Gunderson John G, Morey Leslie C, Stout Robert L, Skodol Andrew E, Shea M Tracie, McGlashan Thomas H, Zanarini Mary C, Grilo Carlos M, Sanislow Charles A, Yen Shirley, Daversa Maria T, Bender Donna S
Harvard Medical School and McLean Hospital, Boston, Mass 02478, USA.
J Clin Psychiatry. 2004 Aug;65(8):1049-56. doi: 10.4088/jcp.v65n0804.
This report investigates the longitudinal association of changes in major depressive disorder (MDD) and borderline personality disorder.
A DSM-IV-diagnosed sample of 161 patients with borderline personality disorder who have been followed with repeated measures at 6, 12, 24, and 36 months are investigated to see whether those with co-occurring MDD differ at baseline and in their course. Proportional hazard regression and cross-lagged panel analyses are used to demonstrate whether changes in the course of either disorder have predictable effects on the course of the other.
The rate of remissions of borderline personality disorder was not affected by whether patients had co-occurring MDD. The rate of MDD remissions was significantly reduced by co-occurring borderline personality disorder. Both regression analyses and panel analyses indicated that improvements in borderline personality disorder were often followed by improvements in MDD but that improvements in MDD were not followed by improvements in borderline personality disorder. Five of the 9 borderline criteria, including those that most relate to affects, were particularly apt to remit prior to MDD remissions.
When borderline personality disorder and MDD co-occur, they can sometimes have independent courses, but more often improvements in MDD are predicted by prior improvements in borderline personality disorder. Clinicians should not ignore borderline personality disorder in hopes that treatment of MDD will be followed by improvement of borderline personality disorder.
本报告调查了重度抑郁症（MDD）与边缘型人格障碍变化之间的纵向关联。
对161例边缘型人格障碍患者的DSM-IV诊断样本进行研究，这些患者在6个月、12个月、24个月和36个月时接受了重复测量，以观察共病MDD的患者在基线和病程中是否存在差异。采用比例风险回归和交叉滞后面板分析来证明任何一种疾病病程的变化是否对另一种疾病的病程有可预测的影响。
边缘型人格障碍的缓解率不受患者是否共病MDD的影响。共病边缘型人格障碍显著降低了MDD的缓解率。回归分析和面板分析均表明，边缘型人格障碍的改善通常伴随着MDD的改善，但MDD的改善并未伴随着边缘型人格障碍的改善。9项边缘型人格障碍标准中的5项，包括那些与情感关系最为密切的标准，在MDD缓解之前特别容易缓解。
当边缘型人格障碍和MDD共病时，它们有时可能有独立的病程，但更常见的是，MDD的改善是由边缘型人格障碍先前的改善所预测的。临床医生不应忽视边缘型人格障碍，期望通过治疗MDD来改善边缘型人格障碍。
