边缘型人格障碍患者共病精神病理学的药物干预：Cochrane系统评价及荟萃分析的二次分析
Pharmacological interventions for co-occurring psychopathology in people with borderline personality disorder: secondary analysis of the Cochrane systematic review with meta-analyses.
作者信息
Pereira Ribeiro Johanne, Juul Sophie, Kongerslev Mickey T, Jørgensen Mie Sedoc, Völlm Birgit A, Edemann-Callesen Henriette, Sales Christian, Schaug Julie P, Lieb Klaus, Simonsen Erik, Stoffers-Winterling Jutta M, Storebø Ole Jakob
机构信息
Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, Slagelse, Denmark; and Department of Psychology, University of Southern Denmark, Odense, Denmark.
Copenhagen Trial Unit, Centre for Clinical Intervention Research, The Capital Region of Denmark, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; and Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark.
出版信息
Br J Psychiatry. 2025 Apr;226(4):226-237. doi: 10.1192/bjp.2024.172. Epub 2024 Oct 21.
BACKGROUND
Medications are commonly used to treat co-occurring psychopathology in persons with borderline personality disorder (BPD).
AIMS
To systematically review and integrate the evidence of medications for treatment of co-occurring psychopathology in people with BPD, and explore the role of comorbidities.
METHOD
Building on the current Cochrane review of medications in BPD, an update literature search was done in March 2024. We followed the methods of this Cochrane review, but scrutinised all identified placebo-controlled trials for reporting of non BPD-specific ('co-occurring') psychopathology, and explored treatment effects in subgroups of samples with and without defined co-occurring disorders. GRADE ratings were done to assess the evidence certainty.
RESULTS
Twenty-two trials were available for quantitative analyses. For antipsychotics, we found very-low-certainty evidence (VLCE) of an effect on depressive symptoms (standardised mean difference (SMD) -0.22, = 0.04), and low-certainty evidence (LCE) of an effect on psychotic-dissociative symptoms (SMD -0.28, = 0.007). There was evidence of effects of anticonvulsants on depressive (SMD -0.44, = 0.02; LCE) and anxious symptoms (SMD -1.11, < 0.00001; VLCE). For antidepressants, no significant findings were observed (VLCE). Exploratory subgroup analyses indicated a greater effect of antipsychotics in samples including participants with co-occurring substance use disorders on psychotic-dissociative symptoms ( = 0.001).
CONCLUSIONS
Our findings, based on VLCE and LCE only, do not support the use of pharmacological interventions in people with BPD to target co-occurring psychopathology. Overall, the current evidence does not support differential treatment effects in persons with versus without defined comorbidities. Medications should be used cautiously to target co-occurring psychopathology.
背景
药物常用于治疗边缘型人格障碍（BPD）患者共病的精神病理学问题。
目的
系统回顾并整合治疗BPD患者共病精神病理学问题的药物证据，并探讨共病的作用。
方法
在Cochrane当前对BPD药物的综述基础上，于2024年3月进行了文献更新检索。我们遵循该Cochrane综述的方法，但仔细审查了所有确定的安慰剂对照试验中关于非BPD特异性（“共病”）精神病理学的报告，并探讨了在有和没有明确共病障碍的样本亚组中的治疗效果。采用GRADE评级来评估证据的确定性。
结果
有22项试验可用于定量分析。对于抗精神病药物，我们发现其对抑郁症状有影响的证据确定性极低（标准化均数差（SMD）-0.22，P = 0.04），对精神病性解离症状有影响的证据确定性低（SMD -0.28，P = 0.007）。有证据表明抗惊厥药物对抑郁症状（SMD -0.44，P = 0.02；低确定性证据）和焦虑症状（SMD -1.11，P < 0.00001；极低确定性证据）有影响。对于抗抑郁药物，未观察到显著结果（极低确定性证据）。探索性子组分析表明，在包括有共病物质使用障碍参与者的样本中，抗精神病药物对精神病性解离症状的影响更大（P = 0.001）。
结论
我们的发现仅基于极低确定性证据和低确定性证据，不支持对BPD患者使用药物干预来针对共病的精神病理学问题。总体而言，目前的证据不支持在有或没有明确共病的患者中存在不同的治疗效果。药物治疗共病的精神病理学问题时应谨慎使用。
Zotero 插件