Olanzapine vs Aripiprazole in the Management of Borderline Personality Disorder

Introduction: The essential feature of borderline personality disorder (BPD) is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity. While according to some studies olanzapine and aripiprazole are effective agents in BPD, there are other studies that deny such an effect. So, with respect to these controversies, an assessment was performed to compare the efficacy and safety of olanzapine vs aripiprazole in this group of patients. Method: Twenty four patients, were entered into one of the two groups (n=12 in each group) for participating in an 8- week, open-label study for random assignment to olanzapine or aripiprazole in a 1:1 ratio. Primary outcome measure included Brief Psychiatric Rating Scale (BPRS) for estimation of baseline psychopathology, clinical outcome and treatment response. In addition, Buss-Durkee Hostility Inventory (BDHI) for the assessment of anger& hostility, and Clinical Global Impressions-Severity Scale (CGI-S), for assessment of overall illness severity were used as secondary scales. The patients were assessed by means of BPRS at baseline (week 0), and weeks 2, 4 and 8. The other scales were scored at baseline and at the end of the assessment. Results: According to the findings both olanzapine and aripiprazole showed a significant improvement in BPRS at the end of the trial (p=0.01 and p=0.04, respectively). BDHI and CGI-S as well improved significantly by olanzapine (p=0.04 and p=0.03, respectively), while it was not so regarding aripiprazole (p=0.06 and p=0.07, respectively). Effect size (ES) analysis for changes in BPRS, indicated a large improvement with both of olanzapine and aripiprazole. Conclusion: Both olanzapine and aripiprazole had relatively comparable effect on general symptoms of BPD, in spite of a bit greater influence of olanzapine on some of the secondary outcome measures.