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Clozapine in borderline personality disorder: A review of the evidence

Anand Beri, MRCPsych

South London and Maudsley NHS Foundation Trust, Maudsley Hospital, London, United Kingdom

Jane Boydell, MRCPsych, PhD

Institute of Psychiatry, King’s College London, London, United Kingdom

Background: Borderline personality disorder (BPD) is a serious mental disorder that is difficult to treat. Possible targets for pharmacotherapy include affective symptoms, cognitive disturbances, and impulsive, self-injurious behaviors. Although many of the medications tested for treatment of BPD have been demonstrated to be useful, no clear pharmacologic treatment has emerged. Clozapine is one of the medications that has been evaluated for the treatment of severe BPD. The aim of this review is to summarize the evidence examining the effectiveness of clozapine in the treatment of BPD.

Methods: A comprehensive search of the health science databases PubMed, EMBASE, CINAHL, PsycINFO, Web of Science, Cochrane Library, and Google Scholar was performed for studies describing the use of clozapine in the treatment of BPD.

Results: After the initial search, no randomized controlled trials evaluating the effectiveness of clozapine in BPD were identified. Therefore, case reports and case series were reviewed, with 12 articles selected for final review.

CONCLUSIONS: This review suggests that clozapine may be a beneficial treatment option for BPD especially in controlling symptom severity, psychotic symptoms, impulsivity, self-mutilation, number of days on enhanced observation, use of restraint, and overall functioning.

KEYWORDS: clozapine, borderline personality disorder, pharmacotherapy, antipsychotics


CORRESPONDENCE: Anand Beri, MRCPsych, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London SE5 8AZ United Kingdom E-MAIL: Anand.beri@slam.nhs.uk
Annals of Clinical Psychiatry ©2014 Quadrant HealthCom Inc.

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