高橋三郎,大野裕：American Psychiatric Association.染矢 俊幸訳.DSM-5 精神疾患の診断・統計マニュアル.医学書院,2014.
The Development of the ICD-11 Classification of Personality Disorders: An Amalgam of Science, Pragmatism, and Politics - PubMed [Internet]. [cited 2021 Oct 29]. Available from: https://pubmed.ncbi.nlm.nih.gov/30601688/
John G Gunderson, Robert L Stout, Thomas H McGlashan, M Tracie Shea, Leslie C Morey, Carlos M Grilo, Mary C Zanarini, Shirley Yen, John C Markowitz, Charles Sanislow, Emily Ansell, Anthony Pinto, Andrew E Skodol
Ten-year course of borderline personality disorder: psychopathology and function from the Collaborative Longitudinal Personality Disorders study.
Arch Gen Psychiatry. 2011 Aug;68(8):827-37. doi: 10.1001/archgenpsychiatry.2011.37. Epub 2011 Apr 4.
Abstract/Text
CONTEXT: Borderline personality disorder (BPD) is traditionally considered chronic and intractable.
OBJECTIVE: To compare the course of BPD's psychopathology and social function with that of other personality disorders and with major depressive disorder (MDD) over 10 years.
DESIGN: A collaborative study of treatment-seeking, 18- to 45-year-old patients followed up with standardized, reliable, and repeated measures of diagnostic remission and relapse and of both global social functioning and subtypes of social functioning.
SETTING: Nineteen clinical settings (hospital and outpatient) in 4 northeastern US cities.
PARTICIPANTS: Three study groups, including 175 patients with BPD, 312 with cluster C personality disorders, and 95 with MDD but no personality disorder.
MAIN OUTCOME MEASURES: The Diagnostic Interview for DSM-IV Personality Disorders and its follow-along version (the Diagnostic Interview for DSM-IV Personality Disorders-Follow-Along Version) were used to diagnose personality disorders and assess changes in them. The Structured Clinical Interview for DSM-IV Axis I Disorders and the Longitudinal Interval Follow-up Evaluation were used to diagnose MDD and assess changes in MDD and in social function.
RESULTS: Eighty-five percent of patients with BPD remitted. Remission of BPD was slower than for MDD (P < .001) and minimally slower than for other personality disorders (P < .03). Twelve percent of patients with BPD relapsed, a rate less frequent and slower than for patients with MDD (P < .001) and other personality disorders (P = .008). All BPD criteria declined at similar rates. Social function scores showed severe impairment with only modest albeit statistically significant improvement; patients with BPD remained persistently more dysfunctional than the other 2 groups (P < .001). Reductions in criteria predicted subsequent improvements in DSM-IV Axis V Global Assessment of Functioning scores (P < .001).
CONCLUSIONS: The 10-year course of BPD is characterized by high rates of remission, low rates of relapse, and severe and persistent impairment in social functioning. These results inform expectations of patients, families, and clinicians and document the severe public health burden of this disorder.
Mary C Zanarini, Frances R Frankenburg, D Bradford Reich, Garrett Fitzmaurice
Attainment and stability of sustained symptomatic remission and recovery among patients with borderline personality disorder and axis II comparison subjects: a 16-year prospective follow-up study.
Am J Psychiatry. 2012 May;169(5):476-83. doi: 10.1176/appi.ajp.2011.11101550.
Abstract/Text
OBJECTIVE: The purposes of this study were to determine time to attainment of symptom remission and to recovery lasting 2, 4, 6, or 8 years among patients with borderline personality disorder and comparison subjects with other personality disorders and to determine the stability of these outcomes.
METHOD: A total of 290 inpatients with borderline personality disorder and 72 comparison subjects with other axis II disorders were assessed during their index admission using a series of semistructured interviews, which were administered again at eight successive 2-year follow-up sessions. For inclusion in the study, patients with borderline personality disorder had to meet criteria for both the Revised Diagnostic Interview for Borderlines and DSM-III-R.
RESULTS: Borderline patients were significantly slower to achieve remission or recovery (which involved good social and vocational functioning as well as symptomatic remission) than axis II comparison subjects. However, by the time of the 16-year follow-up assessment, both groups had achieved similarly high rates of remission (range for borderline patients: 78%-99%; range for axis II comparison subjects: 97%-99%) but not recovery (40%-60% compared with 75%-85%). In contrast, symptomatic recurrence and loss of recovery occurred more rapidly and at substantially higher rates among borderline patients than axis II comparison subjects (recurrence: 10%-36% compared with 4%-7%; loss of recovery: 20%-44% compared with 9%-28%).
CONCLUSIONS: Our results suggest that sustained symptomatic remission is substantially more common than sustained recovery from borderline personality disorder and that sustained remissions and recoveries are substantially more difficult for individuals with borderline personality disorder to attain and maintain than for individuals with other forms of personality disorder.
