Impulsivity is a predisposition toward rapid, unplanned reactions without regard to their negative consequences. It is considered a psychopathological factor common to all cluster B personality disorders (PD), but prominent in borderline personality disorder (BPD). The pharmacological treatment of impulsivity is based on the evidence that the expression of this dimension is mediated by dysregulation of neurotransmitter physiology and is responsive to medications. In fact, American Psychiatric Association (APA) guidelines consider impulsive-behavioural dyscontrol, as well as affective dysregulation and cognitive perceptual symptoms, one of the main targets for pharmacotherapy of BPD. APA guidelines recommend the use of antidepressants and mood stabilizers as first-line treatments for impulsive-behavioural dyscontrol and affective dysregulation, and antipsychotics for cognitive perceptual symptoms. In recent years available data on the efficacy and tolerability of pharmacotherapy in the treatment of impulsivity in PDs are increasing and a large number of different drugs have been evaluated. SSRIs are recommended as first-choice medications for affective instability and impulse dyscontrol, but also efficacy of SNRIs is supported by initial data. Several investigations have been performed on the use of mood stabilizers to control impulsivity in PDs: more substantial data were derived from controlled trials of valproate, although other drugs such as lithium, carbamazepine, oxcarbazepine and lamotrigine were tested with promising results. A few first generation antipsychotics were studied with good effects on behavioral dyscontrol and psychotic like symptoms. More recent investigations have examined atypical antipsychotics, showing significant improvements of impulsivity, anger and hostility. Available findings on drug therapy of impulsivity in PDs are encouraging, but data need to be replicated in further controlled studies. References: - Moeller F.G., Barratt E.S., Dougherty D.M., Schmitz J.M., Swann A.C. (2001) Psychiatric aspects of impulsivity. Am. J. Psychiatry, 158, 1783-1793. - Oldham J.M. (2001) Practice guidelines for the treatment of patients with borderline personality disorders. American Psychiatric Association, Arlington, VA. - Bellino S., Paradiso E., Bogetto F. (2008) Efficacy and tolerability of pharmacotherapies for borderline personality disorder. CNS Drugs, 22, 671-692.
Psychopharmacological treatment of impulsivity in personality disorders
BELLINO, Silvio;RINALDI, Camilla;BOZZATELLO, PAOLA;BOGETTO, Filippo
2009-01-01
Abstract
Impulsivity is a predisposition toward rapid, unplanned reactions without regard to their negative consequences. It is considered a psychopathological factor common to all cluster B personality disorders (PD), but prominent in borderline personality disorder (BPD). The pharmacological treatment of impulsivity is based on the evidence that the expression of this dimension is mediated by dysregulation of neurotransmitter physiology and is responsive to medications. In fact, American Psychiatric Association (APA) guidelines consider impulsive-behavioural dyscontrol, as well as affective dysregulation and cognitive perceptual symptoms, one of the main targets for pharmacotherapy of BPD. APA guidelines recommend the use of antidepressants and mood stabilizers as first-line treatments for impulsive-behavioural dyscontrol and affective dysregulation, and antipsychotics for cognitive perceptual symptoms. In recent years available data on the efficacy and tolerability of pharmacotherapy in the treatment of impulsivity in PDs are increasing and a large number of different drugs have been evaluated. SSRIs are recommended as first-choice medications for affective instability and impulse dyscontrol, but also efficacy of SNRIs is supported by initial data. Several investigations have been performed on the use of mood stabilizers to control impulsivity in PDs: more substantial data were derived from controlled trials of valproate, although other drugs such as lithium, carbamazepine, oxcarbazepine and lamotrigine were tested with promising results. A few first generation antipsychotics were studied with good effects on behavioral dyscontrol and psychotic like symptoms. More recent investigations have examined atypical antipsychotics, showing significant improvements of impulsivity, anger and hostility. Available findings on drug therapy of impulsivity in PDs are encouraging, but data need to be replicated in further controlled studies. References: - Moeller F.G., Barratt E.S., Dougherty D.M., Schmitz J.M., Swann A.C. (2001) Psychiatric aspects of impulsivity. Am. J. Psychiatry, 158, 1783-1793. - Oldham J.M. (2001) Practice guidelines for the treatment of patients with borderline personality disorders. American Psychiatric Association, Arlington, VA. - Bellino S., Paradiso E., Bogetto F. (2008) Efficacy and tolerability of pharmacotherapies for borderline personality disorder. CNS Drugs, 22, 671-692.
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