許多人無法從邊緣型人格違常達到長期恢復
作者：Megan Brooks
出處：WebMD醫學新聞
April 15, 2010 — 研究者在線上發表於4月15日美國精神病學期刊(American Journal of Psychiatry)的研究中結論表示，從邊緣型人格違常恢復，包括症狀緩解以及良好的社會心理功能，對多數病患而言，似乎難以如願。
不過，第一作者、麻塞諸塞州Belmont McLean醫院的Mary C. Zanarini博士等人報告指出，一旦達到，這個恢復會相對穩定。
研究者指出，這些發現來自一個為期10年的前瞻追蹤研究，包括了符合邊緣型人格違常診斷的290個病患，開始時，平均整體功能評估量表分數為38.9，表示多個區域有嚴重不良，例如工作或學校、家庭關係、判斷、思考、情緒等。
病患有80.3%是女性、87.2%是白人，平均年紀26.9歲，在開始時與每隔2年進行半結構式訪談與自我報告、為期10年。退出率相當低，有275人在2年時再度被訪談、4年時有269人、6年時有264 人、8年時有255 人、10年時有249 人。
報告指出，在10年時，93%的病患達到持續至少2年的症狀緩解，86%有持續至少4年的緩解。不過，只有50%的病患從該異常復原，復原之定義為2年的症狀緩解且在之前2年達到好的社會與職業功能，而且整體功能評估量表分數達61以上。
研究者指出，相當嚴肅的問題是，我們的研究對象只有半數達到完整的功能性成人適應且只有輕微的邊緣型人格違常。
此外，34%的病患從邊緣型人格違常恢復，其中約30%達到2年症狀緩解但是有症狀復發，達到4年持續緩解的有15%。
Zanarini博士等人在報告中指出，這些結果和臨床經驗一致。他們指出，目前的研究是國家心智健康研究中心(NIMH)資助的「McLean Study of Adult Development」這項研究的延伸，發現在6年的前瞻追蹤期間有穩定而適度的整體改善。另一篇NIHM資助的研究：「Collaborative Longitudinal Personality Disorders Study」發現，邊緣型病患在2年的前瞻追蹤時，整體功能依舊在尚可的範圍內。
加拿大魁北克蒙特婁McGill大學精神科教授、未參與該研究的Joel Paris醫師向Medscape Psychiatry 表示，來自McLean研究的最新發現並非意料之外；他們確認了文獻登載之外的部份，另一方面，這是描述良好的樣本，我們首次得到這麼多細節。
Paris醫師表示，整體而言，該研究認為邊緣型人格違常病患隨著時間會好一些，但是無法完全恢復。
Zanarini博士的研究團隊指出，McLean研究的長期觀察也認為，相較於需要達到良好整體結果的良好社會心理功能，比較容易達到緩解。
研究者認為，因此，治療邊緣型病患時應考慮以復健模式治療這些心理社會不全，此類模式聚焦在幫助病患獲得僱用、交友、照顧自己的生理健康、發展有助於其休閒時間的興趣。
Zanarini博士和Paris醫師皆宣告沒有相關財務關係。
Am J Psychiatry.線上發表於2010年4月15日。
Long-Term Recovery From Borderline Personality Disorder Out of Reach for Many
By Megan Brooks
Medscape Medical News
April 15, 2010 — Recovery from borderline personality disorder, which includes symptom remission and good psychosocial functioning, seems difficult for most patients to attain, conclude study investigators in the April 15 online issue of the American Journal of Psychiatry.
However, "once attained, such a recovery is relatively stable over time," first study author Mary C. Zanarini, EdD, of McLean Hospital, Belmont, Massachusetts, and colleagues report.
These findings stem from a 10-year, prospective, follow-up study of 290 patients who met diagnostic criteria for borderline personality disorder. At baseline, the mean Global Assessment of Functioning scale score was 38.9, indicating major impairment in several areas, such as work or school, family relations, judgment, thinking, and mood, the researchers note.
The patients who were 80.3% female and 87.2% white, with a mean age of 26.9 years, were evaluated at baseline and every 2 years for 10 years via semistructured interviews and self-report measures. Attrition was relatively low, with 275 patients reinterviewed at 2 years, 269 at 4 years, 264 at 6 years, 255 at 8 years, and 249 at 10 years.
At 10 years, 93% of patients had attained a symptomatic remission lasting at least 2 years, and 86% had sustained remission lasting at least 4 years, the report states. However, only 50% of patients experienced a recovery from the disorder, which the researchers defined as a 2-year symptomatic remission and the attainment of good social and vocational functioning during the previous 2 years, as well as a Global Assessment of Functioning score of 61 or higher.
"It is sobering that only half of our study sample achieved a fully functioning adult adaptation with only mild symptoms of borderline personality disorder," the investigators note.
In addition, 34% of patients who recovered from borderline personality disorder lost their recovery. About 30% of those who achieved a 2-year remission of symptoms experienced a recurrence of symptoms, as did 15% of those who had achieved a 4-year sustained remission.
"This set of results is consistent with clinical experience," Dr. Zanarini and colleagues note in their report. The current study, they point out, is an extension of the National Institute of Mental Health (NIMH)–funded McLean Study of Adult Development, which found "steady, if modest, overall improvement over 6 years of prospective follow-up." Another NIHM-funded study — the Collaborative Longitudinal Personality Disorders Study — found that borderline patients continued to function in the fair range of global functioning during 2 years of prospective follow-up.
Joel Paris, MD, professor of psychiatry at McGill University, Montreal, Quebec, Canada, who was not involved in the study, told Medscape Psychiatry that the latest findings from the McLean study "are not unexpected; they do confirm what is already out there in the literature. On the other hand, this is a well-described sample, and it's the first time we've gotten this much detail."
Taken together, Dr. Paris said, the research suggests that patients with borderline personality disorder "do get better with time, but they don't get all better."
The long-term observations in the McLean study, Dr. Zanarini's team notes, also suggest that remissions are "far more common than the good psychosocial functioning needed to achieve a good global outcome."
"It would thus seem wise for those treating borderline patients to consider a rehabilitation model of treatment for these psychosocial deficits. Such a model would focus on helping patients become employed, make friends, take care of their physical health, and develop interests that would help fill their leisure time productively," the researchers suggest.
Dr. Zanarini and Dr. Paris have disclosed no relevant financial relationships.
Am J Psychiatry. Published online April 15, 2010.
