PSYCHOBIOLOGY OF SUICIDAL BEHAVIOR IN BPD

描述(改编自申请人的摘要)：本建议书是 第一项多维临床研究的竞争性延续， 患者自杀行为的心理社会和生物学危险因素 临界性人格障碍(BPD)，一种伴有自杀的障碍 完成率为3-9%，可与情感性和精神分裂症相媲美 精神错乱。反复的自杀企图，自我伤害，和 冲动性攻击性是BPD患者的定义特征， 与心理社会和生物因素有关，包括儿童史 滥用和中枢5-羟色胺能功能减退，由脑脊液测定 芬氟拉明(Fen)的单胺代谢产物和神经内分泌反应。 在这项研究中，BPD患者与抑郁症患者进行了比较 正常对照的5-羟色胺能功能和病史 除诊断和临床危险因素外，儿童期虐待 之前定义的，并跟踪1年以测试这些 变量作为自杀行为的危险因素。在新的方向上， PET-FDG神经成像在FEN挑战中被引入以测量 前额叶皮质对5-羟色胺能激活的反应。接受研究的患者 在原定的资助期内，将每年跟进，以加强 对先前定义的风险因素的预测分析，包括 共病抑郁、物质使用障碍、高冲动和 攻击性、人际压力源、低社会支持和缺乏 精神治疗。

DESCRIPTION (adapted from applicant's abstract): This proposal is a competing continuation of a first, multidimensional study of the clinical, psychosocial and biological risk factors for suicidal behavior in patients with Borderline Personality Disorder (BPD), a disorder with a suicide completion rate of 3-9 percent, comparable to affective and schizophrenic disorders. Recurrent suicide attempts, self-injury, and impulsive-aggression are defining characteristics of patients with BPD, related to psychosocial and biologic factors, including childhood histories of abuse and diminished central serotonergic function, measured by CSF monoamine metabolites and the neuroendocrine response to Fenfluramine (FEN). In this study, patients with BPD are compared to depressed patients and normal controls on measures of serotonergic functioning and histories of childhood abuse, in addition to the diagnostic and clinical risk factors previously defined, and followed for 1 year to test the role of these variables as risk factors for suicidal behavior. In a new direction, PET-FDG neuroimaging is introduced during the FEN challenge to measure prefrontal cortical response to serotonergic activation. Patients studied in the original grant period will be followed annually to strengthen the predictor analyses of previously defined risk factors, which include co-morbid depression, substance use disorder, high impulsivity and aggressivity, interpersonal stressors, low social support and absence of psychiatric treatment.