The elevation of creatine kinase (CK) levels without neuroleptic malignant syndrome has been reported for several antipsychotics. We present here 4 cases with CK elevation induced by amisulpride, which have been registered for the German pharmacovigilance project, Arzneimittelsicherheit in der Psychiatrie (AMSP). The magnitude of the CK elevation ranged between 1 498 IU/L and 21 018 IU/L. All 4 patients reported myalgia. In each case CK returned to normal after amisulpride discontinuation. In the fourth case, fluids were administered intravenously in order to prevent acute renal failure. None of the cases showed deterioration of renal function. Finally, we present recommendations for clinical practice.

We report the case of a 26-year-old woman suffering from borderline personality disorder (BPD), major depression and bulimia nervosa according to DSM-IV who showed unexplained impairment of the vitamin K-dependent coagulation pathway. Subsequently we discuss different manifestations of self damaging behaviour and comorbidities, as well as psychosocial issues potentially leading to coagulation abnormalities or complications in patients with BPD.

Die medikamentöse Behandlung der Borderline-Persönlichkeitsstörung mit atypischen Antipsychotika war zuletzt Gegenstand mehrerer, meist kleiner Studien und Fallserien. Im Gegensatz zur verbreiteten klinischen Anwendung dieser Substanzklasse bei Borderline-Patientinnen und -Patienten ist die Datenlage nach wie vor spärlich. Die bislang publizierten Daten sprechen für einen potenziellen Nutzen der atypischen Antipsychotika bei psychotischer Symptomatik, bei Impulsivität und möglicherweise auch bei affektiven Symptomen. Die Verträglichkeit war bei meist niedrigen Dosierungen und kurzen Beobachtungszeiträumen akzeptabel. Die bisherige Datenlage unterstützt nicht die oft praktizierte Polypharmazie, allerdings gibt es erste Hinweise auf synergistische Effekte einer Kombinationsbehandlung aus atypischem Antipsychotikum und störungsspezifischer Psychotherapie. Künftige Studien sollten größere Patientenkollektive untersuchen und längere Beobachtungszeiten aufweisen. Die Fragen der erforderlichen Dosis und der optimalen Behandlungsdauer ist gegenwärtig noch offen.

Pharmacotherapy of Borderline personality disorder with atypical antipsychotics has recently been the subject of several mostly small studies and case reports. In contrast to the frequent clinical use of this substance class in borderline patients the amount of data on that subject is still sparse. The clinical data gathered thus far suggest a potential use of atypical antipsychotics in the areas of psychotic symptoms, impulsivity and possibly affective symptoms. The drugs were sufficiently well tolerated; however, the observation period in most studies was short and the dosage low. The current set of clinical data does not support the frequently applied polypharmacy. However, recent data suggest that a therapeutic approach combining atypical antipsychotics and psychotherapy may reveal synergistic effects. Future trials should study larger sample sizes over a longer period of time. Open questions are the required dose and the optimal treatment duration.

We report three consecutive cases of women with borderline personality disorder with psychotic symptoms, who received pharmacotherapy with the new atypical antipsychotic drug aripiprazole. Therapeutic effects were measured using the SCL-90R (symptom check list) and the BSL (borderline symptom list). We observed different responses to aripiprazole. In the first patient we had to discontinue the drug before we were able to observe any therapeutic effects. The second patient also complained about initial side effects. However, after the dose was lowered, the drug was tolerated and she responded well to aripiprazole with respect to all psychopathological aspects. The third patient did not suffer from any side effects under aripiprazole. She responded partially to the drug. Aripiprazole may have a potential role in the pharmacotherapy of borderline personality disorder and may not only target psychotic symptoms in these patients.

We report the case of a patient with schizophrenia, who experienced agranulocytosis during clozapine treatment, followed by bronchopulmonal infection and Guillain-Barré syndrome. The case was recorded within the German surveillance project "drug safety in psychiatry" (AMSP).