Borderline personality disorder

边缘性人格障碍
  • 文章类型: Journal Article
    背景:从理论上讲,患有边缘性人格障碍(BPD)的人经历了较低的认知移情,但情感移情增强。尽管荟萃分析解决了认知移情,情感移情仍未被探索。这项预先注册的系统评价和荟萃分析调查了具有BPD或高BPD特征的个体相对于健康比较的情感移情。使用多维方法,包括,早期的情感同理心,情绪传染,和同情的关注。
    方法:SCOPUS的系统搜索,PubMed,Medline完成,和PsycINFO(2022年6月27日,2023年5月14日和2024年7月1日)完成。纳入的研究将具有BPD/高BPD特征的人的情感移情与健康比较进行了比较,利用实验或自我报告设计,并且是同行评审或博士学位论文。使用纽卡斯尔-渥太华量表评估偏倚风险。
    结果:在确定的22项符合条件的研究中,结果显示,具有BPD/高BPD特征的个体表现出明显更高的情绪传染(Npurched=1797,g=-1.10,95%CI[-1.57,-0.62])。在共情方面没有发现显着差异(Npurched=1545,g=0.06,95%CI[-0.10,0.22]),或对愤怒的早期情感移情(Npurched=245,g=0.28,95%CI[-0.0.53,1.09])和幸福,(Npowered=189,g=0.34,95%CI[-0.1.50,2.18])。
    结论:很少有包括早期情感移情的研究,更广泛的文献和研究异质性中的方法论缺陷表明,在解释这些影响时,强调有针对性的研究的必要性。
    结论:虽然具有BPD/高BPD特征的个体更有可能通过情绪传染主观体验他人的痛苦,在早期情感同理心或直接同情和关心他人的能力方面没有发现差异。
    BACKGROUND: Individuals with Borderline Personality Disorder (BPD) are theorized to experience lower cognitive empathy but heightened affective empathy. Despite meta-analyses addressing cognitive empathy, affective empathy remains unexplored. This pre-registered systematic review and meta-analysis investigated affective empathy in individuals with BPD or high BPD traits relative to healthy comparisons, using a multidimensional approach including, early affective empathy, emotion contagion, and empathic concern.
    METHODS: Systematic search of SCOPUS, PubMed, Medline COMPLETE, and PsycINFO (June 27, 2022, May 14, 2023, and July 1, 2024) was completed. Included studies compared affective empathy in those with BPD/high BPD traits with healthy comparisons, utilized experimental or self-report designs, and were peer-reviewed or PhD theses. Risk of bias was assessed using the Newcastle-Ottawa Scale.
    RESULTS: Among 22 eligible studies identified, results revealed individuals with BPD/high BPD traits showed significantly higher emotion contagion (Npooled = 1797, g = -1.10, 95 % CI [-1.57, -0.62]). No significant differences were found in empathic concern (Npooled = 1545, g = 0.06, 95 % CI [-0.10, 0.22]), or early affective empathy for anger (Npooled = 245, g = 0.28, 95 % CI [-0.0.53, 1.09]) and happiness, (Npooled = 189, g = 0.34, 95 % CI [-0.1.50, 2.18]).
    CONCLUSIONS: Few included studies for early affective empathy, methodological shortcomings in the broader literature and study heterogeneity suggest caution when interpreting these effects, emphasizing the need for targeted research.
    CONCLUSIONS: While individuals with BPD/high BPD traits are more likely to subjectively experience others\' distress through emotion contagion, no differences were found in early affective empathy or ability to direct sympathy and concern towards others.
