SUBTYPING BORDERLINE PERSONALITY DISORDER BY SUICIDAL BEHAVIOR
SUBTYPING BORDERLINE PERSONALITY DISORDER BY SUICIDAL BEHAVIOR
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DOI：
10.1521/pedi.2012.26.3.468
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发表时间：
2012-06-01
影响因子：
2.3
通讯作者：
Chiappetta, Laurel
中科院分区：
文献类型：
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作者：
Soloff, Paul H.;Chiappetta, Laurel
边缘性人格障碍 (BPD) 的病程和结果对绝大多数患者有利；然而，高达 10% 的人死于自杀。这种差异引出了一个问题：BPD 是否存在高致死率亚型，其定义是反复出现自杀行为和随着时间的推移不断增加的企图致死率。在一项前瞻性纵向研究中，我们寻找重复尝试者高致死率的预测因子，并通过对连续致死率评分应用轨迹分析来定义临床亚型。使用标准化仪器对标准定义的 BPD 受试者进行评估并进行纵向随访。自杀行为通过哥伦比亚自杀史、致死率评定量表和自杀意图量表进行评估。将区分单次和重复尝试者的变量输入逻辑回归模型，以定义高致死率和低致死率尝试的预测因子。使用三种尝试和五种尝试模型的轨迹分析确定了致死率评定量表分数的离散模式。高致死率轨迹与住院患者招募和较差的心理社会功能相关，低致死率轨迹与更大的消极主义、药物使用障碍、表演性和/或自恋性 PD 共病相关。疾病严重程度、年龄较大和心理社会功能较差是与自杀行为相关的预后不良亚型的特征。
Course and outcome of Borderline Personality Disorder (BPD) are favorable for the vast majority of patients; however, up to 10% die by suicide. This discrepancy begs the question of whether there is a high lethality subtype in BPD, defined by recurrent suicidal behavior and increasing attempt lethality over time. In a prospective, longitudinal study, we sought predictors of high lethality among repeat attempters, and defined clinical subtypes by applying trajectory analysis to consecutive lethality scores. Criteria-defined subjects with BPD were assessed using standardized instruments and followed longitudinally. Suicidal behavior was assessed on the Columbia Suicide History, Lethality Rating Scale, and Suicide Intent Scale. Variables discriminating single and repeat attempters were entered into logistic regression models to define predictors of high and low lethality attempts. Trajectory analysis using three attempt and five attempt models identified discrete patterns of Lethality Rating Scale scores. A high lethality trajectory was associated with inpatient recruitment, and poor psychosocial function, a low lethality trajectory with greater Negativism, Substance Use Disorders, Histrionic and/or Narcissistic PD co-morbidity. Illness severity, older age, and poor psychosocial function are characteristics of a poor prognosis subtype related to suicidal behavior.