Bieling Peter J, MacQueen Glenda M, Marriot Michael J, Robb Janine C, Begin Helen, Joffe Russell T, Young L Trevor
Mood Disorders Program, Department of Psychiatry and Behavioral Neurosciences, McMaster University and St Joseph's Healthcare, Hamilton, Ontorio, Canada.
Bipolar Disord. 2003 Feb;5(1):14-21. doi: 10.1034/j.1399-5618.2003.00014.x.
Few studies have examined the question of how personality features impact outcome in bipolar disorder (BD), though results from extant work and studies in major depressive disorder suggest that personality features are important in predicting outcome. The primary purpose of this paper was to examine the impact of DSM-IV personality disorder symptoms on long-term clinical outcome in BD.
The study used a 'life-charting' approach in which 87 BD patients were followed regularly and treated according to published guidelines. Outcome was determined by examining symptoms over the most recent year of follow-up and personality symptoms were assessed with the Structured Clinical Interview for DSM-IV (SCID-II) instrument at entry into the life-charting study.
Patients with better outcomes had fewer personality disorder symptoms in seven out of 10 disorder categories and Cluster A personality disorder symptoms best distinguished euthymic and symptomatic patients.
These results raise important questions about the mechanisms linking personality pathology and outcome in BD, and argue that conceptual models concerning personality pathology and BD need to be further developed. Treatment implications of our results, such as need for psychosocial interventions and treatment algorithms, are also described.
尽管现有研究及针对重度抑郁症的研究结果表明人格特征对预后有重要影响，但很少有研究探讨人格特征如何影响双相情感障碍（BD）的预后。本文的主要目的是研究《精神疾病诊断与统计手册》第四版（DSM-IV）中人格障碍症状对双相情感障碍长期临床预后的影响。
本研究采用“病程记录”方法，对87例双相情感障碍患者进行定期随访，并根据已发表的指南进行治疗。通过检查随访最近一年的症状来确定预后，并在进入病程记录研究时使用DSM-IV结构化临床访谈（SCID-II）工具评估人格症状。
在10种障碍类别中的7种中，预后较好的患者人格障碍症状较少，且A类人格障碍症状最能区分心境正常和有症状的患者。
这些结果引发了关于双相情感障碍中人格病理学与预后之间联系机制的重要问题，并表明需要进一步完善有关人格病理学和双相情感障碍的概念模型。我们还描述了研究结果对治疗的启示，如心理社会干预和治疗算法的必要性。
