Consultant Psychiatrist, Spectrum Personality Disorder Service, 1890Eastern Health, Richmond, VIC, Australia.
Spectrum Personality Disorder Service, 1890Eastern Health, Richmond, VIC, Australia; Faculty of Medicine, Nursing and Health Science, Monash University, Clayton, VIC, Australia.
Australas Psychiatry. 2022 Aug;30(4):481-485. doi: 10.1177/10398562211065296. Epub 2022 Feb 9.
Research and clinical experience suggest that people with borderline personality disorder (BPD) are more likely to report greater severity of depressive symptoms than is objectively measured by their clinician. The prominence of low mood in association with BPD can result in the treatment of depressive symptoms being prioritised over the diagnosis and treatment of BPD.
This study investigated the utility of validated clinician-administered and self-report depression rating scales during psychiatric assessment of 49 clients diagnosed with BPD.
Considerable discrepancies emerged between client and clinician ratings of depression, with client-rated scales generating significantly higher depression scores. Both client-rated and clinician-rated depression scores were positively influenced by the severity of BPD symptoms.
These findings raise questions about the interpretation of rating scales in clinical decision-making and highlight inherent uncertainty when diagnosing major depressive disorder in people who have borderline personality disorder. The accurate diagnosis of low mood has significant implications for the treatment and management of both disorders.
研究和临床经验表明，边缘型人格障碍（BPD）患者报告的抑郁症状严重程度比其临床医生客观测量的要高。与 BPD 相关的情绪低落的突出表现可能导致对抑郁症状的治疗优先于 BPD 的诊断和治疗。
本研究在对 49 名被诊断为 BPD 的患者进行精神病评估时，调查了经过验证的临床医生管理和自我报告的抑郁量表的效用。
患者和临床医生对抑郁的评估存在显著差异，患者自评量表产生的抑郁评分显著更高。患者自评和临床医生评定的抑郁评分均受到 BPD 症状严重程度的积极影响。
这些发现引发了对临床决策中量表解释的质疑，并突出了在具有边缘型人格障碍的人群中诊断重度抑郁症时存在的固有不确定性。准确诊断情绪低落对两种疾病的治疗和管理都有重要意义。
