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A case series of clozapine for borderline personality disorder

Catherine Frogley, BSc

St. Andrew’s Academic Centre, Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King’s College London, Northampton, United Kingdom

Katina Anagnostakis, MRCPsych

St. Andrew’s Women’s Service, Northampton, United Kingdom

Shawn Mitchell, MRCPsych

St. Andrew’s Women’s Service, Northampton, United Kingdom

Fiona Mason, FRCPsych

St. Andrew’s Healthcare, Northampton, United Kingdom

David Taylor, PhD

King’s College London, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom

Geoff Dickens, PhD

St. Andrew’s Academic Centre, Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King’s College London, Northampton, United Kingdom

Marco M. Picchioni, MRCP, MRCPsych, PhD

St. Andrew’s Academic Centre, Department of Forensic and Neurodevelopmental Science, Institute of Psychiatry, King’s College London, Northampton, United Kingdom

BACKGROUND: Borderline personality disorder (BPD) is a common, debilitating disorder for which the evidence base for treatment is modest. This case series aimed to explore preliminary evidence of clozapine’s effectiveness for patients with severe BPD.

METHODS: We examined the case notes of 22 female inpatients with a primary diagnosis of BPD who had started treatment with clozapine. Baseline routine clinical data were extracted from the records and at 6 monthly intervals thereafter, up to a maximum of 18 months after starting treatment. Patients also were interviewed about their experiences.

RESULTS: We found evidence for a beneficial effect of clozapine across several clinical domains. Symptom severity, need for enhanced observations, use of additional medication, and the number of aggressive incidents all significantly improved after clozapine. The greatest improvements appeared within the first 6 months of initiating treatment. There also was a significant increase in weight.

CONCLUSIONS: The results suggest that clozapine, with suitable health monitoring, may be beneficial for this clinical population. Larger, randomized, blinded, and controlled prospective studies are needed to confirm these findings.

KEYWORDS: antipsychotic, clozapine, borderline personality disorder, emotionally unstable personality disorder, treatment, pharmacotherapy

ANNALS OF CLINICAL PSYCHIATRY 2013;25(2):125-134

CORRESPONDENCE: Marco M. Picchioni, MRCP, MRCPsych, PhD PO23 Department of Forensic and Neurodevelopmental Science Institute of Psychiatry De Crespigny Park London, SE5 8AF, United Kingdom E-MAIL: marco.picchioni@kcl.ac.uk
Annals of Clinical Psychiatry ©2013 Frontline Medical Communications Inc.

 
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