Prospective Study of Suicidal Behavior in BPD

描述(申请人提供)：近10%的BPD患者 自杀和高达75%的人至少有一次自杀未遂。而当 其中许多尝试的医疗致死率很低，50%的人 至少有一次自杀未遂是高度致命的。尽管 这种严重程度，低致命性自杀企图和非自杀的频率 BPD的自我伤害导致临床医生认为自杀企图仅仅是 “手势”，或操纵性和寻求注意的行为。还有，临床医生 倾向于通过治疗抑郁症的症状来治疗BPD的自杀，当， 事实上，冲动似乎是一个更强的风险因素。我们将研究 与自杀未遂相关的临床和神经生物学因素 使用前瞻性设计的边缘人格障碍患者。通过 管理有组织的临床访谈和腰椎穿刺术，我们计划 测量构成自杀风险的各种状态和特征变量 300名受试者的行为：200名患有BPD(100名尝试者，100名 非未遂者)18-35岁，这是自杀风险最高的时期 在BPD和100名患有重度抑郁症但未诊断为Axis II的患者中。 具体目的是：1.检查临床状态和性格预测因素。 两年随访中的自杀企图；2.检查5-羟色胺能 功能(例如，CSF-5HIAA)和其他自杀未遂的生物学指标 两年随访期间BPD的行为。探索性目标包括：1. 确定高致命性尝试与低致命性尝试的风险因素 BPD；2.在尝试时确定严重抑郁症的共同发病率； 应用压力-素质模型检验状态与特质的交互作用 确定BPD患者自杀行为风险的因素；4.探讨 自残和分离与自杀行为的关系，以及与 状态和特质风险因素。预测自杀行为的困难在于 BPD的治疗要么导致对BPD的严重性认识不足 BPD的自杀风险，或者过度利用住院。 这些发现可能会有重要的临床应用，以便更准确地 在频繁低的背景下对高致命性尝试的预测 致命的自杀行为。

DESCRIPTION (provided by applicant): Nearly 10 percent of all patients with BPD commit suicide and up to 75 percent make at least one suicide attempt. While many of these attempts are low in medical lethality, 50 percent of individuals with BPD have made at least one suicide attempt that is highly lethal. Despite this severity, the frequency of low lethality suicide attempts and non-suicidal self-injury in BPD leads clinicians to consider suicide attempts as merely "gestures," or manipulative and attention-seeking behaviors. Also, clinicians tend to treat suicidality in BPD by treating the symptoms of depression, when, in fact, impulsivity appears to be a stronger risk factor. We will examine clinical and neurobiological factors related to suicide attempts in subjects with borderline personality disorder using a prospective design. Through the administration of structured clinical interviews and lumbar puncture, we plan to measure various state and trait variables that pose risk for suicidal behavior in a cohort of 300 subjects: 200 with BPD (100 attempters, 100 non-attempters) between the ages of 18-35, the period of highest suicide risk in BPD and 100 attempters with Major Depression without an Axis II diagnosis. The specific aims are to: 1. examine clinical state and trait predictors of suicide attempts during a two year follow-up; and 2. examine serotinergic function (e.g., CSF-5HIAA) and other biological indices of suicide attempt behavior in BPD during a two year follow-up. Exploratory aims include: 1. identify the risk factors for high lethality versus low lethality attempts in BPD; 2. determine co-morbidity of Major Depression at time of attempts; 3. apply a stress-diathesis model to examine the interaction of state and trait factors in determining risk for suicidal behavior in BPD; 4. explore the relationship of self-mutilation and dissociation with suicidal acts, and with state and trait risk factors. The difficulty in predicting suicidal behavior in the treatment of BPD leads to either under-recognition of the seriousness of suicidal risk in BPD, or alternatively, over-utilization of hospitalization. These findings may have important clinical application for more accurate prediction of high lethality attempts within the context of frequent low lethality suicidal behaviors.