Feske Ulrike, Mulsant Benoit H, Pilkonis Paul A, Soloff Paul, Dolata Diane, Sackeim Harold A, Haskett Roger F
Western Psychiatric Institute and Clinic, 3811 O'Hara St., Pittsburgh, PA 15213, USA.
Am J Psychiatry. 2004 Nov;161(11):2073-80. doi: 10.1176/appi.ajp.161.11.2073.
Previous research suggests that the comorbidity of major depression with a personality disorder, especially borderline personality disorder, is associated with a poorer response to ECT. The authors compared the acute outcome of ECT in depressed patients with borderline personality disorder, with personality disorders other than borderline personality disorder, and with no personality disorder.
The study subjects were 139 patients with a primary diagnosis of unipolar major depression and scores of at least 20 on the 24-item Hamilton Depression Rating Scale. Patients were treated with suprathreshold right unilateral or bilateral ECT in a standardized manner and were assessed with the Hamilton depression scale within 3 days and 4-8 days after completing ECT.
Compared to patients with personality disorders other than borderline personality disorder (N=42) and those with no personality disorder (N=77), patients with borderline personality disorder (N=20) had less symptomatic improvement assessed up to 8 days after ECT. Patients with personality disorders other than borderline personality disorder responded as well to ECT as those with no personality disorder. Borderline personality disorder patients were more likely to be female and to have medication-resistant depression than the patients in the two comparison groups; they were also younger. However, none of these differences accounted for the borderline personality disorder patients' poorer response to ECT.
Patients with borderline personality disorder have a poorer acute response to ECT, but explanations for this finding remain elusive.
先前的研究表明，重度抑郁症与人格障碍共病，尤其是边缘型人格障碍，与对ECT的反应较差有关。作者比较了边缘型人格障碍的抑郁症患者、非边缘型人格障碍的人格障碍患者以及无人格障碍的抑郁症患者接受ECT后的急性治疗效果。
研究对象为139例初步诊断为单相重度抑郁症且24项汉密尔顿抑郁量表评分至少为20分的患者。患者接受标准化的阈上右侧单侧或双侧ECT治疗，并在完成ECT后的3天内和4 - 8天内用汉密尔顿抑郁量表进行评估。
与非边缘型人格障碍的人格障碍患者（N = 42）和无人格障碍的患者（N = 77）相比，边缘型人格障碍患者（N = 20）在ECT后8天内症状改善较少。非边缘型人格障碍的人格障碍患者对ECT的反应与无人格障碍的患者一样好。与两个对照组的患者相比，边缘型人格障碍患者更可能为女性，且患有药物难治性抑郁症；他们也更年轻。然而，这些差异均不能解释边缘型人格障碍患者对ECT反应较差的原因。
边缘型人格障碍患者对ECT的急性反应较差，但这一发现的原因仍不清楚。
