Medications are commonly used to treat co-occurring psychopathology in persons with borderline personality disorder (BPD)

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.

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 post hoc for reporting of non BPD-specific (‘co-occurring’) 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.

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) −0.22, P = 0.04), and low-certainty evidence (LCE) of an effect on psychotic–dissociative symptoms (SMD −0.28, P = 0.007). There was evidence of effects of anticonvulsants on depressive (SMD −0.44, P = 0.02; LCE) and anxious symptoms (SMD −1.11, P < 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–dissociative symptoms (P = 0.001).

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.

药物通常用于治疗边缘型人格障碍 （BPD） 患者同时发生的精神病理学

系统评价和整合药物治疗 BPD 患者同时发生精神病理学的药物证据，并探讨合并症的作用。

在当前 BPD 药物的 Cochrane 综述的基础上，于 2024 年 3 月进行了更新的文献检索。我们遵循了本 Cochrane 综述的方法，但仔细审查了所有已确定的安慰剂对照试验，以事后报告非 BPD 特异性（“共存”）精神病理学，并探讨了在有和没有确定的共存疾病的样本亚组中的治疗效果。进行 GRADE 评级以评估证据质量。

有 22 项试验可用于定量分析。对于抗精神病药，我们发现对抑郁症状有影响的极低质量证据（VLCE）（标准化均数差（standardised mean difference， SMD）-0.22，P=0.04），以及对精神病-分离症状有影响的低质量证据（LCE）（SMD -0.28，P=0.007）。 有证据表明抗惊厥药对抑郁症有影响 （SMD -0.44，P = 0.02; LCE） 和焦虑症状 （SMD -1.11，P % 3C 0.00001;VLCE）。对于抗抑郁药，未观察到显着发现 （VLCE）。探索性亚组分析表明，在样本中，抗精神病药物对精神病分离症状的影响更大 （P = 0.001）。

我们的研究结果仅基于 VLCE 和 LCE，不支持对 BPD 患者使用药物干预来针对同时发生的精神病理学。总体而言，目前的证据不支持对有明确合并症和无明确合并症的人的治疗效果不同。应谨慎使用药物，以针对同时发生的精神病理学。