Boggild Andrea K, Heisel Marnin J, Links Paul S
University of Toronto, Ontario.
Can J Psychiatry. 2004 Feb;49(2):114-8. doi: 10.1177/070674370404900206.
This study addresses 2 issues: first, whether the diagnosis of borderline personality disorder (BPD) or borderline traits differentiates adult patients who demonstrate disruptive behaviour during hospitalization from those patients who do not; and second, whether other clinical variables can be assessed during the emergency visit to differentiate patients who are likely to show disruptive behaviour in hospital from those who are not.
We completed a case-control, chart-based, retrospective analysis of patients consecutively admitted to an inpatient psychiatric service. We assembled 44 subjects who demonstrated evidence of disruptive behaviour during inpatient hospitalization. These subjects were matched with 61 control subjects admitted during the same time period. Potential participants were excluded if they had a diagnosis of schizophrenia, psychotic disorders, delirium, or dementia or if they had a diagnosis receiving a psychotic specifier.
Univariate analyses revealed that patients with disruptive behaviour were significantly more likely to have been diagnosed with BPD or borderline traits than the comparison group (32.6% vs 13.4%; chi2 = 4.45, df 1; P < 0.05). According to stepwise logistic regression analysis, 4 variables significantly contributed to the final model (R2 = 0.37, P < 0.001) predicting disruptive behaviours with the following odds ratios (ORs): Axis III infectious diseases (OR 7.63; 95% CI, 1.41 to 41.67), Axis IV housing problems (OR 3.58; 95% CI, 1.21 to 10.64), history of suicidal behaviours (OR 3.46; 95% CI, 1.24 to 9.71), and problems with primary supports (OR 0.12; 95% CI, 0.03 to 0.46). This last variable was related to a reduced risk of disruptive behaviours in hospital.
Patients at risk for disruptive behaviour during psychiatric hospitalization are characterized by a history of suicidal or impulsive-aggressive behaviour and social disadvantage.
本研究探讨两个问题：第一，边缘型人格障碍（BPD）或边缘型特质的诊断能否区分住院期间出现破坏性行为的成年患者与未出现此类行为的患者；第二，在急诊就诊时能否评估其他临床变量，以区分住院时可能出现破坏性行为的患者与不会出现此类行为的患者。
我们对连续入住住院精神科服务的患者进行了一项基于病例对照、图表的回顾性分析。我们收集了44名在住院期间有破坏性行为证据的受试者。这些受试者与同期入院的61名对照受试者进行匹配。如果潜在参与者被诊断患有精神分裂症、精神障碍、谵妄或痴呆，或者有接受精神病性说明符的诊断，则将其排除。
单因素分析显示，有破坏性行为的患者被诊断为BPD或边缘型特质的可能性显著高于对照组（32.6%对13.4%；卡方=4.45，自由度1；P<0.05）。根据逐步逻辑回归分析，4个变量对预测破坏性行为的最终模型有显著贡献（R2=0.37，P<0.001），其比值比（OR）如下：轴III传染病（OR 7.63；95%可信区间，1.41至41.67）、轴IV住房问题（OR 3.58；95%可信区间，1.21至10.64）、自杀行为史（OR 3.46；95%可信区间，1.24至9.71）和主要支持问题（OR 0.12；95%可信区间，0.03至0.46）。最后一个变量与住院时破坏性行为风险降低有关。
精神科住院期间有破坏性行为风险的患者具有自杀或冲动攻击行为史以及社会劣势的特征。
