Combination of Long-Acting Injectable Antipsychotics in the Treatment of Psychiatric Disorders-A Systematic Review of the Literature and Case Series.

BACKGROUND: The treatment of refractory schizophrenia is complex, and compliance with oral treatment, including clozapine, can be challenging at times. The purpose of this case series and literature review article is to evaluate the efficacy of the combined use of 2 different long-acting injectable antipsychotics (LAIAs) on the number of psychiatric hospitalizations and emergency department visits. There are currently few data to support this treatment option, despite the frequent use of combinations of oral antipsychotics. METHODS: We extracted the data from 8 different patients who received combination LAIAs from 1 hospital setting. We evaluated the frequency of hospitalization and emergency department visits before and after treatment with a mirror-image study design. A systematic review of existing literature was included to find all previously reported cases of combination LAIAs. RESULTS: The frequency of hospitalizations was greatly reduced after the initiation of combination LAIA treatment in the majority of the cases at study site, as well as in the literature review. The number of ED visits was not as clearly affected. In the literature review, combinations of 2 LAIAs with different mechanisms of action were often documented. Symptom scores were also reduced in most reviewed cases. CONCLUSIONS: Combinations of LAIAs seem to be promising as a treatment option for refractory psychotic disorders. This combination could be a treatment option for patients with limited alternatives, such as clozapine resistant or not eligible. The higher risk of adverse effects and long-term risks are not well documented.

Nonsuicidal Self-Injury in Early Adolescence as a Predictor of Borderline Personality Disorder in Early Adulthood.

Borderline personality disorder (BPD) typically has an onset in adolescence. Nonsuicidal self-injury (NSSI) could be associated with its subsequent development. The aim of this study was to examine whether NSSI among adolescents in the community is associated with a risk for BPD in emerging adulthood. Sixty-nine adolescents (11-13 years old) with a history of NSSI and 61 matched controls were assessed for NSSI and then reassessed between ages 18 to 20 years. Findings showed that continuation of NSSI over time was associated with higher ratings of BPD symptomatology and greater impairment in psychosocial functioning. Both of these relations were mediated by deficits in emotion regulation. These results suggest that adolescents who engage in NSSI may need to be assessed for problems regulating emotions and to be provided with early interventions to help prevent continuation of NSSI.

The Lifetime Course of Borderline Personality Disorder.

Borderline personality disorder (BPD) has historically been seen as a lifelong, highly disabling disorder. Research during the past 2 decades has challenged this assumption. This paper reviews the course of BPD throughout life, including childhood, adolescence, and adulthood. BPD can be accurately identified in adolescence, and the course of the disorder, in adolescence and adulthood, is generally similar, with reductions in symptoms over time. Functional recovery is less consistent, and further research on factors or treatments that may improve the long-term functional outcome of patients with BPD is warranted.

Pain in patients with borderline personality disorder.

OBJECTIVE: Patients with borderline personality disorder (BPD) frequently present to primary care physicians and specialists with pain problems. The aims of the current study are to (1) examine the prevalence of pain symptoms in patients with a diagnosis of BPD compared with a diagnosis of another personality disorder and (2) identify the factors that predict pain experienced in patients with BPD. METHODS: Two hundred and ninety inpatients meeting Revised Diagnostic Interview for Borderlines and DSM-III-R criteria for BPD and 72 patients who met DSM-III-R criteria for another personality disorder were assessed at baseline using semistructured interviews and self-report measures. Ratings of pain were assessed 16 years after baseline diagnosis and compared between diagnostic groups using t-tests. Regression analyses were used to identify predictors of pain among patients with BPD. RESULTS: Patients with BPD are more likely to experience pain and rate their pain as more severe than patients with other personality disorders. In multivariable regression models, there were three significant predictors of severity of pain among patients with BPD: older age, the presence of major depressive disorder, and the severity of childhood abuse other than sexual abuse. CONCLUSION: Patients with BPD report significant pain, which interferes with their lives. A focus on the management of medical and psychiatric comorbidities may improve their long-term functioning.

Treatment of borderline personality disorder in youth.

OBJECTIVES: Borderline personality disorder (BPD) is frequently encountered in both adult and youth populations. There is a robust literature supporting psychotherapy for adults with BPD, but the literature supporting its use for BPD in youth is more limited. METHODS: A literature review was conducted using the keywords "borderline personality disorders" and "adolescence." Relevant articles were reviewed for inclusion. RESULTS: Several specialized treatments have been studied with mixed results. Dialectical behaviour therapy has no randomized controlled trials in adolescents, emotion regulation training has not demonstrated superiority of treatment as usual, and cognitive analytic therapy has demonstrated more rapid recovery but little difference at follow-up. Mentalization-based treatment has one study supporting its use in self-harming adolescents. Pharmacotherapy has no evidence supporting its use in this population. CONCLUSIONS: Structured therapy may be the most important therapeutic component in this population.

OBJECTIFS: Le trouble de la personnalité limite (TPL) est fréquent dans les populations tant des adultes que des adolescents. Il y a une abondante littérature qui soutient la psychothérapie pour les adultes souffrant du TPL, mais la littérature soutenant un traitement du TPL chez les adolescents est plus limitée. MÉTHODES: Une revue de la littérature a été menée à l'aide des mots clés « troubles de la personnalité limite ¼ et « adolescence ¼. Les articles pertinents ont été examinés aux fins d'inclusion. RÉSULTATS: Plusieurs traitements spécialisés ont été étudiés avec des résultats partagés. La thérapie comportementale dialectique n'a pas d'essais randomisés contrôlés chez les adolescents, la formation en régulation émotionnelle n'a pas démontré sa supériorité comme traitement habituel, et la thérapie cognitive analytique a donné lieu à un rétablissement plus rapide mais à peu de différence au suivi. La thérapie basée sur la mentalisation a une seule étude qui en soutient l'utilisation chez les adolescents qui s'automutilent. Aucunes données probantes ne soutiennent l'utilisation de la pharmacothérapie dans cette population. CONCLUSIONS: La thérapie structurée peut être la composante thérapeutique la plus importante pour cette population.

Outcomes in women diagnosed with borderline personality disorder in adolescence.

OBJECTIVE: This study examined the outcomes of patients diagnosed with borderline personality disorder (BPD) prior to age 18. METHOD: In a group of 47 adolescent girls assessed over a 10 year period, 31 had a past diagnosis of BPD while 16 had not met criteria. Subjects were assessed with the SCID-I, the Diagnostic Interview for Borderlines (DIB), the SCL-90-R, the Social Adjustment Scale (SAS-SR), the Affective Lability Scale (ALS), the Barratt Impulsivity Scale (BIS), the Continuous Performance Test (CPT), the Wisconsin Card Sorting Test (WCST), and the Attention Network Task (ANT). RESULTS: 4.3 years after initial presentation (mean age=19.6), only 11 index patients still met criteria for BPD and no new cases developed. Those who did not remit were significantly more likely to have a current episode of major depressive disorder, lifetime substance use disorder, and self-reported childhood sexual abuse. Those who still met BPD criteria also scored higher on the ALS and the total severity scale as well as several subscales of the SCL-90, but not on other measures. CONCLUSIONS: These findings support the validity of an adolescent diagnosis of BPD and show that the majority of cases that develop in early adolescence can be expected to remit within 4 years.