A Cochrane review [Abstract] 1 included 28 studies with a total of 1742 subjects with borderline personality disorder (BPD). In one trial studying acute self-harm, 71% of the patients had BPD. Study participants were mostly outpatients and the baseline severity of illness varied. First-generation antipsychotics (flupenthixol decanoate, haloperidol, thiothixene); second-generation antipsychotics (aripirazole, olanzapine, ziprasidone), mood stabilisers (carbamazepine, valproate semisodium, lamotrigine, topiramate), antidepressants (amitriptyline, fluoxetine, fluvoxamine, phenelzine sulfate, mianserin) and dietary supplementation (omega-3 fatty acid) were tested. First-generation antipsychotics were subject to older trials, whereas recent studies focussed on second-generation antipsychotics and mood stabilisers. Active drug was compared with either placebo, active comparator or combination of drugs. The studies last from 32 days to 24 weeks with a mean duration of approximately 12 weeks.There were numerous different outcomes in the trials. The findings supported the use of second-generation antipsychotics, mood stabilisers, and omega-3 fatty acids, but most effect estimates were based on single studies. The long-term use of these drugs has not been assessed. Adverse event data were scarce, except for olanzapine. There was a possible increase in self-harming behaviour, significant weight gain, sedation and changes in haemogram parameters with olanzapine. A significant decrease in body weight was observed with topiramate treatment. All drugs were well tolerated in terms of attrition. S
Comment: The quality of evidence is downgraded by study quality (inadequate allocation concealment), inconsistency (heterogeneity in populations, medications and outcomes) and imprecise results (limited study size for each comparison).
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