyright (C) 2008 John Wiley & Sons, Ltd.