Prospective Study of Suicidal Behavior in BPD

描述（由申请人提供）：近10%的BPD患者 自杀，高达75%的人至少有一次自杀企图。而 这些尝试中的许多在医学上的致命性很低， 至少有一次自杀企图是致命的尽管 这种严重程度，低致命性自杀企图和非自杀的频率 BPD中的自伤导致临床医生认为自杀企图仅仅是 “手势”，或操纵和寻求注意力的行为。此外，临床医生 倾向于通过治疗抑郁症状来治疗BPD中的自杀倾向，当， 事实上，冲动似乎是一个更大的风险因素。我们将研究 与受试者自杀企图相关的临床和神经生物学因素 边缘型人格障碍的患者进行了一项前瞻性研究。通过 管理结构化的临床访谈和腰椎穿刺，我们计划 来衡量各种状态和特质变量， 在300名受试者的队列中进行行为：200名BPD患者（100名患者，100名 18-35岁之间，自杀风险最高的时期 和100名没有轴II诊断的重度抑郁症患者。 具体目标是：1.检查临床状态和特征预测因子 2.在2年的随访中自杀未遂;检查肾上腺素能 功能（例如，CSF-5 HIAA）和其他自杀未遂生物学指标 两年随访期间BPD的行为。探索的目标包括：1。 确定高致命性与低致命性尝试的风险因素， BPD;在尝试时确定重性抑郁症的共病; 3. 运用压力-素质模型考察状态与特质的交互作用 决定BPD自杀行为风险的因素; 4.探索 自残和精神分裂与自杀行为的关系， 状态和特质风险因素。预测自杀行为的困难在于 BPD的治疗导致对BPD严重性的认识不足， BPD中的自杀风险，或者过度使用住院治疗。 这些发现可能具有重要的临床应用，以更准确地 在频繁的低致命性尝试的背景下预测高致命性尝试 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.