{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:51:15Z","timestamp":1787313075700,"version":"build-2736575974"},"reference-count":77,"publisher":"Royal College of Psychiatrists","issue":"4","license":[{"start":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T00:00:00Z","timestamp":1729468800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["cambridge.org"],"crossmark-restriction":true},"short-container-title":["Br J Psychiatry"],"published-print":{"date-parts":[[2025,4]]},"abstract":"<jats:sec id=\"S0007125024001727_sec_a1\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Medications are commonly used to treat co-occurring psychopathology in persons with borderline personality disorder (BPD)<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125024001727_sec_a2\">\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To systematically review and integrate the evidence of medications for treatment of co-occurring psychopathology in people with BPD, and explore the role of comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125024001727_sec_a3\" sec-type=\"methods\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>\n                      Building on the current Cochrane review of medications in BPD, an update literature search was done in March 2024. We followed the methods of this Cochrane review, but scrutinised all identified placebo-controlled trials\n                      <jats:italic>post hoc<\/jats:italic>\n                      for reporting of non BPD-specific (\u2018co-occurring\u2019) psychopathology, and explored treatment effects in subgroups of samples with and without defined co-occurring disorders. GRADE ratings were done to assess the evidence certainty.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125024001727_sec_a4\" sec-type=\"results\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Twenty-two trials were available for quantitative analyses. For antipsychotics, we found very-low-certainty evidence (VLCE) of an effect on depressive symptoms (standardised mean difference (SMD) \u22120.22,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.04), and low-certainty evidence (LCE) of an effect on psychotic\u2013dissociative symptoms (SMD \u22120.28,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.007). There was evidence of effects of anticonvulsants on depressive (SMD \u22120.44,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.02; LCE) and anxious symptoms (SMD \u22121.11,\n                      <jats:italic>P<\/jats:italic>\n                      &lt; 0.00001; VLCE). For antidepressants, no significant findings were observed (VLCE). Exploratory subgroup analyses indicated a greater effect of antipsychotics in samples including participants with co-occurring substance use disorders on psychotic\u2013dissociative symptoms (\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"S0007125024001727_sec_a5\" sec-type=\"conclusions\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings, based on VLCE and LCE only, do not support the use of pharmacological interventions in people with BPD to target co-occurring psychopathology. Overall, the current evidence does not support differential treatment effects in persons with versus without defined comorbidities. Medications should be used cautiously to target co-occurring psychopathology.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1192\/bjp.2024.172","type":"journal-article","created":{"date-parts":[[2024,10,20]],"date-time":"2024-10-20T22:45:19Z","timestamp":1729464319000},"page":"226-237","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":8,"title":["Pharmacological interventions for co-occurring psychopathology in people with borderline personality disorder: secondary analysis of the Cochrane systematic review with meta-analyses"],"prefix":"10.1192","volume":"226","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6019-022X","authenticated-orcid":false,"given":"Johanne","family":"Pereira Ribeiro","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6171-2904","authenticated-orcid":false,"given":"Sophie","family":"Juul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4405-0486","authenticated-orcid":false,"given":"Mickey T.","family":"Kongerslev","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3320-1231","authenticated-orcid":false,"given":"Mie Sedoc","family":"J\u00f8rgensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4571-3410","authenticated-orcid":false,"given":"Birgit A","family":"V\u00f6llm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2436-367X","authenticated-orcid":false,"given":"Henriette","family":"Edemann-Callesen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6049-0644","authenticated-orcid":false,"given":"Christian","family":"Sales","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1283-4024","authenticated-orcid":false,"given":"Julie P.","family":"Schaug","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9609-4261","authenticated-orcid":false,"given":"Klaus","family":"Lieb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6134-2392","authenticated-orcid":false,"given":"Erik","family":"Simonsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5286-8133","authenticated-orcid":false,"given":"Jutta M.","family":"Stoffers-Winterling","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0204-7745","authenticated-orcid":false,"given":"Ole