TREATING SUICIDAL BEHAVIOR AND SELF MUTILATION IN BPD

本课题的目的是：对边缘型人格障碍（BPD）自杀及自残行为的治疗进行随机对照试验。自杀行为和自残是当代精神病学面临的两个最严重的问题，但人们对这些行为的有效预防和治疗知之甚少。虽然临床医生认为BPD患者是操纵性的和寻求关注的，自杀行为和自残在这些患者中尤其常见，并导致显著的死亡率和昂贵的发病率。不幸的是，关于BPD中自杀行为和自残治疗的系统调查很少。辩证行为疗法（DBT）是一种认知行为疗法，已被证明可以显著减少BPD患者的自我伤害行为。虽然DBT作为BPD自杀患者的治疗选择越来越受欢迎，但除了开发者进行的原始研究外，没有其他复制研究。我们的研究将是首次大规模复制DBT。在药物方面，氟西汀、选择性5 -羟色胺再摄取抑制剂（SSRI）和其他SSRI类药物的研究表明，它们在降低BPD患者自残和自杀意念率方面具有疗效。此外，对自杀未遂者和BPD中血清素功能的生物学研究表明，SSRIs在治疗BPD中的自残行为方面具有潜在的益处。虽然DBT与SSRIs联合治疗已成为BPD门诊患者最常用的治疗方法之一，但目前还没有对心理与药物联合治疗BPD的疗效进行系统的研究。在这个为期五年的项目中，我们拟评估DBT、SSRI以及DBT和SSRI联合治疗BPD自伤行为的疗效，并进行DBT的复制。我们将采用随机四细胞设计，比较DBT+安慰剂、DBT+氟西汀、氟西汀+临床管理和安慰剂+临床管理。我们将在纽约州精神病学研究所进行这个项目，并将在J. Mann博士的指导下得到MHCRC自杀行为的支持。在5年的时间里，180名BPD患者将被随机分配到12个月的治疗和12个月的自然随访。

The purpose of this project is: to conduct a randomized controlled trial for the treatment of suicidal and self-mutilating behaviors with suicidal patients who have borderline personality disorder (BPD). Suicidal behavior and self-mutilation are two of the most serious problems confronting contemporary psychiatry, but little is known about the effective prevention and treatment of these behaviors. While clinicians have viewed patients with BPD as manipulative and attention- seeking, suicidal behavior and self-mutilation are especially common in these patients and results in significant mortality and costly morbidity. Unfortunately, systematic investigation of the treatment of suicidal behavior and self-mutilation in BPD is sparse. One psychosocial treatment dialectical behavior therapy (DBT), a cognitive- behavioral treatment-has been shown to significantly decrease self- injurious behaviors in BPD. While DBT has become increasingly popular as the treatment of choice for suicidal patients with BPD, there are no replication studies other than the original study conducted by the developer. Our study will be the first large-scale replication of DBT. With respect to medication, studies of fluoxetine, a selective serotonin reuptake inhibitor (SSRI), and other SSRIs have shown their efficacy in decreasing rates of self-mutilation and suicidal ideation in BPD. Furthermore, biological studies of serotonergic functioning in suicide attempters and BPD suggest the potential benefit of SSRIs in treating self-injurious behavior in BPD. Although the combination of DBT and SSRIs has become one of the most common treatments provided to outpatients with PBD, no systematic investigation of the efficacy of combined psychotherapy and medication in BPD has ever been conducted. In this five-year project, we propose to evaluate the efficacy of DBT, SSRI, and combined DBT and SSRI in the treatment of self-injurious behaviors in BPD and to conduct a replication of DBT. We will use a randomized four cell design comparing DBT+placebo, DBT+fluoxetine, fluoxetine+clinical management, and placebo+clinical management. We will conduct this project at the New York State Psychiatric Institute and will have the support of the MHCRC for Suicidal Behavior under the direction of Dr. J. Mann. Over a 5 year period, 180 subjects with BPD will be randomized to 12 months of treatments and a naturalistic follow- up at 12 months.