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  • 文章类型: Systematic Review
    在临床环境中,在被诊断为边缘性人格障碍(BPD)的个体中,通常75%是女性,25%是男性,尽管社区中没有报告这种差异。在文学中,对男性BPD治疗的有效性和经验知之甚少。我们旨在回顾男性BPD治疗的有效性和经验,并概述未来的研究重点,以促进更好的康复。从开始到2022年7月29日,我们搜索了OvidMEDLINE和PsycINFO的合格研究。包括同行评审的有关BPD男性治疗效果或经验的主要研究文章。来自符合条件的研究的数据在叙述性综述中进行了综合。我们审查的方案已在PROSPERO(CRD42022351908)上预先注册。17项研究符合纳入标准,来自八个国家的BPD男性代表。心理治疗包括辩证行为疗法,情感可预测性和问题解决的系统培训,基于心理的治疗,和精神分析疗法。药物治疗包括托吡酯,双丙戊酸钠延长释放,和高剂量巴氯芬.五项研究调查了BPD男性的服务利用率。与女性相比,男性获得BPD治疗或发现治疗有帮助的可能性较小.我们的发现证明了心理治疗和药物干预在减少愤怒方面的潜在功效,侵略,和违反规则的行为,自杀相关结局减少的证据有限。我们的发现受到纳入研究的力量不足和异质性的限制。需要进行更大样本量和定性研究的进一步研究,以更好地了解BPD男性的治疗经验。
    In clinical settings, among individuals diagnosed with borderline personality disorder (BPD), typically 75% are female and 25% male, although this discrepancy is not reported in the community. In the literature, little is known of the effectiveness and experiences of treatment of men with BPD. We aimed to review the effectiveness and experiences of treatment for men with BPD and outline future research priorities to promote better recovery. We searched Ovid MEDLINE and PsycINFO for eligible studies from inception until July 29, 2022. Peer-reviewed primary research articles on treatment effectiveness or experience for men with BPD were included. Data from eligible studies were synthesized in a narrative review. The protocol of our review was pre-registered on PROSPERO (CRD42022351908). Seventeen studies met the inclusion criteria, and men with BPD from eight countries were represented. Psychological therapies included Dialectical Behavioral Therapy, Systems Training for Emotional Predictability and Problem Solving, Mentalization Based Therapy, and psychoanalytic therapy. Pharmacologic treatment included topiramate, divalproex Extended-Release, and high-dose baclofen. Five studies investigated the service utilization of men with BPD. Compared to women, men were less likely to access treatment for BPD or find treatment helpful. Our findings demonstrated the potential efficacy of psychotherapy and pharmacologic interventions in reducing anger, aggression, and rule-breaking behavior, with limited evidence for reduction in suicide-related outcomes. Our findings are limited by inadequate power and heterogeneity of the included studies. Further research with larger sample sizes and qualitative studies is needed to better understand the treatment experience for men with BPD.
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  • 文章类型: Journal Article
    功能性癫痫(FS)在DSM-5中被分类为转换障碍,在ICD-11中被分类为分离障碍,显示出具有各种精神病合并症的多因素精神病理学。比如抑郁和焦虑。一些研究发现FS和人格障碍之间存在相关性,主要是集群B中的那些,在这个集群中,边缘性人格障碍(BPD)或边缘性人格特质在FS中最普遍。情绪失调是BPD的标志,通常在FS患者中报道。C群人格障碍,如回避或强迫症,在FS中也有报道。在这次审查中,我们旨在评估FS与人格障碍之间的关系。在FS背景下评估人格障碍与确定最合适的干预措施有关。认知行为疗法(CBT)被认为是治疗FS的一线方法。在各种CBT策略中,辩证行为疗法,专门针对情绪失调,可能对BPD患者有帮助。未来的研究应该评估系统性评估FS中人格障碍的优势,以解决特定的治疗计划,并评估其对癫痫复发的有效性。心理合并症,和生活质量。
    https://www.crd.约克。AC.英国/PROSPEROFILES/509286_STRATEGY_20240203。pdf,标识符CRD42024509286。
    Functional seizures (FS) are classified as conversion disorders in the DSM-5 and dissociative disorders in the ICD-11, showing a multifactorial psychopathology with various psychiatric comorbidities, such as depression and anxiety. Several studies have found a correlation between FS and personality disorders, mainly those in cluster B. Within this cluster, borderline personality disorder (BPD) or borderline personality traits are the most prevalent in FS. Emotion dysregulation is a hallmark of BPD and is commonly reported in individuals with FS. Cluster C personality disorders, such as avoidant or obsessive-compulsive disorders, have also been reported in FS. In this review, we aim to evaluate the relationship between FS and personality disorders. Assessing personality disorders in the context of FS is relevant for determining the most appropriate intervention. Cognitive-behavioral therapy (CBT) is considered the first-line approach to treating FS. Among various CBT strategies, dialectical behavior therapy, which specifically targets emotion dysregulation, may be helpful for individuals with BPD. Future research should assess the advantages of systematically evaluating personality disorders in FS to address specific treatment planning and evaluate its effectiveness on seizure recurrence, psychological comorbidities, and quality of life.
