Refer to Table II for pertinent selleck compound positive results within the class of antipsychotic medications. Table II Antipsychotics demonstrating efficacy in borderline personality disorder. MAOI, monoamine oxidase inhibitor Anticonvulsants Affective symptoms associated with BPD, particularly those related to intolerance of aloneness and dependency, are refractory relative to impulsive aggression Inhibitors,research,lifescience,medical and self-injurious behavior.18-21 Despite phenomenological similarity between BPD and the bipolar spectrum, characteristic, associated interpersonal and identity disturbances distinguish

affective instability in BPD.97-101 Although older studies indicated lithium as efficacious for BPD,33,102 risks associated Inhibitors,research,lifescience,medical with toxicity or noncompliance and the need for frequent monitoring have limited its clinical utility. Temporal aspects of affective instability in BPD appear to be similar to rapid-cycling variants of bipolar disorder, motivating more frequent use of other mood stabilizers. Despite early documentation of clinical benefit from carbamazepine,

its efficacy in trials was inconsistent and possibly associated with worsening depressive symptoms.103-105 Valproate, lamotrigine, and topiramate offer greater Inhibitors,research,lifescience,medical therapeutic benefits in treating affective instability and impulsivity in BPD.22,29 As a class, anticonvulsant medications offer moderate-to-large effects on impulsive aggression, affective instability, and overall functioning, with potentially

greater effect size than associated with atypical antipsychotic treatment.25,27 Inhibitors,research,lifescience,medical Trials with topiramate suggest a broad spectrum of therapeutic benefit, particularly in anger and interpersonal functioning.106-110 However, adverse cognitive sequelae may interfere with psychotherapy for some Inhibitors,research,lifescience,medical BPD patients, and potential weight loss may become troubling for patients with comorbid eating disorders. Lamotrigine treatment improves impulsivity, affective symptoms,111 and aggression,41,112 but it requires lengthy titration to avoid life-threatening rash and toxicity. Tofacitinib molecular weight Valproate appears to be particularly efficacious in BPD patients with prominent impulsive aggression, rather than affective instability.113 Table III shows GSK-3 pertinent positive results within the class of mood stabilizer/anticonvulsant medications. These medications stabilize excitatory neurotransmission, but they differ greatly in mechanism of action and effects on glutamatergic and GABAergic signaling, so specific mechanisms of therapeutic response in BPD remain unclear. The long-term risk versus benefit analysis for these medications in BPD needs to be determined case by case, particularly with respect to recognized risks of teratogenicity for women of child-bearing age. Table III Mood stabilizers demonstrating efficacy in borderline personality disorder.