Collaborative Longitudinal Study of Personality Disorder

描述（由申请人提供）：我们提出了一个为期4年的合作纵向人格障碍研究（CLPS），一个自然的，前瞻性的，多中心的研究733寻求治疗的主题。我们将对被诊断患有四种DSM-IV人格障碍（PD）的受试者进行至少10年的随访（最近招募的少数民族受试者为6年）：典型型、边缘型、回避型和强迫型。此外，我们将测试PD的“混合”模型，该模型由与间歇性表达的症状性行为相关的更稳定的人格特征组成。我们迄今为止的研究结果表明，随着时间的推移，PD表现出作为综合征的一致性，但改善率与DSM-IV定义不一致。我们在更新期的中心目标是进一步发展一个经验基础，以便根据PD的更稳定和更不稳定的要素来重新定义PD。这需要一个有重点的后续评估，以继续描述（目标1）和预测（目标2）的过程（S）的PD相比，重度抑郁症（MDD），并跟踪时间进程和介质的变化的稳定元素（特质）和不稳定元素（症状行为）的PD精神病理学（目标3）。将每年对受试者进行一次评估，评估工具侧重于PD精神病理学的基本组成部分及其病程介质，包括特质和症状状态及严重程度、轴I障碍的病程、心理社会功能、治疗利用和应激性生活事件。在过去的4年中，额外招募了65名非洲裔美国人和西班牙裔受试者，使我们能够在扩大的少数民族人群中检查这些受试者。CLPS的独特之处在于其大量的人格障碍受试者，他们的评估的全面性，以及前瞻性随访的长度。这一建议将导致有意义的新知识的人格精神病理学的分类，研究潜在的表型和机制的变化，并开发新的治疗目标的直接影响。

DESCRIPTION (provided by applicant): We propose a 4-year continuation of the Collaborative Longitudinal Personality Disorders Study (CLPS), a naturalistic, prospective, multicenter study of 733 treatment-seeking subjects. We will obtain a minimum of 10 years of follow-up on subjects (6 years on recently recruited minority subjects) diagnosed with four DSM-IV personality disorders (PDs): schizotypal, borderline, avoidant, and obsessive-compulsive, in addition, we will test a "hybrid" model of PDs that consists of more stable personality traits linked to intermittently expressed, symptomatic behaviors. Our findings to date document that PDs show consistency as syndromes over time, but rates of improvement that are inconsistent with DSM-IV definitions. Our central goal for the renewal period is to develop further an empirical base for redefining PDs in terms of their more vs. less stable elements. This requires a focused follow-along assessment to continue to describe (Aim 1) and to predict (Aim 2) the course(s) of PDs in contrast to major depressive disorder (MDD) and to track the temporal course and mediators of change of both stable elements (traits) and unstable elements (symptomatic behaviors) of PD psychopathology (Aim 3). Subjects will be assessed annually with instruments focused on the essential components of PD psychopathology and their course mediators, including trait and symptom status and severity, course of Axis I disorders, psychosocial functioning, treatment utilization, and stressful life events. Enrollment of an additional 65 African-American and Hispanic subjects with PDs during the past 4 years now enables us to examine these in expanded ethnic minority populations. CLPS is unique in its large number of personality-disordered subjects, comprehensiveness of their assessment, and length of prospective follow-up. This proposal will result in meaningful new knowledge about personality psychopathology with direct implications for classification, research on underlying phenotypes and mechanisms of change, and the development of new targets for treatment.