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首页> 外文期刊>The journal of clinical psychiatry >Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials.
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Effectiveness of pharmacotherapy for severe personality disorders: meta-analyses of randomized controlled trials.

机译：药物疗法对严重人格障碍的有效性：随机对照试验的荟萃分析。

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CONTEXT: There has been little systematic attempt to validate current pharmacologic treatment algorithms and guidelines for severe personality disorder. OBJECTIVE: We evaluated studies on the effectiveness of psychoactive drugs on specific symptom domains for borderline and/or schizotypal personality disorder.DATA SOURCES: The literature was searched for placebo-controlled randomized clinical trials (PC-RCTs) on the effectiveness of psychopharmacologic drugs in personality disorder patients. The PubMed, PsychINFO, PiCarta, Cochrane, and Web of Science databases were searched using the search terms borderline personality, schizotypal personality, personality disorder, cluster A, cluster B, treatment, drug, pharmacotherapy, antipsychotic, antidepressant, mood stabilizer, effect, outcome, review, and meta-analysis for studies published between 1980 and December 2007, and references were identified from bibliographies from articles and books. STUDY SELECTION: Placebo-controlled randomized clinical trials on the efficacy of antipsychotics, antidepressants, and mood stabilizers regarding cognitive-perceptual symptoms, impulsive-behavioral dyscontrol, and affective dysregulation (with subdomains depressed mood, anxiety, anger, and mood lability) were selected in patients with well defined borderline and/or schizotypal personality disorder. Studies whose primary emphasis was on the treatment of Axis I disorders were excluded. Meta-analyses were conducted using 21 retrieved studies.RESULTS: Antipsychotics have a moderate effect on cognitive-perceptual symptoms (5 PC-RCTs; standardized mean difference [SMD]=0.56) and a moderate to large effect on anger (4 PC-RCTs; SMD=0.69). Antidepressants have no significant effect on impulsive-behavioral dyscontrol and depressed mood. They have a small but significant effect on anxiety (5 PC-RCTs; SMD=0.30) and anger (4 PC-RCTs; SMD=0.34). Mood stabilizers have a very large effect on impulsive-behavioral dyscontrol (6 PC-RCTs; SMD=1.51) and anger (7 PC-RCTs; SMD=1.33), a large effect on anxiety (3 PC-RCTs; SMD=0.80), but a moderate effect on depressed mood (5 PC-RCTs; SMD=0.55). Mood lability as an outcome measure was seldomly assessed. Mood stabilizers have a more pronounced effect on global functioning (3 PC-RCTs; SMD=0.79) than have antipsychotics (5 PC-RCTs; SMD=0.37). The effect of antidepressants on global functioning is negligible.CONCLUSIONS: Drug therapy tailored to well-defined symptom domains can have a beneficial effect on patients with severe personality disorder. The findings from this study raise questions on current pharmacologic algorithms.
机译：背景：几乎没有系统性的尝试来验证当前针对严重人格障碍的药物治疗算法和指南。目的：我们评估了针对边缘性和/或精神分裂型人格障碍的特定症状域上精神活性药物有效性的研究。数据来源：文献检索了安慰剂对照的随机临床试验（PC-RCTs），研究了精神药物在精神分裂症中的有效性人格障碍患者。使用以下搜索词搜索了PubMed，PsychINFO，PiCarta，Cochrane和Web of Science数据库：边缘人格，分裂型人格，人格障碍，A组，B组，治疗，药物，药物疗法，抗精神病药，抗抑郁药，情绪稳定剂，效果，对1980年至2007年12月间发表的研究进行了结果，评论和荟萃分析，并从文章和书籍的书目中找到了参考文献。研究选择：选择安慰剂对照的关于抗精神病药，抗抑郁药和情绪稳定剂在认知知觉症状，冲动行为失调和情感失调（伴有情绪低落，情绪低落，焦虑，愤怒和情绪低落的领域）的疗效的随机临床试验。有明确的边缘性和/或精神分裂型人格障碍的患者。主要研究轴心轴疾病治疗的研究被排除在外。结果：抗精神病药对认知知觉症状有中等程度的影响（5个PC-RCT;标准平均差[SMD] = 0.56），对愤怒有中度到大的影响（4个PC-RCT）。 ; SMD = 0.69）。抗抑郁药对冲动行为失调和情绪低落没有明显影响。它们对焦虑（5例PC-RCT; SMD = 0.30）和愤怒（4例PC-RCT; SMD = 0.34）有很小但显着的影响。情绪稳定剂对冲动行为失控（6个PC-RCT; SMD = 1.51）和愤怒（7个PC-RCT; SMD = 1.33）有很大影响，对焦虑（3个PC-RCT; SMD = 0.80）有很大影响。 ，但对情绪低落有中等效果（5个PC-RCT; SMD = 0.55）。很少评估情绪不稳定性作为结果指标。与抗精神病药（5种PC-RCT; SMD = 0.37）相比，情绪稳定剂对整体功能（3种PC-RCT; SMD = 0.79）的影响更为明显。结论：针对明确的症状域量身定制的药物治疗可对重度人格障碍患者产生有益的影响。这项研究的发现提出了有关当前药理学算法的疑问。

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