[Olanzapine and cognitive-behavioural group therapy in borderline personality disorder]

Borderline Personality Disorder (BPD) is considered one of the most difficult psychiatric conditions to treat, neither psychological nor pharmacological treatments have been shown to be particularly effective. We present a proposal for the treatment of patients diagnosed with BPD which uses an atypical neuroleptic, olanzapine, and cognitive-behavioural group therapy aimed at dealing with the following problems: Interpersonal Conflict, Affective Instability, Impulsiveness, and Confused Identity.

Six patients diagnosed with BPD using the International Personality Disorder Evaluation (IPDE) were treated during 6 months with olanzapine (at dosages of 5-20mg/day) and dialectical behaviour therapy, with weekly 2-hour sessions.

All of these patients followed the programme during the first 2 months, and 3 of the 6 completed it, showing an improvement in their behavioural disorder, as indicated by a decrease in parasuicidal episodes (i.e. suicide attempts and self-mutilative acts) and fewer visits to the emergency department. One of the patients dropped out due to side effects.

The possibility of using a combined therapeutic approach enables us to project controlled clinical trials over a longer period of time, thus making it possible to assess behavioural changes which are difficult to observe in conventional clinical trials.