Q. My 19 yr. old daughter was "diagnosed" with BPD a year ago, though her journey has been going on for three years now. She is currently on Clozaril 400mg (down from 600mg). She complains of "crawling skin" and has been told that this is tactile hallucination. She has been on Clozaril for about six months. Now she will try Thorazine. What are tactile hallucinations? Are they drug induced? Will Clozaril or Thorazine help? If not, what?

A. I am not sure if it will help to be on Clozaril or not. There are two literature reports that it helps some people a good deal, but it has side effects of weight gain and mental slowing. Tactile "hallucinations" would not be a normal finding in BPD. People feel things if they are anxious, but it is not delusional/hallucinatory that I have ever seen.

Thorazine in borderlines will not work. There is not any data to show that typical neuroleptics (Thorazine, Haldol, Navane, Stelazine, Trilafon, etc.) do anything in borderlines other than tranquilize them for the first few weeks they are on it. The chances of tardive dyskinesia are high. In fact, any side effect is intolerable for a medication that does not work. Controlled trials show it to be ineffective. Better to use an antidepressant as we have documented in our studies. Anticonvulsants (Tegretol, Depakote, Lamictal, etc.) would be a better choice, too. Heck, Cowdry and Gardner showed neuroleptics were ineffective 15 years ago.