    UNASSIGNED: https://www.crd.york.ac.uk/PROSPEROFILES/509286_STRATEGY_20240203.pdf, identifier CRD42024509286.
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  • 文章类型: Journal Article
    目的:综合定性研究,对接受辩证行为治疗的被诊断患有(或报告显示)边缘型人格障碍的个体进行研究,旨在理解他们对变化过程和治疗效果的看法。
    方法:对多个在线数据库和灰色文献来源进行了全面的文献检索。使用经过改编的关键评估技能计划工具对论文进行了质量评估。在合成过程中采用了气象学方法。
    结果:11项研究符合纳入审查的标准。通过综合过程确定的主要主题是DBT的影响,支持结构和1:1治疗组件。
    结论:合成揭示了DBT中各种过程的重要性,患者将其视为改变的活性成分。这些过程中的许多过程与拟议的变化理论过程和对DBT有效性的定量研究相一致。
    OBJECTIVE: To synthesise qualitative research on individuals diagnosed with (or reportedly showing traits of) borderline pattern personality disorder who underwent dialectical behaviour therapy, aiming to comprehend their perceptions of change processes and the therapy\'s effects.
    METHODS: A comprehensive literature search was conducted across multiple online databases and grey literature sources. Papers were quality appraised using an adapted version of the Critical Appraisal Skills Programme tool. A metaethnographic approach was employed during the synthesis.
    RESULTS: Eleven studies met criteria for inclusion in the review. The main themes identified through the synthesis process were the impact of DBT, the supportive structure and the 1:1 therapy component.
    CONCLUSIONS: The synthesis uncovered the importance of various processes within DBT that patients perceived as active ingredients for their change. Many of these processes aligned with proposed theoretical processes of change and quantitative research on DBT\'s effectiveness.
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  • 文章类型: Journal Article
    边缘性人格障碍(BPD)是一种复杂的心理健康状况,其特征是情绪不稳定,关系,自我形象,和行为。患有BPD的人经常在激烈的情绪中挣扎,冲动,保持稳定的关系。催产素,被称为“爱激素”或“结合激素”,“在社会纽带中起着至关重要的作用,信任,同理心,情绪调节及其失调可能导致BPD困难。本系统综述旨在分析现有文献,检查复杂的相互作用,并鼓励未来的研究和治疗策略。
    对PubMed文献的系统搜索,Embase和Psychinfo,没有任何语言或时间限制,直到2024年3月,将同义词库和与“边缘性人格障碍”和“催产素”相关的免费搜索索引术语组合在一起,产生310个结果(77个在PubMed,Embase中的166和Psychinfo中的67)。分析了94篇全文,共纳入70篇文献进行定性分析。
    催产素可能会影响依恋风格,父母的行为,和应激反应,特别是有童年创伤史的人。催产素之间的相互作用,遗传学,早期生活经历,和环境因素有助于BPD的复杂性。催产素受体基因的遗传变异可能会影响社交和情感能力,并有助于精神病理学的发展。此外,早期不良经历,比如童年的虐待,可以改变催产素的功能,影响社会认知和情绪调节。然而,催产素在BPD治疗中的作用仍不确定,一些研究表明,避免社会威胁等特定症状的潜在益处,而其他人则表明对非语言行为和心理化的不利影响。
    了解催产素在BPD中的作用可以为潜在的治疗干预措施提供见解。虽然基于催产素的治疗可能有望解决特定症状,需要进一步的研究。
    UNASSIGNED: Borderline personality disorder (BPD) is a complex mental health condition marked by instability in mood, relationships, self-image, and behavior. Individuals with BPD often struggle with intense emotions, impulsivity, and maintaining stable relationships. Oxytocin, known as the \"love hormone\" or \"bonding hormone,\" plays a crucial role in social bonding, trust, empathy, and emotional regulation and its dysregulation may contribute to BPD difficulties. This systematic review aims to analyze existing literature, examining the intricate interplay and encouraging future research and treatment strategies.