The 10-year course of psychosocial functioning among patients with borderline personality disorder and axis Ⅱ comparison - Search Results - PubMed [Internet]. [cited 2021 Oct 29]. Available from: https://pubmed.ncbi.nlm.nih.gov/?term=The+10-year+course+of+psychosocial+functioning+among+patients+with+borderline+personality+disorder+and+axis+Ⅱ comparison
マーシャ・M.リネハン,大野裕訳：境界性パーソナリティ障害の弁証法的行動療法 DBTによるBPDの治療.誠信書房,2007.
Anthony Bateman, Peter Fonagy
Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder.
Am J Psychiatry. 2009 Dec;166(12):1355-64. doi: 10.1176/appi.ajp.2009.09040539. Epub 2009 Oct 15.
Abstract/Text
OBJECTIVE: This randomized controlled trial tested the effectiveness of an 18-month mentalization-based treatment (MBT) approach in an outpatient context against a structured clinical management (SCM) outpatient approach for treatment of borderline personality disorder.
METHOD: Patients (N=134) consecutively referred to a specialist personality disorder treatment center and meeting selection criteria were randomly allocated to MBT or SCM. Eleven mental health professionals equal in years of experience and training served as therapists. Independent evaluators blind to treatment allocation conducted assessments every 6 months. The primary outcome was the occurrence of crisis events, a composite of suicidal and severe self-injurious behaviors and hospitalization. Secondary outcomes included social and interpersonal functioning and self-reported symptoms. Outcome measures, assessed at 6-month intervals, were analyzed using mixed effects logistic regressions for binary data, Poisson regression models for count data, and mixed effects linear growth curve models for self-report variables.
RESULTS: Substantial improvements were observed in both conditions across all outcome variables. Patients randomly assigned to MBT showed a steeper decline of both self-reported and clinically significant problems, including suicide attempts and hospitalization.
CONCLUSIONS: Structured treatments improve outcomes for individuals with borderline personality disorder. A focus on specific psychological processes brings additional benefits to structured clinical support. Mentalization-based treatment is relatively undemanding in terms of training so it may be useful for implementation into general mental health services. Further evaluations by independent research groups are now required.
JF Clarkin,FE Yeomans,OF Kernberg:Psychotherapy for borderline personality Focusing on object relations.American Psychiatric Publishing,2004.
Young JE,Klosko JS,Weishaar ME.伊藤絵美訳：スキーマ療法 パーソナリティの問題に対する統合的認知行動療法アプローチ.金剛出版,2008.
Klaus Lieb, Birgit Völlm, Gerta Rücker, Antje Timmer, Jutta M Stoffers
Pharmacotherapy for borderline personality disorder: Cochrane systematic review of randomised trials.
Br J Psychiatry. 2010 Jan;196(1):4-12. doi: 10.1192/bjp.bp.108.062984.
Abstract/Text
BACKGROUND: Many patients with borderline personality disorder receive pharmacological treatment, but there is uncertainty about the usefulness of such therapies.
AIMS: To evaluate the evidence of effectiveness of pharmacotherapy in treating different facets of the psychopathology of borderline personality disorder.
METHOD: A Cochrane Collaboration systematic review and meta-analysis of randomised comparisons of drug v. placebo, drug v. drug, or single drug v. combined drug treatment in adult patients with borderline personality disorder was conducted. Primary outcomes were overall disorder severity as well as specific core symptoms. Secondary outcomes comprised associated psychiatric pathology and drug tolerability.
RESULTS: Twenty-seven trials were included in which first- and second-generation antipsychotics, mood stabilisers, antidepressants and omega-3 fatty acids were tested. Most beneficial effects were found for the mood stabilisers topiramate, lamotrigine and valproate semisodium, and the second-generation antipsychotics aripiprazole and olanzapine. However, the robustness of findings is low, since they are based mostly on single, small studies. Selective serotonin reuptake inhibitors so far lack high-level evidence of effectiveness.
CONCLUSIONS: The current evidence from randomised controlled trials suggests that drug treatment, especially with mood stabilisers and second-generation antipsychotics, may be effective for treating a number of core symptoms and associated psychopathology, but the evidence does not currently support effectiveness for overall severity of borderline personality disorder. Pharmacotherapy should therefore be targeted at specific symptoms.
