权益分类	功能权益	普通用户	{{item.name}}会员
{{category.name}}	{{benefitItem.name}}

Refining Borderline Personality Disorder Using Flexible Latent Variable Modeling

使用灵活的潜变量模型改善边缘性人格障碍

基本信息

批准号：
8145562
负责人：
Michael Nelson Hallquist
金额：
$ 5.29万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2012-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8145562
关键词：
Accounting Address Adult Affect Affective Aggressive behavior Alcohols Applied Research Behavior Behavior Therapy Behavioral Behavioral Genetics Bipolar Disorder Borderline Personality Disorder Case Management Chronic Classification Clinical Clinical Research Comorbidity Complex Conceptions DSM-IV Data Data Set Databases Diagnosis Diagnostic Diagnostic and Statistical Manual Diffuse Dimensions Disease Distal Distress Emotions Epidemiologic Studies Epidemiology Failure Family Feedback Functional disorder Future Genetic Heritability Heterogeneity Housing Hybrids Individual Inpatients Intention Interview Longitudinal Studies Measures Mental disorders Methods Modeling Mood Disorders National Institute of Mental Health Neurobiology Outcome Outpatients Participant Pathology Patient Self-Report Patients Personality Personality Disorders Phenotype Population Prevalence Process Property Psyche structure Psychiatric therapeutic procedure Psychopathology Psychophysiology Quality of life Questionnaires Reaction Time Recommendation Recording of previous events Relative (related person)Research Resolution Respondent Sampling Selection Bias Self-Injurious Behavior Severities Simulate Source Speed Statistical Models Strategic Planning Structure Suicide Surveys Syndrome Taxonomy Testing Treatment Cost Treatment outcome Twin Multiple Birth Validation Work base clinically significant design disease classification disorder subtype effective therapy flexibility improved longitudinal course neuroimaging novel patient population public health relevance repaired response simulation suicidal tool trait treatment strategy

项目摘要

DESCRIPTION (provided by candidate): Borderline Personality Disorder (BPD) is a complex psychiatric disorder associated with subjective misery, poor quality of life, and chronic suicidality, with estimates of suicide completion as high as 10%. Because of aggressive, suicidal, and self-injurious behaviors, treatment utilization among BPD patients is significantly higher than patients with mood disorders or other personality disorders, resulting in significant treatment costs. Although this disorder affects 1-2% of the population, individuals with BPD account for 10-20% of all outpatients and 15% of inpatients. Despite the significant societal burden, subjective distress, and poor psychiatric outcomes associated with BPD, the phenotype is not well understood relative to other forms of psychopathology. Improving the construct validity of BPD has been impeded, in part, by the considerable heterogeneity reflected in theoretical conceptualizations and the DSM diagnostic criteria. Existing diagnostic criteria define a meaningful, but diffuse, construct and future research efforts will be impeded if patients are selected using these criteria alone. The proposed research seeks to refine the BPD phenotype by exploring additional clinical and experimental markers, as well as using flexible latent variable modeling and statistical simulation to clarify the classification of the disorder. This work will result in an empirically derived taxonomy of BPD consisting of traits, subtypes, or both, as well as data-based thresholds for identifying clinically significant borderline pathology. This research has the potential to identify more homogeneous groups of BPD patients, which will increase the resolving power and replicability of future empirical work. Additionally, clarifying the heterogeneity among BPD patients will improve future treatment research, as clinical strategies can be tailored better to individual patients. The specific aims are: 1) to assess the efficiency of extant analytic methods for resolving the latent structure of BPD using Monte Carlo simulation methods, 2) to clarify within-BPD heterogeneity using hybrid latent variable models that integrate continuous and categorical conceptions, and 3) to refine the BPD phenotype by exploring additional clinical and experimental markers. This proposed research will be conducted using two major epidemiological datasets (the National Comorbidity Survey Replication and the National Epidemiologic Survey on Alcohol and Related Conditions) and a large sample of 616 participants aggregated from five prior studies, approximately 25% of whom have BPD. In addition, an experimental psychopathology measure of rejection sensitivity will be developed and validated using a smaller sample of 168 adult participants, and this measure will be integrated into classification models. We expect that the DSM-IV BPD features are best described by a single continuous dimension of severity, but that subtypes of the disorder will be identified on the basis of additional markers, including aggression, mistrustfulness, preoccupied attachment, and rejection sensitivity. Competing dimensional, categorical, and integrative models will be tested. PUBLIC HEALTH RELEVANCE: Borderline Personality Disorder (BPD) is a complex psychiatric disorder associated with aggressive, suicidal, and self-injurious behaviors that often require intensive long-term treatment, resulting in significant treatment costs. Although this disorder is disproportionately represented in inpatient and outpatient settings relative to its prevalence in the population, patients diagnosed with this condition are so heterogeneous that it has been difficult to identify its causes or to design effective treatments. The proposed research seeks to refine the prevailing conception of BPD using sophisticated statistical models and epidemiological samples, which will permit better classification of BPD, resulting in improved treatment outcomes for patients.

