Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
J Affect Disord. 2015 Jan 1;170:39-45. doi: 10.1016/j.jad.2014.08.046. Epub 2014 Sep 3.
Little is known regarding correlates of borderline personality-spectrum symptoms (BPSS) among adolescents with bipolar disorder (BP).
Participants were 90 adolescents, 13-19 years of age, who fulfilled DSM-IV-TR criteria for BP using semi-structured diagnostic interviews. BPSS status was ascertained using the Life Problems Inventory which assessed identity confusion, interpersonal problems, impulsivity, and emotional lability. Analyses compared adolescents with "high" versus "low" BPSS based on a median split.
Participants with high, relative to low, BPSS were younger, and had greater current and past depressive episode severity, greater current hypo/manic episode severity, younger age of depression onset, and reduced global functioning. High BPSS participants were more likely to have BP-II, and had higher rates of social phobia, generalized anxiety disorder, conduct disorder, oppositional defiant disorder, homicidal ideation, assault of others, non-suicidal self-injury, suicidal ideation, and physical abuse. Despite greater illness burden, high BPSS participants reported lower rates of lithium use. The most robust independent predictors of high BPSS, identified in multivariate analyses, included lifetime social phobia, non-suicidal self-injury, reduced global functioning, and conduct and/or oppositional defiant disorder.
The study design is cross-sectional and cannot determine causality.
High BPSS were associated with greater mood symptom burden and functional impairment. Presence of high BPSS among BP adolescents may suggest the need to modify clinical monitoring and treatment practices. Future prospective studies are needed to examine the direction of observed associations, the effect of treatment on BPSS, and the effect of BPSS as a moderator or predictor of treatment response.
对于双相障碍（BP）青少年的边缘型人格谱症状（BPSS）相关因素知之甚少。
参与者为 90 名 13-19 岁的青少年，他们使用半结构化诊断访谈符合 DSM-IV-TR 双相障碍标准。使用生活问题清单确定 BPSS 状态，该清单评估了身份混乱、人际关系问题、冲动和情绪不稳定。根据中位数分割，分析比较了“高”与“低”BPSS 的青少年。
与低 BPSS 相比，高 BPSS 的参与者年龄更小，当前和过去的抑郁发作严重程度更大，当前轻躁狂/躁狂发作严重程度更大，抑郁发作年龄更早，整体功能降低。高 BPSS 参与者更有可能患有 BP-II，并有更高的社交恐惧症、广泛性焦虑症、品行障碍、对立违抗性障碍、杀人意念、攻击他人、非自杀性自伤、自杀意念和身体虐待发生率。尽管疾病负担更大，但高 BPSS 参与者报告的锂使用率较低。在多变量分析中确定的高 BPSS 的最强独立预测因子包括终生社交恐惧症、非自杀性自伤、整体功能降低以及品行和/或对立违抗性障碍。
研究设计是横断面的，不能确定因果关系。
高 BPSS 与更严重的情绪症状负担和功能障碍相关。BP 青少年中存在高 BPSS 可能表明需要修改临床监测和治疗实践。未来的前瞻性研究需要检查观察到的关联的方向、治疗对 BPSS 的影响以及 BPSS 作为治疗反应的调节剂或预测因子的影响。