Jakob","family":"Storeb\u00f8","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"170","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"key":"S0007125024001727_ref72","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.14m09228"},{"key":"S0007125024001727_ref42","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.159.12.2048"},{"key":"S0007125024001727_ref9","doi-asserted-by":"publisher","DOI":"10.1186\/s40479-019-0106-3"},{"key":"S0007125024001727_ref74","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-023-01452-6"},{"key":"S0007125024001727_ref15","first-page":"283","volume-title":"Encyclopedia of Substance Abuse Prevention, Treatment, and Recovery","author":"Fisher","year":"2014"},{"key":"S0007125024001727_ref48","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2021.159"},{"key":"S0007125024001727_ref53","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-198908000-00002"},{"key":"S0007125024001727_ref8","doi-asserted-by":"publisher","DOI":"10.1007\/s00115-023-01566-5"},{"key":"S0007125024001727_ref62","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v65n0314"},{"key":"S0007125024001727_ref6","volume-title":"Clinical Practice Guideline for the Management of Borderline Personality Disorder","year":"2013"},{"key":"S0007125024001727_ref70","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1986.01800070070009"},{"key":"S0007125024001727_ref69","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-198608000-00008"},{"key":"S0007125024001727_ref26","volume-title":"Review Manager 5 (RevMan 5), version 5.4.","year":"2020"},{"key":"S0007125024001727_ref38","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.106.022707"},{"key":"S0007125024001727_ref65","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.107.037903"},{"key":"S0007125024001727_ref14","first-page":"CD012956","article-title":"Pharmacological interventions for people with borderline personality disorder","volume":"2","author":"Stoffers-Winterling","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"S0007125024001727_ref56","doi-asserted-by":"publisher","DOI":"10.3310\/hta22170"},{"key":"S0007125024001727_ref49","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v69n0617"},{"key":"S0007125024001727_ref40","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.160.1.167"},{"key":"S0007125024001727_ref33","doi-asserted-by":"publisher","DOI":"10.1016\/j.biopsych.2004.11.044"},{"key":"S0007125024001727_ref11","doi-asserted-by":"publisher","DOI":"10.1080\/13651501.2019.1576904"},{"key":"S0007125024001727_ref28","doi-asserted-by":"publisher","DOI":"10.1177\/20451253221090832"},{"key":"S0007125024001727_ref5","doi-asserted-by":"publisher","DOI":"10.1037\/per0000599"},{"key":"S0007125024001727_ref31","doi-asserted-by":"publisher","DOI":"10.1016\/0165-0327(82)90026-X"},{"key":"S0007125024001727_ref51","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v69n0412"},{"key":"S0007125024001727_ref23","doi-asserted-by":"publisher","DOI":"10.1002\/jrsm.11"},{"key":"S0007125024001727_ref25","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/31.1.140"},{"key":"S0007125024001727_ref71","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1176\/ajp.143.4.519","article-title":"Positive effects of carbamazepine on behavioral dyscontrol in borderline personality disorder","volume":"143","author":"Gardner","year":"1986","journal-title":"Am J Psychiatry"},{"key":"S0007125024001727_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2023.11.053"},{"key":"S0007125024001727_ref32","unstructured":"32 New York State Psychiatric Institute. Treating Suicidal Behavior and Self-Mutilation in People With Borderline Personality Disorder. Clinicaltrials.gov, 2007 (https:\/\/clinicaltrials.gov\/show\/NCT00533117)."},{"key":"S0007125024001727_ref16","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0","author":"Higgins","year":"2011"},{"key":"S0007125024001727_ref35","doi-asserted-by":"publisher","DOI":"10.1177\/0269881105051540"},{"key":"S0007125024001727_ref30","first-page":"255","article-title":"Efficacy of extended-release divalproex combined with \u2018condensed\u2019 dialectical behavior therapy for individuals with borderline personality disorder","volume":"24","author":"Moen","year":"2012","journal-title":"Ann Clin Psychiatry"},{"key":"S0007125024001727_ref50","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.2006.163.5.833"},{"key":"S0007125024001727_ref24","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1207"},{"key":"S0007125024001727_ref77","doi-asserted-by":"publisher","DOI":"10.1521\/pedi_2021_35_502"},{"key":"S0007125024001727_ref13","volume-title":"Diagnostic and Statistical Manual of Mental Disorders (DSM-5)","year":"2013"},{"key":"S0007125024001727_ref36","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-018-0506-8"},{"key":"S0007125024001727_ref54","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1176\/ajp.150.12.1843","article-title":"Continuation pharmacotherapy of borderline personality disorder with haloperidol and phenelzine","volume":"150","author":"Cornelius","year":"1993","journal-title":"Am J Psychiatry"},{"key":"S0007125024001727_ref60","doi-asserted-by":"publisher","DOI":"10.1097\/01.jcp.0000195113.61291.48"},{"key":"S0007125024001727_ref52","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.162.6.1221"},{"key":"S0007125024001727_ref55","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0b013e31819a4bae"},{"key":"S0007125024001727_ref4","doi-asserted-by":"publisher","DOI":"10.1037\/per0000091"},{"key":"S0007125024001727_ref73","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12767"},{"key":"S0007125024001727_ref43","first-page":"263","volume-title":"Impulsivity