描述(由Candiate提供)：边缘人格障碍(BPD)是一种复杂的精神障碍，与主观痛苦、低质量的生活质量和慢性自杀有关，估计自杀未遂的比例高达10%。由于具有攻击性、自杀和自残行为，BPD患者的治疗利用率显著高于情绪障碍或其他人格障碍患者，从而导致显著的治疗成本。虽然这种疾病影响了1-2%的人口，但患有BPD的个人占所有门诊患者的10%-20%，占住院患者的15%。尽管与BPD相关的重大社会负担、主观痛苦和糟糕的精神结局，但相对于其他形式的精神病理学，BPD的表型还没有得到很好的理解。BPD结构效度的提高在一定程度上受到理论概念化和DSM诊断标准所反映的相当大的异质性的阻碍。现有的诊断标准定义了一个有意义但分散的结构，如果仅使用这些标准来选择患者，未来的研究工作将受到阻碍。这项拟议的研究试图通过探索更多的临床和实验标记物，以及使用灵活的潜变量建模和统计模拟来澄清疾病的分类，来完善BPD的表型。这项工作将导致BPD的经验性分类，包括特征、亚型或两者，以及识别临床上有意义的临界性病理的基于数据的阈值。这项研究有可能识别出更多同质的BPD患者群体，这将增加未来实证工作的分辨率和可重复性。此外，澄清BPD患者之间的异质性将改善未来的治疗研究，因为临床策略可以更好地适应个别患者。具体目标是：1)使用蒙特卡罗模拟方法评估现有分析方法解析BPD潜在结构的效率，2)使用结合连续和范畴概念的混合潜变量模型来阐明BPD内部的异质性，3)通过探索额外的临床和实验标记物来提炼BPD的表型。这项拟议的研究将使用两个主要的流行病学数据集(国家共病调查复制和全国酒精及相关疾病流行病学调查)和来自先前五项研究的616名参与者的大样本进行，其中约25%患有BPD。此外，还将开发拒绝敏感性的实验性精神病理学测量，并使用168名成年参与者的较小样本进行验证，该测量将被整合到分类模型中。我们期望DSM-IV的BPD特征最好用一个连续的严重程度维度来描述，但障碍的亚型将根据其他标记来识别，包括攻击性、不信任、全神贯注的依恋和拒绝敏感性。将测试相互竞争的维度模型、分类模型和综合模型。公共卫生相关性：临界性人格障碍(BPD)是一种复杂的精神障碍，与攻击性、自杀和自我伤害行为有关，通常需要长期密集治疗，导致巨额治疗费用。尽管与其在人群中的流行率相比，这种疾病在住院和门诊环境中的比例不成比例，但被诊断为这种疾病的患者是如此不同，以至于很难确定其原因或设计有效的治疗方法。拟议的研究试图使用复杂的统计模型和流行病学样本来完善BPD的普遍概念，这将允许对BPD进行更好的分类，从而改善患者的治疗结果。