Psychiatria Danubina, Vol. 31 No. 3, 2019.
Review article
https://doi.org/10.24869/psyd.2019.290
AN INTEGRATIVE MODEL OF PERSONALITY DISORDER: PART 3: MECHANISM-BASED APPROACH TO THE PHARMACOTHERAPY OF PERSONALITY DISORDER: AN EMERGING CONCEPT
Dragan Svrakic
; Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, USA; Veterans Affairs Medical Center, Saint Louis, Missouri, USA
Aaron Mofsen
; Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, USA
Ravikumar Chockalingam
; Veterans Affairs Medical Center, Saint Louis, Missouri, USA
Mirjana Divac-Jovanovic
; Faculty for Media and Communications, Department of Psychology, Singidunum University, Belgrade, Serbia
Charles F. Zorumski
; Department of Psychiatry, Washington University in St. Louis School of Medicine, St. Louis, USA
Abstract
Temperament traits of Novelty Seeking, Harm Avoidance, Reward Dependence, and Persistence, are well defined in terms of their neural circuitry, neurochemical modulators, and patterns of associative learning. When heritably excessive, each of these traits may become a mechanistically fundamental biogenetic trait vulnerability for personality disorder. The other main risk factor for personality disorder is environmental, notably abuse, neglect, and psychological trauma. The emerging concept of mechanism-based pharmacotherapy aims to activate the brain’s homeostasis as the only available delivery system to re-calibrate complex neurophysiological participants in each of the temperament traits. In a positive feedback, a homeostasis-driven improvement of excessive temperament is expected to facilitate maturation of neocortical networks of cognition, most reliably in expert psychotherapy (Part I of this paper) and, ultimately, thereby improve top-down cortical control of subcortical affect reactivity. As an emerging concept informed by neuroscience and clinical research, mechanism based pharmacotherapy has the potential to be superior to traditional symptom-based treatments. Such mechanism-based approach illustrates what the pharmacological treatment of Research Domain Criteria (RDoC) might look like.
Keywords
personality disorder; temperament; pharmacotherapy; RDoC
Hrčak ID:
235244
URI
Publication date:
7.10.2019.
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