Overview

Borderline Personality Disorder (BPD) is one of the most prevalent psychiatric disorders with high morbidity and mortality. It affects the lives of millions worldwide and is often highly incapacitating, leading to significant psychosocial dysfunction. Moreover, nearly all patients have experienced suicidal ideation and about 10% actually commit suicide, a rate almost 50 times higher than in the general population. Mostly young women are at greater risk for the disorder and are three times more likely to be diagnosed with BPD than men.

BPD aetiology is complex and could be explained by both biological and environmental factors. Among the environmental factors, sexual or physical abuse, parental divorce, loss or illnesses are identified as the most common ones. These factors can induce dysfunctional behaviours, which might cause emotional dysregulation, high impulsivity and frequent selfinjurious behaviour.

However, there are no pharmacologic interventions that are known to be specifically effective to treat BPD. Therapeutic options for this devastating disorder is still far from adequate for treating acute illness episodes, relapses, and recurrences and in restoring premorbid functioning. In addition, some patients are unable to tolerate existing therapies for BPD, which leads to either frequent changes in medications or to non-adherence. Therefore there is an urgent need for the development of more rapidly effective treatments for BPD.

A growing body of evidence suggests that glutamatergic neurotransmission, in particular N-methyl-D-aspartate (NMDA) subtype may play a role in the pathophysiology of multiple psychiatric disorders. This has led to various clinical trials with glutamate modulating drugs. The trial drug is an uncompetitive NMDA receptor antagonist approved for Alzheimer's disease is increasingly being studied in a variety of non-dementia psychiatric disorders. Results from these studies have proved that the trial drug was safe and well tolerated and has the potential for use in the treatment of psychiatric disorders.

To date, there are no published data on the use of trial drug in the treatment for BPD. Therefore, the investigators intend to study the efficacy of this novel drug as an addition to ongoing therapy with atypical antipsychotics in patients with Borderline Personality Disorder. This study will recruit 150 BPD patients. The patients will be randomly allocated to receive either the study medication (20mg/ day) or placebo via oral administration for twelve weeks. To observe the efficacy of the trial treatment, all participants will be assessed at various time intervals for different borderline and cognitive symptoms.

Eligibility

Inclusion criteria

        Participants will be eligible to proceed in the study if they meet all of the following
        criteria (as determined in the screening session):
          1. Men and women aged between 18-65 years of age
          2. A diagnosis of BPD according to the Diagnostic Interview for Borderline patients or
             the Zanarini Rating Scale for Borderline Personality Disorder
          3. Proficient in reading and writing English
        Exclusion criteria
        Potential participants who meet the criteria for any of the following will be excluded from
        participating in the study:
          1. Clinical evidence of CNS pathology, neurological disorder, head injury, epileptic
             seizures or convulsions.
          2. Currently pregnant or breastfeeding
          3. A current DSM-IV-TR diagnosis of substance abuse or dependence disorder, or another
             Axis I disorder including a past or current diagnosis of schizophrenia, delusional
             (paranoid) disorder, schizoaffective disorder, bipolar I (mixed, manic, depressed or
             euthymic) or psychotic depression. Individuals with bipolar II will be included
          4. Clinically significant and active evidence of liver or kidney disease, hematological,
             respiratory, endocrine or cardiovascular disease.
          5. Use of prescription drugs that may cause relevant drug interactions with the study
             drug according to the summary of product characteristics: NMDAR antagonists
             (amantadine, ketamine, dextromethorphan), L-Dopa, dopamine agonists and cholinergic
             agonists.
          6. Commencing new psychotherapy/ new medication during the trial period.
          7. History of mental retardation or documented IQ below 75