Centre for Population and HealthSciences, University of Glasgow, UK.
Br J Psychiatry. 2010 Dec;197(6):456-62. doi: 10.1192/bjp.bp.109.074286.
Longer-term follow-up of patients with borderline personality disorder have found favourable clinical outcomes, with long-term reduction in symptoms and diagnosis.
We examined the 6-year outcome of patients with borderline personality disorder who were randomised to 1 year of cognitive-behavioural therapy for personality disorders (CBT-PD) or treatment as usual (TAU) in the BOSCOT trial, in three centres across the UK (trial registration: ISRCTN86177428).
In total, 106 participants met criteria for borderline personality disorder in the original trial. Patients were interviewed at follow-up by research assistants masked to the patient's original treatment group, CBT-PD or TAU, using the same measures as in the original randomised trial. Statistical analyses of data for the group as a whole are based on generalised linear models with repeated measures analysis of variance type models to examine group differences.
Follow-up data were obtained for 82% of patients at 6 years. Over half the patients meeting criteria for borderline personality disorder at entry into the study no longer did so 6 years later. The gains of CBT-PD over TAU in reduction of suicidal behaviour seen after 1-year follow-up were maintained. Length of hospitalisation and cost of services were lower in the CBT-PD group compared with the TAU group.
Although the use of CBT-PD did not demonstrate a statistically significant cost-effective advantage, the findings indicate the potential for continued long-term cost-offsets that accrue following the initial provision of 1 year of CBT-PD. However, the quality of life and affective disturbance remained poor.
对边缘型人格障碍患者进行的长期随访发现，其临床结局良好，症状和诊断长期减轻。
我们在英国三个中心的 BOSCOT 试验中，检查了随机分配到 1 年认知行为治疗人格障碍（CBT-PD）或常规治疗（TAU）的边缘型人格障碍患者的 6 年结局，这些患者符合原试验的标准。
共有 106 名患者在原始试验中符合边缘型人格障碍标准。研究助理在随访时对患者进行访谈，他们对患者的原始治疗组、CBT-PD 或 TAU 一无所知，使用与原始随机试验相同的措施。对整个组进行数据分析采用的是广义线性模型，重复测量方差分析类型的模型来检验组间差异。
在 6 年后，82%的患者获得了随访数据。超过一半在研究开始时符合边缘型人格障碍标准的患者，6 年后不再符合该标准。在 1 年随访后，CBT-PD 在减少自杀行为方面优于 TAU 的效果得到了维持。与 TAU 组相比，CBT-PD 组的住院时间和服务成本更低。
尽管 CBT-PD 的使用没有显示出具有统计学意义的成本效益优势，但研究结果表明，在最初提供 1 年 CBT-PD 之后，可能会持续产生长期的成本节约。然而，生活质量和情感障碍仍然很差。
