Wrege Johannes S, Busmann Mareike, Meyer Andrea H, Euler Sebastian, Lang Undine E, Walter Marc
Department of Psychosomatic and Psychotherapy, Psychiatric University Hospital Basel, Basel, Switzerland.
Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Clin Psychol Psychother. 2021 May;28(3):633-641. doi: 10.1002/cpp.2526. Epub 2020 Dec 22.
Despite the preponderance of treatment outcome predictors in patients with borderline personality disorder (BPD), the predictive value of measures of impulsiveness is inconclusive. This naturalistic study consecutively included hospitalized patients with BPD (N = 99) who underwent a standardized and structured 12-week inpatient treatment programme, which integrated cognitive-behavioural and psychodynamic elements. The Brief Symptom Checklist (BSCL) was applied as outcome measure over four time points: pretreatment, posttreatment, first follow-up at 6 to 8 weeks and second follow-up at 1 year after discharge. Impulsiveness was measured using the Barratt Impulsiveness Scale (BIS) at the pretreatment time point. The BSCL significantly decreased between pretreatment and posttreatment, followed by an increase after posttreatment without reaching pretreatment extent. The temporal course of the BSCL significantly varied with pretreatment BIS in that patients with higher impulsiveness revealed a stronger re-increase of symptom severity from posttreatment to end of follow-up than those with lower impulsiveness. The least impulsive patients thereby showed no rebound effect. The robustness of the results was examined by cross-validation. The results indicate that irrespective of the level of impulsiveness, patients with BPD profit from a structured inpatient treatment. However, long-term treatment success was impaired in patients with high level of impulsiveness at pretreatment. Thus, self-ratings of impulsiveness in BPD patients can be utilized for treatment planning. After discontinuation of interventions, relapse prevention should be implemented early in high impulsive patients as symptoms recrudesce in the course after discharge.
尽管边缘型人格障碍（BPD）患者的治疗结果预测因素众多，但冲动性测量指标的预测价值尚无定论。这项自然主义研究连续纳入了99名住院的BPD患者，他们接受了一个标准化、结构化的为期12周的住院治疗项目，该项目整合了认知行为和心理动力元素。使用简明症状清单（BSCL）在四个时间点作为结果测量指标：治疗前、治疗后、出院后6至8周的首次随访以及出院后1年的第二次随访。在治疗前时间点使用巴拉特冲动性量表（BIS）测量冲动性。BSCL在治疗前和治疗后之间显著下降，随后在治疗后有所上升，但未达到治疗前的程度。BSCL的时间进程与治疗前的BIS显著不同，即冲动性较高的患者与冲动性较低的患者相比，从治疗后到随访结束症状严重程度的再次上升更为明显。因此，最不冲动的患者没有出现反弹效应。通过交叉验证检验了结果的稳健性。结果表明，无论冲动性水平如何，BPD患者都能从结构化的住院治疗中获益。然而，治疗前冲动性水平高的患者长期治疗成功率受到损害。因此，BPD患者的冲动性自评可用于治疗计划。在干预措施停止后，应在高冲动性患者出院后症状复发时尽早实施预防复发措施。
