Collaborative Longitudinal Study of Personality Disorder

描述（由申请人提供）：我们提出一项为期4年的合作纵向人格障碍研究（CLPS），这是一项自然的、前瞻性的、多中心的研究，共有733名寻求治疗的受试者。我们将对诊断为四种DSM-IV型人格障碍（分裂型、边缘型、回避型和强迫症）的受试者进行至少10年的随访（最近招募的少数受试者为6年），此外，我们将测试一种“混合”人格障碍模型，该模型由更稳定的人格特征与间歇性表达的症状性行为相关联。到目前为止，我们的研究结果表明，随着时间的推移，pd作为综合征表现出一致性，但其改善率与DSM-IV的定义不一致。我们在更新期的中心目标是进一步发展一个经验基础，以便根据其更稳定与更不稳定的元素重新定义pd。这需要一个集中的后续评估，以继续描述（目标1）和预测（目标2）PD与重度抑郁症（MDD）的病程，并追踪PD精神病理的稳定因素（特征）和不稳定因素（症状性行为）的时间病程和变化介质（目标3）。每年将对受试者进行评估，评估的工具集中在PD精神病理学的基本组成部分及其过程介质上，包括特征和症状状态和严重程度、轴I障碍的过程、社会心理功能、治疗利用和压力生活事件。在过去的4年里，我们增加了65名非裔美国人和西班牙裔pd患者，使我们能够在扩大的少数民族人群中检查这些疾病。CLPS的独特之处在于其大量的人格障碍受试者，其评估的全面性，以及预期随访的长度。这一建议将产生有意义的关于人格精神病理学的新知识，对分类、潜在表型和变化机制的研究以及新治疗靶点的开发具有直接意义。

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.