Zanarini Mary C, Frankenburg Frances R, Hennen John, Silk Kenneth R
Laboratory for the Study of Adult Development, McLean Hospital, Belmont, MA 02478, USA.
J Clin Psychiatry. 2004 Jan;65(1):28-36. doi: 10.4088/jcp.v65n0105.
The purpose of this study was to describe the psychiatric treatment received by a well-defined sample of patients with borderline personality disorder and Axis II comparison subjects over 6 years of prospective follow-up.
362 inpatients were interviewed about their treatment histories during their index admission (1992-1995). 290 patients met both Revised Diagnostic Interview for Borderlines and DSM-III-R criteria for borderline personality disorder and 72 met DSM-III-R criteria for at least 1 nonborderline Axis II disorder (and neither criteria set for borderline personality disorder). Over 94% of surviving patients were re-interviewed about their psychiatric treatment histories 2, 4, and 6 years later.
Only 33% of borderline patients were hospitalized during the final 2 years of the 6-year follow-up, a substantial decline from the 79% who had prior hospitalizations at baseline. Much the same pattern emerged for day and/or residential treatment (from 55% to 22%). In contrast, about three quarters of borderline patients were still in psychotherapy and taking psychotropic medications after 6 years of follow-up. Additionally, over 70% of borderline patients participating in these outpatient modalities did so for at least 75% of each follow-up period. While rates of intensive psychotherapy declined significantly over time (from 36% to 16%), rates of intensive polypharmacy remained relatively stable over time, with about 40% of borderline patients taking 3 or more concurrent standing medications during each follow-up period, about 20% taking 4 or more, and about 10% taking 5 or more.
The results of this study suggest that the majority of borderline patients continue to use outpatient treatment in a sustained manner through 6 years of follow-up, but only a declining minority use more restrictive and costly forms of treatment.
本研究旨在描述一组明确界定的边缘型人格障碍患者样本以及轴II对照受试者在6年的前瞻性随访中接受的精神科治疗情况。
对362名住院患者在其首次入院期间（1992 - 1995年）的治疗史进行了访谈。290名患者符合《边缘型人格障碍修订诊断访谈》和DSM - III - R边缘型人格障碍标准，72名患者符合DSM - III - R至少一种非边缘型轴II障碍标准（且不符合边缘型人格障碍的任何标准）。在6年后，对超过94%的存活患者再次进行访谈，了解他们的精神科治疗史。
在6年随访的最后2年中，只有33%的边缘型患者住院，与基线时79%有过住院治疗的患者相比大幅下降。日间和/或住院治疗也出现了大致相同的模式（从55%降至22%）。相比之下，约四分之三的边缘型患者在随访6年后仍在接受心理治疗并服用精神药物。此外，参与这些门诊治疗方式的边缘型患者中，超过70%在每个随访期至少75%的时间里接受治疗。虽然强化心理治疗的比例随时间显著下降（从36%降至16%），但强化联合用药的比例随时间保持相对稳定，约40%的边缘型患者在每个随访期服用3种或更多同时使用的常备药物，约20%服用4种或更多，约10%服用5种或更多。
本研究结果表明，大多数边缘型患者在6年的随访中持续采用门诊治疗，但只有越来越少的患者使用更具限制性和成本更高的治疗形式。
