Markowitz John C, Petkova Eva, Biyanova Tatyana, Ding Ke, Suh Eun Jung, Neria Yuval
New York State Psychiatric Institute and Columbia University College of Physicians & Surgeons, New York, New York.
Depress Anxiety. 2015 Dec;32(12):919-26. doi: 10.1002/da.22436. Epub 2015 Oct 6.
Axis I comorbidity complicates diagnosing axis II personality disorders (PDs). PDs might influence Axis I outcome. No research has examined psychotherapy effects on PDs of treating Axis I comorbidity. Secondary analysis of a randomized controlled trial examined PD diagnostic stability after brief psychotherapy of chronic posttraumatic stress disorder (PTSD).
Patients with chronic PTSD were randomly assigned to 14 weeks of prolonged exposure, interpersonal psychotherapy, or relaxation therapy. Assessments included the Structured Clinical Interview for DSM-IV, Patient Version (SCID-P) and Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) at baseline, week 14, and for treatment responders (≥30% clinician-administered PTSD scale improvement, defined a priori) at week 26 follow-up. We hypothesized patients whose PTSD improved would retain fewer baseline PD diagnoses posttreatment, particularly with personality traits PTSD mimics, e.g. paranoid and avoidant.
Forty-seven (47%) of 99 SCID-II patients evaluated at baseline received a SCID-II diagnosis: paranoid (28%), obsessive-compulsive (27%), and avoidant (23%) PDs were most prevalent. Among 78 patients who repeated SCID-II evaluations posttreatment, 45% (N = 35) had baseline PD diagnoses, of which 43% (N = 15/35) lost at week 14. Three (7%) patients without baseline PDs acquired diagnoses at week 14; 10 others shifted diagnoses. Treatment modality and PTSD response were unrelated to PD improvement. Of treatment responders reevaluated at follow-up (N = 44), 56% with any baseline Axis II diagnosis had none at week 26.
This first evaluation of Axis I psychotherapy effects on personality disorder stability found that acutely treating a chronic state decreased apparent trait-across most PDs observed. These exploratory findings suggest personality diagnoses may have limited prognostic meaning in treating chronic PTSD.
轴I共病使轴II人格障碍（PDs）的诊断复杂化。人格障碍可能会影响轴I的治疗结果。尚无研究探讨心理治疗对治疗轴I共病时人格障碍的效果。一项随机对照试验的二次分析研究了慢性创伤后应激障碍（PTSD）的简短心理治疗后人格障碍诊断的稳定性。
慢性创伤后应激障碍患者被随机分配接受14周的延长暴露疗法、人际心理治疗或放松疗法。评估包括在基线、第14周以及在第26周随访时对治疗有反应者（临床医生评定的PTSD量表改善≥30%，预先定义）使用《精神疾病诊断与统计手册》第四版患者版结构化临床访谈（SCID-P）和《精神疾病诊断与统计手册》第四版轴II障碍结构化临床访谈（SCID-II）。我们假设PTSD症状改善的患者在治疗后保留的基线人格障碍诊断会减少，尤其是那些与PTSD相似的人格特质，如偏执和回避型。
在基线时接受SCID-II评估的99名患者中，47名（47%）获得了SCID-II诊断：最常见的人格障碍是偏执型（28%）、强迫型（27%）和回避型（23%）。在治疗后重复进行SCID-II评估的78名患者中，45%（N = 35）有基线人格障碍诊断，其中43%（N = 15/35）在第14周时诊断消失。3名（7%）无基线人格障碍诊断的患者在第14周获得了诊断；另外10名患者诊断发生了变化。治疗方式和PTSD反应与人格障碍的改善无关。在随访时重新评估的治疗有反应者（N = 44）中，56%有任何基线轴II诊断的患者在第26周时均无此类诊断。
这项对轴I心理治疗对人格障碍稳定性影响的首次评估发现，急性治疗慢性状态可减少在大多数观察到的人格障碍中明显的特质。这些探索性结果表明，人格诊断在治疗慢性PTSD中可能具有有限的预后意义。
