Use of gabapentin in group B – DSM-IV personality disorders

LETTERS TO THE EDITORS

Use of gabapentin in group B – DSM-IV personality disorders

Hilda C P Morana^I; Maria Laura Ramalho Olivi^II; Claudiane Salles Daltio^III

^IPsychiatric Institute of the Clinical Hospital and of the Medical School of the University of São Paulo

^IIPublic Health Service of São Paulo - SUS-SP

^IIIPsychiatric Institute of the Medical School of the University of São Paulo - IPq-HC FMUSP

Mr. editor,

Many professionals are skeptical regarding the treatment of personality disorders (PD) for considering it protracted and unsatisfactory.¹

The therapeutical refractoriness of PD cannot be deduced from the diagnostic label in itself, but from the assessment of all the factors related to the subject's personality and global functioning. The identification of psychopathological aspects related to excitability, mood pattern, emotional lability and tolerance to frustrations, are important in the treatment, and may be accessible to pharmacological and psychotherapeutic approaches and to the psychosocial rehabilitation. The adequate development of social feelings, as a capability of considering the other, and the ethical awareness are decisive factors for that. The PD outpatient clinic at the Psychiatric Institute of HC-FMUSP (IPq) has started its activities at the beginning of 1999 aiming the early intervention on those patients, in order to prevent the delinquent behavior, very common in the life history of those subjects. From June 2002 up to June 2003, 137 PD patients were seen at IPq's outpatient clinics. Of these, 40 [29.19%] were seen at the PD outpatient clinic.

It was observed that many of them had a long history of psychiatric consultations and hospitalizations, without improvement, besides representing a burden to their families and to society.

The main complaints were related to aggressiveness, hostility, impulsiveness, immediatism, irresponsibility, suggestibility, lack of introspection, affective and working instability, trend to lie frequently, drug use (without dependence), obstinate behavior and insensitivity regarding the others. Some of them had already committed some crimes against people, such as murder attempt, robbery, rape and corporal lesion, rarely with legal consequences due to lack of denunciation.

Several neuropsychopharmacological studies suggest a biological substrate for PD, what could be reduced by psychopharmacological intervention.² Gabapentin was chosen due to its probable inhibitory effect in the brain neurotransmission,³ reducing the psychic hyper-excitability, different from that seen in mood disorders.

The aim of this observational study was to assess the behavioral improvement in group B PD (DSM IV) patients with the use of gabapentin.

The diagnosis was established using international criteria (ICD10;DSM-IV), and, in some cases, using personality assessment instruments (Rorschach Proof and PCL-R).^4,5 The intervention was psychotherapeutical and pharmacological.

Twenty-nine patients have been treated (8 with antisocial PD; 13 impulsive type; 7 histrionic type and 1 narcissistic), with the maximal dose of gabapentin 1200 mg/day, alone or concomitantly with other drugs (neuroleptics, mood stabilizers and benzodiazepines). In 23 of them (79.9%) it was verified, through the reports of patients and their people in charge, an improvement in the initial picture after 6 weeks of treatment, with decrease of aggressiveness, impulsivity, antisocial behavior and drug abuse. There was also an improvement in the concentration and introspection capabilities and higher interest in productive activities. No other medication used in this service had such satisfactory results on equivalent number of patients and treatment duration.

Further controlled studies with larger samples are needed to verify the positive finding reported.

References

1. Cawthra R, Gibb R. Severe personality disorder – whose responsibility? Br J Psychiatry v. 173; 1998. p. 8-10.

2. Bloom FE, David MD, Kupfer J. Psychopharmacology: the fourth generation of progress. Am Coll Neuropsychopharmacol v.30. p. 2002. Available at: http://www.acnp.org/g4/GN401000152/Default.htm. Access in May 2003.

3. Herranz JL. Gabapentin: its mechanisms of action in the year 2003. 2003;(12);1159-65.

4. Silveira A. Prova de Rorschach: elaboração do psicograma. São Paulo: Edbras; 1985.

5. Morana H. Identificação do ponto de corte para a escala PCL-R (Psychopathy Checklist Revised) em população forense brasileira: caracterização de dois subtipos da personalidade; transtorno global e parcial. Doctorate thesis submitted to the University of São Paulo. São Paulo, SP; 2004. Available at www.teses.usp.br.

Publication Dates

• Publication in this collection
  28 Oct 2004
• Date of issue
  June 2004