TREATING SUICIDAL BEHAVIOR AND SELF MUTILATION IN BPD

本课题的目的是：对边缘型人格障碍（BPD）自杀患者进行自杀和自残行为治疗的随机对照试验。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，但对这些行为的有效预防和治疗却知之甚少。 虽然临床医生认为BPD患者具有操纵性和寻求关注，但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，对BPD中自杀行为和自残治疗的系统调查很少。 一种心理社会治疗辩证行为疗法（DBT），一种认知行为疗法，已被证明能显著减少BPD患者的自伤行为。 虽然DBT作为BPD自杀患者的治疗选择越来越受欢迎，但除了开发人员进行的原始研究外，没有复制研究。 我们的研究将是第一次大规模复制DBT。关于药物治疗，氟西汀（一种选择性5-羟色胺再摄取抑制剂（SSRI））和其他SSRI的研究表明，它们在降低BPD患者自残和自杀意念的发生率方面具有疗效。此外，对自杀者和BPD中的多巴胺能功能的生物学研究表明SSRIs在治疗BPD中的自伤行为方面具有潜在益处。 虽然DBT和SSRIs的组合已成为最常见的治疗提供给门诊患者的PBD之一，没有系统的调查，联合心理治疗和药物治疗BPD的疗效进行过。在这个为期五年的项目中，我们建议评估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。 我们将使用随机四单元设计，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。 我们将在纽约州立精神病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年的时间内，180名BPD受试者将随机接受12个月的治疗，并在12个月时进行自然随访。

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.