and Aggression","author":"Markovitz","year":"1995"},{"key":"S0007125024001727_ref17","first-page":"1459","article-title":"GRADE guidelines: 9. Rating up the quality of evidence","volume":"11","author":"Guyatt","year":"2011","journal-title":"Chinese J Evidence-Based Med"},{"key":"S0007125024001727_ref1","doi-asserted-by":"publisher","DOI":"10.1521\/pedi_2012_26_093"},{"key":"S0007125024001727_ref46","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1988.01800260015002"},{"key":"S0007125024001727_ref2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00476-1"},{"key":"S0007125024001727_ref57","doi-asserted-by":"publisher","DOI":"10.1016\/0924-977X(94)90296-8"},{"key":"S0007125024001727_ref58","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v63n0511"},{"key":"S0007125024001727_ref37","doi-asserted-by":"publisher","DOI":"10.1177\/070674371305800705"},{"key":"S0007125024001727_ref39","doi-asserted-by":"publisher","DOI":"10.1097\/YIC.0b013e32834d0e50"},{"key":"S0007125024001727_ref44","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2014.13101348"},{"key":"S0007125024001727_ref59","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v62n0311"},{"key":"S0007125024001727_ref47","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1986.01800070070009"},{"key":"S0007125024001727_ref61","doi-asserted-by":"publisher","DOI":"10.1097\/00004714-199502000-00005"},{"key":"S0007125024001727_ref27","unstructured":"27 Boehringer Ingelheim. A Study to Test Different Doses of BI 1358894 and Find Out Whether They Reduce Symptoms in People With Borderline Personality Disorder. Clinicaltrials.gov, 2024 (https:\/\/clinicaltrials.gov\/study\/NCT04566601?a=14)."},{"key":"S0007125024001727_ref68","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2018.17091006"},{"key":"S0007125024001727_ref34","first-page":"270","article-title":"A preliminary study of lamotrigine in the treatment of affective instability in borderline personality disorder","volume":"24","author":"Reich","year":"2009","journal-title":"Int Clin Psychopharmacol"},{"key":"S0007125024001727_ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2023.03.003"},{"key":"S0007125024001727_ref67","doi-asserted-by":"publisher","DOI":"10.1001\/archpsyc.1993.01820170055007"},{"key":"S0007125024001727_ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.psc.2018.07.009"},{"key":"S0007125024001727_ref75","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.116.194720"},{"key":"S0007125024001727_ref45","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v65n0118"},{"key":"S0007125024001727_ref20","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.4 (Updated August 2023)","author":"Page","year":"2023"},{"key":"S0007125024001727_ref76","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-047416"},{"key":"S0007125024001727_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2022.07.014"},{"key":"S0007125024001727_ref22","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions Version 6.4 (6.4.)","author":"Deeks","year":"2023"},{"key":"S0007125024001727_ref64","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.162.6.1221"},{"key":"S0007125024001727_ref63","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.2006.163.5.833"},{"key":"S0007125024001727_ref66","doi-asserted-by":"publisher","DOI":"10.1016\/j.eurpsy.2007.01.565"},{"key":"S0007125024001727_ref41","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.v62n1103"},{"key":"S0007125024001727_ref7","unstructured":"7 National Institute for Health and Care Excellence (NICE). Borderline Personality Disorder: Recognition and Management. Clinical Guideline [CG78]. NICE, 2009 (www.nice.org.uk\/guidance\/cg78)."},{"key":"S0007125024001727_ref10","doi-asserted-by":"publisher","DOI":"10.1007\/s40263-021-00852-7"},{"key":"S0007125024001727_ref12","article-title":"Pharmacological interventions for people with borderline personality disorder","author":"Stoffers-Winterling","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"S0007125024001727_ref21","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.327.7414.557"}],"container-title":["The British Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0007125024001727","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,29]],"date-time":"2025-04-29T02:17:57Z","timestamp":1745893077000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0007125024001727\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,21]]},"references-count":77,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,4]]}},"alternative-id":["S0007125024001727"],"URL":"https:\/\/doi.org\/10.1192\/bjp.2024.172","relation":{},"ISSN":["0007-1250","1472-1465"],"issn-type":[{"value":"0007-1250","type":"print"},{"value":"1472-1465","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,21]]},"assertion":[{"value":"\u00a9 The Author(s), 2024. Published by Cambridge University Press on behalf of Royal College of Psychiatrists","name":"copyright","label":"Copyright","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http:\/\/creativecommons.org\/licenses\/by\/4.0\/), which permits unrestricted re-use, distribution and reproduction, provided the original article is properly cited.","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}},{"value":"This content has been made available to all.","name":"free","label":"Free to read"}]}}