Links P S, Heslegrave R J, Mitton J E, van Reekum R, Patrick J
Department of Psychiatry, University of Toronto, Ontario.
Can J Psychiatry. 1995 Feb;40(1):9-14. doi: 10.1177/070674379504000105.
The objective of this paper was to examine the prognostic significance of borderline personality disorder (BPD) and substance abuse in a cohort of former inpatients screened for BPD and followed up prospectively seven years after the index admission. The impact of comorbidity on borderline psychopathology, impulsivity and psychosocial functioning was examined. The original cohort was assembled between April 1983 and December 1985. Admissions were screened for borderline characteristics which resulted in a sample of 130 subjects, 88 of whom were positive for BPD based on the Diagnostic Interview for Borderlines. At seven years follow-up, 81 out of 130 (62.3%) subjects were re-interviewed. Six (4.6%) had committed suicide, two (1.5%) were deceased and 41 (31.6%) were lost to follow-up. The subjects with BPD and substance abuse were significantly differentiated from subjects with BPD only, substance abuse only and neither disorder on the basis of demonstrating more borderline psychopathology and more self-destructive and suicidal thoughts and behaviours. Probands with initial diagnoses of BPD and substance abuse were twice as likely to be diagnosed BPD on follow-up as probands with initial diagnosis of BPD only (relative risk = 2.19, 95% CI, 1.21 to 3.97). These findings and other research suggest that patients with comorbid BPD and substance abuse should be encouraged to focus on their abuse problems as a priority.
本文的目的是在一组曾因边缘型人格障碍（BPD）接受筛查且在首次入院后进行了7年前瞻性随访的前住院患者中，研究边缘型人格障碍和物质滥用的预后意义。研究了共病对边缘型精神病理学、冲动性和社会心理功能的影响。最初的队列于1983年4月至1985年12月组建。对入院患者进行边缘型特征筛查，结果得到130名受试者的样本，其中88名基于《边缘型人格诊断访谈》被诊断为BPD阳性。在7年随访时，130名受试者中有81名（62.3%）接受了再次访谈。6名（4.6%）自杀，2名（1.5%）死亡，41名（31.6%）失访。患有BPD和物质滥用的受试者与仅患有BPD、仅患有物质滥用以及两种障碍均无的受试者相比，在表现出更多的边缘型精神病理学以及更多的自我毁灭和自杀想法及行为方面存在显著差异。初始诊断为BPD和物质滥用的先证者在随访时被诊断为BPD的可能性是仅初始诊断为BPD的先证者的两倍（相对风险=2.19，95%CI，1.21至3.97）。这些发现及其他研究表明，应鼓励患有BPD和物质滥用共病的患者将其滥用问题作为首要关注点。
