Slotema C W, Blom Jan D, Niemantsverdriet Marieke B A, Deen Mathijs, Sommer Iris E C
Parnassia Psychiatric Institute, The Hague, Netherlands.
Faculty of Social and Behavioural Sciences, Leiden University, Leiden, Netherlands.
Front Psychiatry. 2018 Mar 14;9:84. doi: 10.3389/fpsyt.2018.00084. eCollection 2018.
A diagnosis of psychotic disorder is traditionally considered incompatible with borderline personality disorder (BPD), even though patients sometimes fulfill the diagnostic criteria for both disorders. How often this happens is barely known, as is the influence of comorbid psychotic disorders on the outcome of BPD. Since studies on isolated auditory verbal hallucinations in patients with BPD indicate that these perceptual symptoms have severe consequences and are associated with suicidal behavior and hospitalization, patients with comorbid psychotic disorders are unlikely to fare better.
To examine the point prevalence of psychotic disorders in patients with BPD, their association with the outcome of BPD, and their predictive value for outcome.
In a cross-sectional design, 84 female outpatients diagnosed with BPD were interviewed with the aid of the MINI-International Neuropsychiatric Interview to establish the point prevalence of comorbid psychotic and other comorbid disorders. After termination of their treatment at a specialized outpatient clinic, the type of referral was considered to be a "good" outcome when they were referred to their general practitioner or to basic psychiatric care for noncomplex patients, and a "poor" outcome when referred to a specialized psychiatric department or to a psychiatric district team for patients with severe psychiatric disorders.
Psychotic disorders were present in 38% of the patients with BPD. With a prevalence of 20%, psychotic disorder not otherwise specified (NOS) was the most common subtype; the least common types were schizophrenia (2%), substance-induced psychotic disorder (2%), and brief psychotic disorder (1%). Among six types of comorbid disorders, only psychotic disorders were associated with a poor outcome; they were also for a poor outcome, along with comorbid mood disorders, eating disorders, and somatoform disorders, as well as the severity of BPD, and, counterintuitively, more years of education.
Psychotic disorders, notably of the psychotic disorder NOS subtype, are common among patients with BPD, and their presence is associated with a poor outcome. This implies that adequate diagnosis and treatment of both disorders is warranted in this subgroup with a dual diagnosis.
传统上认为精神病性障碍的诊断与边缘型人格障碍（BPD）不相容，尽管患者有时同时符合这两种障碍的诊断标准。这种情况发生的频率鲜为人知，共病的精神病性障碍对BPD结局的影响也不清楚。由于对BPD患者孤立的幻听研究表明，这些感知症状具有严重后果，且与自杀行为和住院治疗有关，因此共病精神病性障碍的患者预后不太可能更好。
研究BPD患者中精神病性障碍的时点患病率、其与BPD结局的关联以及对结局的预测价值。
采用横断面设计，借助MINI国际神经精神访谈对84名诊断为BPD的女性门诊患者进行访谈，以确定共病精神病性障碍和其他共病障碍的时点患病率。在她们在专科门诊结束治疗后，若被转介至全科医生处或接受针对非复杂患者的基础精神科护理，则转诊类型被视为“良好”结局；若被转介至专科精神科或针对严重精神障碍患者的精神科区域团队，则视为“不良”结局。
38%的BPD患者存在精神病性障碍。未另行指定的精神病性障碍（NOS）患病率为20%，是最常见的亚型；最不常见的类型是精神分裂症（2%）、物质所致精神病性障碍（2%）和短暂精神病性障碍（1%）。在六种共病障碍类型中，只有精神病性障碍与不良结局相关；它们与共病的情绪障碍、进食障碍、躯体形式障碍以及BPD的严重程度一样，也是不良结局的预测因素，而且与直觉相反的是，还与受教育年限更长有关。
精神病性障碍，尤其是精神病性障碍NOS亚型，在BPD患者中很常见，其存在与不良结局相关。这意味着对于这个双重诊断的亚组患者，对两种障碍进行充分的诊断和治疗是必要的。
