Department of Biomedicine, Pharmacology and Therapeutics Unit, Faculty of Medicine, University of Porto, Porto, Portugal.
Department of Psychiatry and Mental Health, University Hospital Centre of São João, Porto, Portugal.
Clin Psychol Psychother. 2023 Nov-Dec;30(6):1324-1337. doi: 10.1002/cpp.2888. Epub 2023 Jul 31.
Borderline personality disorder (BPD) is a highly debilitating psychiatric condition. Despite the expansion of new BPD specific forms of psychotherapy in the last few decades, high dropout rates have been reported in these treatments. Treatment discontinuation is associated with poor patient outcomes, inefficient resource utilization and the demoralization of healthcare providers.
In order to identify predictors of psychotherapy dropout among patients with BPD, a systematic search of Medline, the Cochrane Library, PsycInfo and PsycArticles was conducted. Studies included were randomized-controlled trials in which patients diagnosed with BPD were exposed to a therapeutic intervention consisted of an evidence-based psychotherapy. The quality of evidence in the studies was assessed through the use of revised Cochrane risk of bias tool.
Six articles, incorporating four types of psychotherapy programmes, were included. Overall, the studies present low risk of attrition and reporting bias and unclear risk of selection, performance and detection bias. Patients with weaker therapeutic alliance scores and higher hostility presented with higher dropout rates. In contrast, better mindfulness skills and greater performance in specific neuropsychological domains, such as memory and executive control, were identified as predictive of lower risk of dropout. Sociodemographic variables and treatment history did not influence treatment retention.
Factors that influence discontinuation should be taken into consideration in future treatment programmes, in an effort to optimize retention. Qualitative assessments of patients' reasons for dropping out may also help guide adjustments.
边缘型人格障碍（BPD）是一种高度致残的精神疾病。尽管在过去几十年中扩展了新的 BPD 特定形式的心理治疗，但这些治疗方法的高辍学率已被报道。治疗中断与患者预后不良、资源利用效率低下以及医疗保健提供者士气低落有关。
为了确定 BPD 患者心理治疗辍学的预测因素，对 Medline、Cochrane 图书馆、PsycInfo 和 PsycArticles 进行了系统搜索。纳入的研究是将被诊断为 BPD 的患者暴露于基于证据的心理治疗的随机对照试验。通过使用修订后的 Cochrane 偏倚风险工具评估研究中的证据质量。
纳入了六篇文章，其中包括四种心理治疗方案。总体而言，这些研究的失访和报告偏倚风险较低，选择、表现和检测偏倚风险不明确。具有较弱治疗联盟评分和更高敌意的患者辍学率更高。相比之下，更好的正念技能和在特定神经认知领域（如记忆和执行控制）的表现被确定为辍学风险较低的预测因素。社会人口统计学变量和治疗史并未影响治疗保留率。
应在未来的治疗计划中考虑影响停药的因素，以努力优化保留率。对患者停药原因的定性评估也可能有助于指导调整。
