Prada Paco, Nicastro Rosetta, Zimmermann Julien, Hasler Roland, Aubry Jean-Michel, Perroud Nader
TRE Program, Service of Psychiatric Specialties, Department of Mental Health and Psychiatry, University Hospital of Geneva, 20 rue de Lausanne, 1201, Geneva, Switzerland,
Atten Defic Hyperact Disord. 2015 Sep;7(3):199-209. doi: 10.1007/s12402-015-0165-2. Epub 2015 Jan 30.
Attention deficit hyperactivity disorder (ADHD) is frequently comorbid with borderline personality disorder (BPD). However, few studies have examined how comorbid BPD-ADHD patients, treated or not with methylphenidate (MPH), respond to psychotherapy compared to non-comorbid BPD patients. In this perspective, we used a naturalistic study to compare, during a month-long intensive dialectical behaviour therapy (DBT), the clinical course of BPD patients and comorbid BPD-ADHD patients who were treated or untreated with MPH. Out of the 158 BPD patients recruited, 59 had adult ADHD as a comorbidity; among these, 29 underwent a treatment with MPH or des-methylphenidate, while the 30 others did not. MPH treatment was given non-randomly and only when ADHD was considered to be hampering the capacity of the subjects to follow the therapy. Patients completed the following forms upon admission and after 1 month of treatment: the adult ADHD Self-Report Scale (ASRS v.1.1), the Barratt Impulsiveness Scale (BIS-10), the State-Trait Anger Expression (STAXI), the Beck Depression Inventory II (BDI-II), and the Beck Hopelessness Scale. At baseline, comorbid BPD-ADHD patients showed significantly higher impulsiveness than BPD patients. In the entire sample, there was a significant decrease in all dimensions ranging from small to large effect sizes during the 4-week intensive DBT. BPD-ADHD patients who were undergoing MPH treatment showed a significantly improved response to DBT treatment for Trait-State Anger scores, motor impulsiveness, depression severity, and ADHD severity, when compared to those without stimulant medication. This study outlines the importance of systematically screening BPD patients for ADHD, since a MPH-based treatment will improve the symptoms of patients who are comorbid for BPD and ADHD. Due to the non-random allocation of subjects, more severely affected patients were more readily placed on MPH; this suggests that the more severe the ADHD symptoms, the greater the chance for the patient of being treated.
注意力缺陷多动障碍（ADHD）常与边缘型人格障碍（BPD）共病。然而，很少有研究探讨共病BPD-ADHD患者（无论是否接受哌甲酯（MPH）治疗）与非共病BPD患者相比，对心理治疗的反应如何。从这个角度来看，我们进行了一项自然主义研究，在为期一个月的强化辩证行为疗法（DBT）期间，比较接受或未接受MPH治疗的BPD患者和共病BPD-ADHD患者的临床病程。在招募的158例BPD患者中，59例合并成人ADHD；其中，29例接受了MPH或去甲哌甲酯治疗，另外30例未接受治疗。MPH治疗并非随机给予，仅在ADHD被认为妨碍受试者接受治疗的能力时才给予。患者在入院时和治疗1个月后填写以下表格：成人ADHD自陈量表（ASRS v.1.1）、巴拉特冲动性量表（BIS-10）、状态-特质愤怒表达量表（STAXI）、贝克抑郁量表第二版（BDI-II）和贝克绝望量表。在基线时，共病BPD-ADHD患者的冲动性显著高于BPD患者。在整个样本中，在为期4周的强化DBT期间，所有维度从小到中等效应量均有显著下降。与未使用兴奋剂药物的患者相比，接受MPH治疗的BPD-ADHD患者在特质-状态愤怒得分、运动冲动性、抑郁严重程度和ADHD严重程度方面对DBT治疗的反应有显著改善。这项研究概述了对BPD患者进行ADHD系统筛查的重要性，因为基于MPH的治疗将改善共病BPD和ADHD患者的症状。由于受试者的非随机分配，受影响更严重的患者更容易接受MPH治疗；这表明ADHD症状越严重，患者接受治疗的机会就越大。
