Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-16T17:12:27.375Z Has data issue: false hasContentIssue false
  • English
  • Français

An Open-Label Trial of Divalproex Extended-Release in the Treatment of Borderline Personality Disorder

Published online by Cambridge University Press:  07 November 2014

Daphne Simeon ,
Bryann Baker ,
William Chaplin ,
Ashley Braun  and
Eric Hollander
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Borderline personality disorder (BPD) is associated with several symptoms, including impulsivity, aggression, and intense unstable affect, which can be targeted with anticonvulsant agents. Divalproex extended-release (ER) is used widely in clinical practice, which leads to the question of its efficacy and tolerability in treating BPD.

Methods:

This study assessed the efficacy and tolerability of divalproex ER in 20 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition BPD via a 12-week openlabel trial. Primary outcome measures included the Clinical Global Impression–Improvement (CGI-I) scale and the Global Assessment Scale. Secondary outcome measures assessed aggression (Aggression Questionnaire, Overt Aggression Scale-Modified); affective disturbance (Affective Intensity Measure, Affective Lability Scale); dissociation (Dissociative Experiences Scale); and general psychopathology (Symptom-Checklist 90–Revised).

Results:

Thirteen subjects were male and seven were female with a mean age of 37.0±11.3 years. Treatment was associated with statistically significant improvement on the CGI-I, the Global Assessment Scale, the Overt Aggression Scale–Modified irritability subscale, and the Aggression Questionnaire. A trend toward significant improvement was observed on the Affective Intensity Measure. Seven out of 10 completers (70%) were treatment responders, with an endpoint CGI-I of 2 (much improved) or 1 (very much improved). There was no significant decline in affective lability or in dissociation. One participant discontinued treatment due to adverse events.

Conclusion:

These findings support that divalproex ER is an efficacious and well-tolerated pharmacologic agent for BPD, with the additional advantage of single daily dosing at bedtime. Placebo-controlled trials are needed for replication.

Type
Original Research
Information
CNS Spectrums , Volume 12 , Issue 6 , June 2007 , pp. 439 - 443
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.Stein, DJ, Simeon, D, Frenkel, M, Islam, MN, Hollander, E. An open trial of valproate in borderline personality disorder. J Clin Psychiatry. 1995;56:506–510.Google ScholarPubMed
2.Hollander, E, Allen, A, Lopez, RP, et al.A preliminary double-blind, placebo-controlled trial of divalproex sodium in borderline personality disorder. J Clin Psychiatry. 2001;62:199–203.CrossRefGoogle ScholarPubMed
3.Hollander, E, Tracy, KA, Swann, AC, et al.Divalproex in the treatment of impulsive aggression: efficacy in cluster B personality disorders. Neuropsychopharmacology. 2003;28:1186–1197.CrossRefGoogle ScholarPubMed
4.Hollander, ED, Swann, AC, Coccaro, EF, Jiang, P, Smith, TB. Impact of trait impulsivity and state aggression on divalproex versus placebo response in borderline personality disorder. Am J Psychiatry. 2005;162:621–624.CrossRefGoogle ScholarPubMed
5.Tritt, K, Nickel, C, Lahmann, C, et al.Lamotrigine treatment of aggression in female borderline-patients: a randomized, double-blind, placebo-controlled study. J Psychopharmacol. 2005;19:287–291.CrossRefGoogle ScholarPubMed
6.Nickel, MK, Nickel, C, Kaplan, P, et al.Treatment of aggression with topiramate in male borderline patients: a double-blind, placebo-controlled study. Biol Psychiatry. 2005;57:495–499.CrossRefGoogle ScholarPubMed
7.Nickel, MK, Nickel, C, Mitterlehner, FO, et al.Topiramate treatment of aggression in female borderline personality disorder patients: a double-blind, placebo-controlled study. J Clin Psychiatry. 2004;65:1515–1519.CrossRefGoogle ScholarPubMed
8.First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IVAxis I Disorders, Patient Version (SCID-P). version 2. New York, NY: New York State Psychiatric Institute Biometrics Research; 1995.Google Scholar
9.Pfohl, B, Blum, N, Zimmerman, M. Structured Interview for DSM-IV Personality Disorders SIDP-IV. Iowa City, Ia: University of Iowa; 1995.Google Scholar
10.Guy, W. Assessment Manual for Psychopharmacology. rev. Rockville, Md: U.S. Department of Health, Education, and Welfare, Alcohol, Drug Abuse and Mental Health Administration; 1976. DHEW Publ No ADM 76-338.Google Scholar
11.Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J. The global assessment scale. A procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry. 1976;33:766–771.CrossRefGoogle Scholar
12.Buss, AH, Perry, M. The aggression questionnaire. J Pers Soc Psychol. 1992;63:452–459.CrossRefGoogle ScholarPubMed
13.Yudofsky, SC, Silver, JM, Jackson, W, Endicott, J, Williams, D. The Overt Aggression Scale for the objective rating of verbal and physical aggression. Am J Psychiatry. 1986;143:35–39.Google ScholarPubMed
14.Harvey, PD, Greenberg, BR, Serper, MR. The affective lability scales: development, reliability, and validity. J Clin Psychol. 1989;45:786–793.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
15.Larsen, RJ, Diener, E, Emmons, RA. Affect intensity and reactions to daily life events. J Pers Soc Psychol. 1986;51:803–814.CrossRefGoogle Scholar
16.Bernstein-Carlson, E, Putnam, FW. An update on the Disssociative Experiences Scale. Dissociation. 1993;6:16–27.Google Scholar
17.Derogatis, LR, Lipman, RS, Rickels, K, Uhlenhuth, EH, Covi, L. The Hopkins Symptom Checklist (HSCL): a self-report symptom inventory. Behav Sci. 1974;19:1–15.CrossRefGoogle ScholarPubMed