Boldrini Tommaso, Tanzilli Annalisa, Pontillo Maria, Chirumbolo Antonio, Vicari Stefano, Lingiardi Vittorio
Department of Dynamic and Clinic Psychology, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
Department of Developmental Psychology and Socialization, University of Padova, Padova, Italy.
Front Psychiatry. 2019 Jul 5;10:429. doi: 10.3389/fpsyt.2019.00429. eCollection 2019.
Increasing evidence shows that personality pathology is common among patients at clinical high risk (CHR) for psychosis. Despite the important impact that this comorbidity might have on presenting high-risk psychopathology, psychological functioning, and transition to full psychotic disorders, the relationship between personality syndromes and CHR state has received relatively little empirical attention. The present meta-analytic review aimed at 1) estimating the prevalence rates of personality disorders (PDs) in CHR individuals and 2) examining the potential role of PDs in predicting transition from CHR state to a full-blown psychotic disorder. The systematic search of the empirical literature identified 17 relevant studies, including a total of 1,868 CHR individuals. Three distinct meta-analyses were performed to provide prevalence estimates of PDs in the CHR population. The first and more comprehensive meta-analysis focused on any comorbid PD (at least one diagnosis), the second one focused on schizotypal personality disorder (SPD), and the last one focused on borderline personality disorder (BPD). Moreover, a narrative review was presented to define the predictive role of personality disorders in promoting more severe outcomes in CHR patients. The findings showed that the prevalence rate of personality disorders in CHR patients was 39.4% (95% CI [26.5%-52.3%]). More specifically, 13.4% (95% CI [8.2%-18.5%]) and 11.9% (95% CI [0.73%-16.6%]) of this clinical population presented with SPD and BPD, respectively. Finally, the studies examining the effects of baseline personality diagnoses on conversion to psychotic disorders showed contradictory and insufficient results concerning the potential significant impact of SPD. Conversely, no effect of BPD was found. This meta-analytic review indicated that the CHR population includes a large subgroup with serious personality pathology, that may present with attenuated psychotic symptoms conjointly with distinct and very heterogeneous personality features. These findings support the need for improved understanding of both core psychological characteristics of CHR patients and differentiating aspects of personality that could have relevant clinical implications in promoting individualized preventive interventions and enhancing treatment effectiveness.
越来越多的证据表明，人格病理学在临床高危（CHR）精神病患者中很常见。尽管这种共病可能对呈现高危精神病理学、心理功能以及向完全性精神障碍的转变产生重要影响，但人格综合征与CHR状态之间的关系相对较少受到实证关注。本荟萃分析综述旨在：1）估计CHR个体中人格障碍（PDs）的患病率；2）研究PDs在预测从CHR状态转变为完全性精神障碍方面的潜在作用。对实证文献的系统检索确定了17项相关研究，共纳入1868名CHR个体。进行了三项不同的荟萃分析以提供CHR人群中PDs的患病率估计。第一项也是更全面的荟萃分析关注任何共病的PD（至少一项诊断），第二项关注分裂型人格障碍（SPD），最后一项关注边缘型人格障碍（BPD）。此外，还进行了叙述性综述以确定人格障碍在促进CHR患者出现更严重结局方面的预测作用。研究结果表明，CHR患者中人格障碍的患病率为39.4%（95%可信区间[26.5%-52.3%]）。更具体地说，该临床人群中分别有13.4%（95%可信区间[8.2%-18.5%]）和11.9%（95%可信区间[0.73%-16.6%]）患有SPD和BPD。最后，研究基线人格诊断对转变为精神障碍影响的研究显示，关于SPD的潜在显著影响结果相互矛盾且不充分。相反，未发现BPD有影响。本荟萃分析综述表明，CHR人群包括一个有严重人格病理学的大亚组，可能同时出现轻度精神病症状以及独特且非常异质的人格特征。这些发现支持了有必要更好地理解CHR患者的核心心理特征以及人格的不同方面，这些方面在促进个体化预防干预和提高治疗效果方面可能具有相关临床意义。
