Zanarini M C, Frankenburg F R, Reich D B, Wedig M M, Conkey L C, Fitzmaurice G M
Laboratory for the Study for Adult Development, McLean Hospital and the Department of Psychiatry, Harvard Medical School, Belmont, MA, USA.
Acta Psychiatr Scand. 2014 Sep;130(3):205-13. doi: 10.1111/acps.12255. Epub 2014 Mar 4.
The purpose of this study was to determine the most clinically relevant baseline predictors of time-to-recovery from borderline personality disorder.
Two hundred and ninety in-patients meeting rigorous criteria for borderline personality disorder were assessed during their index admission using a series of semistructured interviews and self-report measures. Recovery status, which was defined as concurrent symptomatic remission and good social and full-time vocational functioning, was reassessed at eight contiguous 2-year time periods. Survival analytic methods (Cox regression), which controlled for overall baseline severity, were used to estimate hazard ratios and their confidence intervals.
All told, 60% of the borderline patients studied achieved a 2-year recovery. In bivariate analyses, seventeen variables were found to be significant predictors of earlier time-to-recovery. Six of these predictors remained significant in multivariate analyses: no prior psychiatric hospitalizations, higher IQ, good full-time vocational record in 2 years prior to index admission, absence of an anxious cluster personality disorder, high extraversion, and high agreeableness.
Taken together, the results of this study suggest that prediction of time-to-recovery for borderline patients is multifactorial in nature, involving factors related to lack of chronicity, competence, and more adaptive aspects of temperament.
本研究旨在确定边缘型人格障碍康复时间最具临床相关性的基线预测因素。
对290名符合边缘型人格障碍严格标准的住院患者在其首次入院期间进行了一系列半结构化访谈和自我报告测量。康复状态定义为症状同时缓解以及良好的社交和全职职业功能，在连续的8个2年时间段内进行重新评估。使用控制总体基线严重程度的生存分析方法（Cox回归）来估计风险比及其置信区间。
总体而言，所研究的边缘型患者中有60%实现了2年康复。在双变量分析中，发现17个变量是早期康复时间的显著预测因素。其中6个预测因素在多变量分析中仍然显著：无既往精神病住院史、智商较高、首次入院前2年有良好的全职职业记录、不存在焦虑型人格障碍、外向性高和宜人性高。
综上所述，本研究结果表明，边缘型患者康复时间的预测本质上是多因素的，涉及与缺乏慢性病程、能力以及气质更具适应性方面相关的因素。
