Zanarini M C, Frankenburg F R, Khera G S, Bleichmar J
Laboratory for the Study of Adult Development, McLean Hospital, 115 Mill St., Belmont, MA 02478, USA.
Compr Psychiatry. 2001 Mar-Apr;42(2):144-50. doi: 10.1053/comp.2001.19749.
In this study, we describe the types and amounts of psychiatric treatment received by a well-defined sample of borderline personality disorder (BPD) inpatients, and compare these parameters with those of a group of carefully diagnosed personality-disordered controls. Finally, we assess the risk factors associated with a history of intensive, high-cost treatment, which we defined as having had two or more prior psychiatric hospitalizations. The treatment histories of 290 borderline inpatients and 72 axis II controls were assessed using a reliable semistructured interview. All nine forms of treatment studied except electroconvulsive therapy (ECT) were common among borderline patients (36% to 96%). In addition, a significantly higher percentage of borderline patients than axis II controls reported a history of individual and group therapy, day and residential treatment, psychiatric hospitalization, participating in self-help groups, and taking standing medications. They were also significantly younger when they first entered individual therapy and began to take standing medications. In addition, borderline patients spent more time than axis II controls in individual therapy and psychiatric hospitals, and were on standing medications for a significantly longer period of time. They also reported a significantly higher number of psychiatric hospitalizations, lifetime number of standing medications, and number of psychotropic medications taken at the same time. In addition, we found a highly significant multivariate predictive model for multiple prior hospitalizations. The six significant predictors were age 26 or older, a history of quasi psychotic thought, lifetime number of self-mutilative efforts and suicide attempts, a childhood history of reported sexual abuse, and an adult history of being physically and/or sexually assaulted. Taken together, these results confirm clinical impressions concerning the high rates of mental health services used by borderline patients. They also suggest that particularly high rates of costly inpatient treatment are associated with a complex admixture of older age, BPD symptoms in the cognitive and impulse realms, and traumatic life experiences occurring in both childhood and adulthood.
在本研究中，我们描述了明确界定的边缘型人格障碍（BPD）住院患者接受的精神治疗类型及数量，并将这些参数与一组经过仔细诊断的人格障碍对照者的参数进行比较。最后，我们评估与强化、高成本治疗史相关的风险因素，我们将强化、高成本治疗定义为有过两次或更多次先前的精神病住院治疗经历。使用可靠的半结构化访谈评估了290名边缘型住院患者和72名轴II对照者的治疗史。除电休克治疗（ECT）外，所研究的所有九种治疗形式在边缘型患者中都很常见（36%至96%）。此外，报告有个体和团体治疗、日间和住院治疗、精神病住院治疗、参加自助团体以及服用常备药物史的边缘型患者比例显著高于轴II对照者。他们首次进入个体治疗和开始服用常备药物时的年龄也显著更小。此外，边缘型患者在个体治疗和精神病医院花费的时间比轴II对照者更多，服用常备药物的时间也显著更长。他们还报告有显著更多的精神病住院治疗次数、终生常备药物数量以及同时服用的精神药物数量。此外，我们发现了一个针对多次先前住院治疗的高度显著的多变量预测模型。六个显著的预测因素为26岁或以上的年龄、准精神病性思维史、终生自我伤害行为和自杀未遂次数、报告的童年性虐待史以及成年期身体和/或性侵犯史。综合来看，这些结果证实了关于边缘型患者使用心理健康服务比例较高的临床印象。它们还表明，特别高比例的昂贵住院治疗与年龄较大、认知和冲动领域的BPD症状以及童年和成年期发生的创伤性生活经历的复杂混合有关。