National Collaborating Centre for Mental Health (UK)
Borderline Personality Disorder: Treatment and Management
Abstract/Text
The guideline on Borderline Personality Disorder, commissioned by NICE and developed by the National Collaborating Centre for Mental Health, sets out clear, evidence- and consensus-based recommendations for healthcare staff on how to treat and manage borderline personality disorder. Personality disorder now accounts for a substantial portion of the workload of most community mental health teams in the UK and borderline personality disorder is associated with significant functional impairments for the individual. The NICE guideline takes the first comprehensive view of the disorder and is an important resource for healthcare professionals to improve people’s long-term outcomes. Recent years have seen an exponential rise in available treatments for personality disorder and the guideline on borderline personality disorder covers the available evidence on all of those interventions. It also includes management of crises, configuration and organisation of services and experience of care. The primary focus is on adults, but the guideline looks at emerging characteristics of borderline personality disorder in younger people. The guideline also considers the needs of those with learning disabilities and contains a useful overview of borderline personality disorder.
Sabine C Herpertz, Mary Zanarini, Charles S Schulz, Larry Siever, Klaus Lieb, Hans-Jürgen Möller, WFSBP Task Force on Personality Disorders, World Federation of Societies of Biological Psychiatry (WFSBP)
World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of personality disorders.
World J Biol Psychiatry. 2007;8(4):212-44. doi: 10.1080/15622970701685224.
Abstract/Text
These practical guidelines for the biological treatment of personality disorders in primary care settings were developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). They embody the results of a systematic review of all available clinical and scientific evidence pertaining to the biological treatment of three specific personality disorders, namely borderline, schizotypal and anxious/avoidant personality disorder in addition to some general recommendations for the whole field. The guidelines cover disease definition, classification, epidemiology, course and current knowledge on biological underpinnings, and provide a detailed overview on the state of the art of clinical management. They deal primarily with biological treatment (including antidepressants, neuroleptics, mood stabilizers and some further pharmacological agents) and discuss the relative significance of medication within the spectrum of treatment strategies that have been tested for patients with personality disorders, up to now. The recommendations should help the clinician to evaluate the efficacy spectrum of psychotropic drugs and therefore to select the drug best suited to the specific psychopathology of an individual patient diagnosed for a personality disorder.
R W Cowdry, D L Gardner
Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine.
Arch Gen Psychiatry. 1988 Feb;45(2):111-9.
Abstract/Text
Sixteen female outpatients with borderline personality disorder and prominent behavioral dyscontrol, but without a current episode of major depression, were studied in a double-blind, crossover trial of placebo and the following four active medications: alprazolam (average dose, 4.7 mg/d); carbamazepine (average dose, 820 mg/d); trifluoperazine hydrochloride (average dose, 7.8 mg/d); and tranylcypromine sulfate (average dose, 40 mg/d). Each trial was designed to last six weeks. Tranylcypromine and carbamazepine trials had the highest completion rates. Physicians rated patients as significantly improved relative to placebo while receiving tranylcypromine and carbamazepine. Patients rated themselves as significantly improved relative to placebo only while receiving tranylcypromine. Patients who tolerated a full trial of trifluoperazine showed improvement, those receiving carbamazepine demonstrated a marked decrease in the severity of behavioral dyscontrol, and those receiving alprazolam had an increase in the severity of the episodes of serious dyscontrol. As an adjunct to psychotherapy, pharmacotherapy can produce modest but clinically important improvement in the mood and behavior of patients with borderline personality disorder. As a research tool, patterns of pharmacological response may provide clues to biological mechanisms underlying dysphoria and behavioral dyscontrol.
D L Gardner, R W Cowdry
Alprazolam-induced dyscontrol in borderline personality disorder.
Am J Psychiatry. 1985 Jan;142(1):98-100.
Abstract/Text
The authors report a significant increase in dyscontrol in patients with borderline personality disorder who were taking alprazolam during a double-blind, placebo-controlled crossover study. They suggest that caution be used in prescribing alprazolam to patients with similar histories.
D Ebert, R Albert, A May, A Merz, H Murata, I Stosiek, B Zahner
The serotonin syndrome and psychosis-like side-effects of fluvoxamine clinical use--an estimation of incidence.
Eur Neuropsychopharmacol. 1997 Feb;7(1):71-4.
Abstract/Text
OBJECTIVE: The incidence of the serotonin syndrome or serotonin-syndrome-like side effects during treatment with the selective serotonin reuptake inhibitor (SSRI) fluvoxamine should be evaluated.
METHOD: 200 inpatients treated for the first time with fluvoxamine were prospectively evaluated for the occurrence of a serotonin syndrome over a period of 8200 treatment days. Retrospective follow-up data of outpatient treatment covered 8891 days.
RESULTS: No full-blown serotonin syndrome occurred, but 3 patients developed a reversible change of mental status with insomnia, agitation, confusion and incoherent thoughts without other symptoms of the serotonin syndrome.
CONCLUSIONS: It is concluded that the occurrence of a potentially lethal serotonin syndrome is rare in fluvoxamine treatment psychosis-like syndromes as a side effect of serotonergic stimulation might occur. In the investigated sample the rate was 0.006-0.04 per 100 treatment days.
