Zanarini Mary C, Frankenburg Frances R, Bradford Reich D, Harned Alayna L, Fitzmaurice Garrett M
From the *Department of Psychiatry, McLean Hospital, Belmont; †Department of Psychiatry, Harvard Medical School; and ‡Department of Psychiatry, Boston University School of Medicine, Boston, MA.
J Clin Psychopharmacol. 2015 Feb;35(1):63-7. doi: 10.1097/JCP.0000000000000232.
The purpose of this study was to assess the classes and types of psychotropic medication reported by borderline patients and axis II comparison subjects over 16 years of prospective follow-up. Medication use was assessed at baseline using a semistructured interview of proven reliability and validity as well as its follow-up analog at 8 contiguous 2-year follow-up periods. A significantly higher percentage of borderline patients than axis II comparison subjects reported taking an antidepressant, an anxiolytic, an antipsychotic, and a mood stabilizer over time. They also reported more commonly taking 7 of the 10 more specific types of medication studied (ie, all but tricyclic antidepressants, monoamine oxidase inhibitor antidepressants, and atypical antipsychotics). The rates over time of taking antipsychotics and mood stabilizers were stable, whereas there was a significant decline in the rates of antidepressants and anxiolytics from baseline to 8-year follow-up (but not from 8- to 16-year follow-up) reported by those in both study groups. In terms of specific medications, rates of atypical antidepressants and anticonvulsants were the most stable. In contrast, nonbenzodiazepine anxiolytics declined the most steadily over time, whereas rates of atypical antipsychotics increased significantly over the 16 years of prospective follow-up. Taken together, the results of this study suggest that a substantial percentage of borderline patients continue to use the major classes of medication over time. They also suggest that the declining rates of use tend to stabilize less than a decade after index admission.
本研究的目的是评估边缘型人格障碍患者和轴II对照受试者在16年的前瞻性随访中报告使用的精神药物类别和类型。在基线时，通过具有可靠信效度的半结构化访谈以及在连续8个为期2年的随访阶段使用类似的随访访谈来评估药物使用情况。随着时间的推移，报告服用抗抑郁药、抗焦虑药、抗精神病药和心境稳定剂的边缘型人格障碍患者的比例显著高于轴II对照受试者。他们还更常报告服用所研究的10种更具体药物类型中的7种（即除三环类抗抑郁药、单胺氧化酶抑制剂抗抑郁药和非典型抗精神病药之外的所有药物）。服用抗精神病药和心境稳定剂的比例随时间保持稳定，而两个研究组报告的从基线到8年随访期间抗抑郁药和抗焦虑药的比例显著下降（但从8年到16年随访期间未下降）。就具体药物而言，非典型抗抑郁药和抗惊厥药的比例最稳定。相比之下，非苯二氮䓬类抗焦虑药随时间下降最为稳定，而非典型抗精神病药的比例在16年的前瞻性随访中显著增加。总体而言，本研究结果表明，相当比例的边缘型人格障碍患者长期持续使用主要类别的药物。这些结果还表明，在首次入院后不到十年，用药比例下降的趋势往往趋于稳定。
