Krysinska Karolina, Heller Travis S, De Leo Diego
Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, Queensland, Australia.
Curr Opin Psychiatry. 2006 Jan;19(1):95-101. doi: 10.1097/01.yco.0000191498.69281.5e.
This article reviews literature published over the period January 2004-May 2005 on suicidal behaviour and self-harm in personality disorders.
Studies have confirmed that personality disorders and their co-morbidity with other psychiatric conditions are risk factors for both fatal and nonfatal suicidal behaviours, and self-mutilation. Negative life events, childhood sexual abuse, difficulties in social functioning, deficits in future-directed thinking and time perception, as well as familial and neurocognitive factors may be related to increased suicide risk in individuals with borderline and other personality disorders. Findings seem to confirm that suicidality and self-injurious behaviour are efficient DSM-IV diagnostic criteria for borderline personality disorder. Out of several psychosocial and pharmacological interventions for treating suicidality in personality disorders, only one randomized, controlled study has recently been published. Medico-legal concerns related to the clinical management of chronically suicidal patients, including hospitalization and alternative treatment approaches, are also discussed.
Although recent studies have contributed to the theoretical knowledge and clinical practice, there are unsettled questions that should be addressed in the future. More randomized, controlled trials evaluating the efficacy of interventions in suicidal individuals with personality disorders should be conducted. As the majority of studies conducted to date have concentrated on borderline personality disorder and antisocial personality disorder, the prevalence and risk factors for suicidal behaviours and self-mutilation in other personality disorders require further clarification. The introduction of unified nomenclature related to suicidal behaviours and self-mutilation would facilitate comparability of results across studies.
本文回顾了2004年1月至2005年5月期间发表的关于人格障碍患者自杀行为和自我伤害的文献。
研究证实，人格障碍及其与其他精神疾病的共病是致命和非致命自杀行为以及自残行为的危险因素。负面生活事件、童年期性虐待、社会功能障碍、前瞻性思维和时间感知缺陷以及家庭和神经认知因素可能与边缘型人格障碍及其他人格障碍患者自杀风险增加有关。研究结果似乎证实，自杀观念和自我伤害行为是边缘型人格障碍有效的《精神疾病诊断与统计手册》第四版诊断标准。在几种用于治疗人格障碍患者自杀观念的心理社会和药物干预措施中，近期仅发表了一项随机对照研究。还讨论了与慢性自杀患者临床管理相关的医学法律问题，包括住院治疗和替代治疗方法。
尽管近期研究为理论知识和临床实践做出了贡献，但仍有一些未解决的问题有待未来解决。应开展更多评估干预措施对人格障碍自杀患者疗效的随机对照试验。由于迄今为止开展的大多数研究都集中在边缘型人格障碍和反社会人格障碍上，其他人格障碍患者自杀行为和自残行为的患病率及危险因素需要进一步明确。引入与自杀行为和自残相关的统一命名法将有助于不同研究结果之间的可比性。
