Borderline personality disorder is characterized by mood instability, cognitive symptoms,
impulsive behavior, and disturbed relationships (1-3). A variety of psychotherapies have been
developed (4-6) and, while research on the use of medication is ongoing, no drug has been
approved in the United States or elsewhere for its treatment (7). Second generation
antipsychotics have been the most intensively studied (8-11). Current treatments for BPD are
often inadequate. Dialectical behavioral therapy has been shown to reduce BPD but finding
trained psychologists is difficult.
Dysfunctions in the serotoninergic and dopaminergic systems have been demonstrated in—and
considered as possible causes for—symptoms associated with the disorder (25-28). Several
studies on the use of traditional (29) and atypical antipsychotic agents in patients with
borderline personality disorder (30-31) have shown a positive effect on individual symptoms
(29, 32-36). However, we are not aware of any study evaluating Brexpiprazole in the treatment
of patients with borderline personality disorder. In the proposed double-blind,
placebo-controlled study, the influence of Brexpiprazole on the multifaceted
psychopathological symptoms and aggression of patients with borderline personality disorder
will be investigated.
Brexpiprazole therefore has distinctive properties that make it a promising option for
patients with BPD. Brexpiprazole is a novel D2 partial agonist, has affinity for 5-HT1A, acts
as an antagonist of the noradrenergic α1/2 receptor, partial agonist for D3, and antagonist
for 5-HT2A (37-39). In addition, because of low rates of side effects, Brexpiprazole should
be a well-tolerated and in fact desired medication approach to BPD.