基于心理化治疗对边缘型人格障碍和精神分裂症患者的不同影响：一项探索性比较。
Diverging effects of mentalization based treatment for patients with borderline personality disorder and schizophrenia: an explorative comparison.
作者信息
Weijers Jonas G, van Kaam Fleur, Selten Jean-Paul, de Winter Remco F P, Ten Kate Coriene
机构信息
GGZ Rivierduinen, Institute for Mental Health Care, Leiden, Netherlands.
MHeNs School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands.
出版信息
Front Psychiatry. 2023 Aug 25;14:1226507. doi: 10.3389/fpsyt.2023.1226507. eCollection 2023.
INTRODUCTION
There is robust evidence that both patients with schizophrenia (SCZ) and borderline personality disorder (BPD) display mentalizing difficulties. Less is known however about differences in the way mentalization based treatment (MBT) impacts mentalizing capacity in SCZ and BPD patients. This study compares the impact of MBT on mentalizing capacity in individuals with SCZ and BPD.
METHOD
The thematic apperception test was used to measure mentalizing capacity. It was administered at the beginning and end of treatment to 26 patients with SCZ and 28 patients with BPD who enrolled in an 18-month long MBT program. For comparison a sample of 28 SCZ patients who did not receive MBT was also included. Using the social cognition and object-relations system, these narratives were analyzed and scored. Missing data was imputed and analyzed using intention-to-treat ANCOVAs with post-treatment measures of mentalizing capacity as dependent variables, group type as independent variable and baseline mentalizing capacities as covariates.
RESULTS
Results showed that patients with BPD showed significantly more improvement on several measures of mentalizing, including complexity of representation (η = 0.50, < 0.001), understanding of social causality (η = 0.41, < 0.001) and emotional investment in relationships (η = 0.41, < 0.001) compared to patients with SCZ who received MBT. No differences were found regarding affect-tone of relationships (η = 0.04, = 0.36). SCZ patients who received MBT showed greater performance on understanding of social causality (η = 0.12, = 0.01) compared to SCZ patients who did not receive MBT, but no differences were observed on complexity of representations, capacity for emotional investment or affect-tone of relationships.
DISCUSSION
Patients with BPD performed better after receiving MBT on three dimensions of mentalizing capacity than SCZ patients who received MBT. Remarkably, SCZ patients who received MBT performed better on one dimension of mentalizing capacity compared to SCZ patients who did not receive MBT. Whereas MBT for BPD clearly involves improvement on most aspects of mentalizing, MBT for SCZ seems to thwart a further decline of other-oriented, cognitive mentalizing. Treatment goals should be adapted toward these disorder-specific characteristics.
引言
有充分证据表明，精神分裂症（SCZ）患者和边缘型人格障碍（BPD）患者均存在心理化困难。然而，关于基于心理化的治疗（MBT）对SCZ和BPD患者心理化能力影响方式的差异，我们了解得较少。本研究比较了MBT对SCZ和BPD患者心理化能力的影响。
方法
采用主题统觉测验来测量心理化能力。在一项为期18个月的MBT项目开始和结束时，对26名SCZ患者和28名BPD患者进行了该测验。为作比较，还纳入了28名未接受MBT的SCZ患者样本。使用社会认知和客体关系系统对这些叙述进行分析和评分。对缺失数据进行插补，并使用意向性分析协方差分析进行分析，将心理化能力的治疗后测量值作为因变量，组类型作为自变量，基线心理化能力作为协变量。
结果
结果显示，与接受MBT的SCZ患者相比，BPD患者在心理化的几个测量指标上有更显著的改善，包括表征复杂性（η = 0.50，< 0.001）、对社会因果关系的理解（η = 0.41，< 0.001）以及对人际关系的情感投入（η = 0.41，< 0.001）。在人际关系的情感基调方面未发现差异（η = 0.04， = 0.36）。与未接受MBT的SCZ患者相比，接受MBT的SCZ患者在对社会因果关系的理解上表现更好（η = 0.12， = 0.01），但在表征复杂性、情感投入能力或人际关系的情感基调方面未观察到差异。
讨论
接受MBT后，BPD患者在心理化能力的三个维度上比接受MBT的SCZ患者表现更好。值得注意的是,与未接受MBT的SCZ患者相比，接受MBT的SCZ患者在心理化能力的一个维度上表现更好。虽然针对BPD的MBT显然涉及心理化大多数方面的改善，但针对SCZ的MBT似乎阻止了以他人为导向的认知心理化的进一步下降。治疗目标应根据这些特定疾病的特征进行调整。
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