Clinical Outcome of Psychopharmacologic Treatment of Borderline and Schizotypal Personality Disordered Subjects

This paper reviews the biological and psychopharmacologic nature of personality disordered subjects,specifically those with borderline (BPD) and schizotypal (ScPD) personality disorder. Generallyspeaking, there is no agent of choice for the treatment of either BPD or ScPD. Many agents of differentclasses appear to offer some benefit to selected subjects depending upon their symptom presentation.For example, ScPD or BPD subjects with prominent cognitive/perceptual distortion may respondto neuroleptic agents, while some BPD subjects with depressed mood may respond best to antidepressants.The hypothesis that biological and behavioral dimensions underlie the psychopharmacologicresponse to treatment in personality disordered subjects, proposed over the past decade, is now beingtested. The most salient example of this is the testing of serotonin-specific agents (e.g., fluoxetine) forpotential antiaggressive efficacy in personality disordered subjects with prominent histories of impulsiveaggressive behavior and putative reduced serotonin system function.