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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：药物治疗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：验证目前的药理学治疗算法及其严重人格障碍的准则几乎没有系统尝试。目的：我们评估了对临界和/或斯基质型人格障碍的特定症状结构域对精神活性药物的有效性的研究人格障碍患者。使用搜索术语界线个性，斯科匹卡人格，人格障碍，集群A，群体B，治疗，药物，药物治疗，抗精神病药，抗抑郁，情绪稳定剂，抗精神病药，抗抑郁药，情绪稳定剂，抗精神病药，抗抑郁药，情绪稳定剂，抗精神病药，抗抑郁药，抗精神病毒，抗抑郁药，情绪稳定剂，效果， 1980年至2007年12月期间出版的研究结果，审查和荟萃分析，以及从文章和书籍的书目中确定了参考文献。研究选择：安慰剂控制的随机临床试验对抗精神病药，抗抑郁药剂和情绪稳定剂关于认知感知症状，冲动行为的障碍和情感失调（具有亚地区抑郁情绪，焦虑，愤怒和情绪较小）的疗效在患有良好定义的边缘线和/或斯分泌人格障碍的患者中。排除了初次强调治疗轴I障碍的研究被排除在外。使用21检索研究进行了荟萃分析。结果：抗精神病药有对认知感知症状的效果适得（5个PC-RCT;标准化平均差= 0.56），对愤怒的中等效果（4个PC-RCT） ; SMD = 0.69）。抗抑郁药对冲动行为的障碍和情绪抑郁情绪没有显着影响。它们对焦虑有很小但显着影响（5个PC-RCT; SMD = 0.30）和愤怒（4个PC-RCT; SMD = 0.34）。情绪稳定剂对冲动行为的障碍（6个PC-RCT; SMD = 1.51）和愤怒（7个PC-RCT; SMD = 1.33）有很大的影响，对焦虑有很大的影响（3个PC-RCT; SMD = 0.80） ，但对抑郁情绪的效果（5个PC-RCT; SMD = 0.55）。作为结果措施的情绪可怜很少评估。情绪稳定剂对全球功能（3个PC-RCT）有更明显的影响（3个PC-RCT; SMD = 0.79），而不是抗精神病药（5个PC-RCT; SMD = 0.37）。抗抑郁药对全球功能的影响可忽略不计本研究的调查结果提出了关于当前药理学算法的问题。

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