Gunderson John G, Daversa Maria T, Grilo Carlos M, McGlashan Thomas H, Zanarini Mary C, Shea M Tracie, Skodol Andrew E, Yen Shirley, Sanislow Charles A, Bender Donna S, Dyck Ingrid R, Morey Leslie C, Stout Robert L
McLean Hospital, 155 Mill St., Belmont, MA 02478, USA.
Am J Psychiatry. 2006 May;163(5):822-6. doi: 10.1176/ajp.2006.163.5.822.
The primary purpose of this report was to investigate whether characteristics of subjects with borderline personality disorder observed at baseline can predict variations in outcome at the 2-year follow-up.
Hypothesized predictor variables were selected from prior studies. The patients (N=160) were recruited from the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. Patients were assessed at baseline and at 6, 12, and 24 months with the Structured Clinical Interview for DSM-IV Axis I Disorders; the Diagnostic Interview for DSM-IV Personality Disorders, a modified version of that instrument; the Longitudinal Interval Follow-Up Evaluation; and the Childhood Experiences Questionnaire-Revised. Univariate Pearson's correlation coefficients were calculated on the primary predictor variables, and with two forward stepwise regression models, outcome was assessed with global functioning and number of borderline personality disorder criteria.
The authors' most significant results confirm prior findings that more severe baseline psychopathology (i.e., higher levels of borderline personality disorder criteria and functional disability) and a history of childhood trauma predict a poor outcome. A new finding suggests that the quality of current relationships of patients with borderline personality disorder have prognostic significance.
Clinicians can estimate 2-year prognosis for patients with borderline personality disorder by evaluating level of severity of psychopathology, childhood trauma, and current relationships.
本报告的主要目的是调查在基线时观察到的边缘型人格障碍患者的特征是否能够预测两年随访期内的结局变化。
从先前的研究中选择假设的预测变量。患者(N = 160)来自协作性纵向人格障碍研究的四个临床地点。使用《精神疾病诊断与统计手册》第四版轴I障碍的结构化临床访谈、该工具的修改版《精神疾病诊断与统计手册》第四版人格障碍诊断访谈、纵向间隔随访评估以及修订后的童年经历问卷,在基线以及6个月、12个月和24个月时对患者进行评估。对主要预测变量计算单变量Pearson相关系数,并通过两个向前逐步回归模型,以整体功能和边缘型人格障碍标准数量来评估结局。
作者最显著的结果证实了先前的发现,即更严重的基线精神病理学(即更高水平的边缘型人格障碍标准和功能残疾)以及童年创伤史预示着不良结局。一项新发现表明,边缘型人格障碍患者当前人际关系的质量具有预后意义。
临床医生可以通过评估精神病理学的严重程度、童年创伤和当前人际关系来估计边缘型人格障碍患者的两年预后。