    UNASSIGNED: A systematic search of Literature in PubMed, Embase and Psychinfo, without any language or time restriction, was performed until March 2024 combining thesaurus and free-search indexing terms related to \"borderline personality disorder\" and \"oxytocin\", producing 310 results (77 in PubMed, 166 in Embase and 67 in Psychinfo). Ninety-four full texts were analyzed, and 70 articles were included in qualitative analysis.
    UNASSIGNED: Oxytocin may influence attachment styles, parental behaviors, and stress responses, particularly in individuals with a history of childhood trauma. The interaction between oxytocin, genetics, early life experiences, and environmental factors contributes to the complexity of BPD. Genetic variations in the oxytocin receptor gene may influence social and emotional abilities and contribute to the development of psychopathology. Additionally, early adverse experiences, such as childhood maltreatment, can alter oxytocin functioning, impacting social cognition and emotional regulation.However, oxytocin\'s role in BPD treatment remains uncertain, with some studies suggesting potential benefits for specific symptoms like social threat avoidance, while others indicate adverse effects on nonverbal behavior and mentalizing.
    UNASSIGNED: Understanding oxytocin\'s role in BPD offers insights into potential therapeutic interventions. While oxytocin-based treatments may hold promise for addressing specific symptoms, further research is needed.
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  • 文章类型: Journal Article
    绘制评估临床样本中精神病临床高风险(CHR-P)和边缘性人格障碍(BPD)的研究,专注于临床/研究/预防范式,并提出知情的研究建议。
    我们进行了符合PRISMA-ScR/JBI标准的范围审查(方案:https://osf.io/8mz7a)的主要研究研究(横截面/纵向设计),使用有效的措施/标准来评估临床样本中的CHR-P和BPD(阈值/亚阈值)。在标题/摘要/关键词中报告CHR-P/精神病症状和人格障碍,在WebofScience/PubMed/(EBSCO)PsycINFO中确定,直到23/08/2023。
    纳入了33项研究,并将其分为四个主题,反映了各自的临床/研究/预防范式:(i)BPD作为CHR-P青年的合并症(k=20),强调早期发现和干预精神病;(ii)作为BPD住院患者的合并症的减毒精神病综合征(APS)(k=2),重点关注因非精神病性精神障碍入院的住院青少年/年轻成年人;(iii)混合样本(k=7),包括早期干预服务和转诊途径的描述;(iv)诊断方法(k=4)强调“临床高危精神状态”(CHARMS)标准,以确定严重精神障碍的多能风险状态。
    范围审查揭示了CHR-P和BPD的临床护理的多种方法,没有统一的治疗策略。未来研究的建议应侧重于:(i)探索早期干预诊所的转诊途径,以促进及时干预;(ii)在急诊科等创新环境中加强早期发现策略;(iii)提高心理健康素养,以促进寻求帮助的行为;(iv)将合并症作为复杂的系统进行分析,以更好地了解和瞄准早期心理病理学;(vi)调查BPD的潜在风险;(vi)发展跨领域的干预措施,以了解他们(x)评估早期干预措施的成本效益,以确定不同国家的可扩展性。
    https://osf.io/8mz7a。
    UNASSIGNED: To map studies assessing both clinical high risk for psychosis (CHR-P) and borderline personality disorder (BPD) in clinical samples, focusing on clinical/research/preventive paradigms and proposing informed research recommendations.
    UNASSIGNED: We conducted a PRISMA-ScR/JBI-compliant scoping review (protocol: https://osf.io/8mz7a) of primary research studies (cross-sectional/longitudinal designs) using valid measures/criteria to assess CHR-P and BPD (threshold/subthreshold) in clinical samples, reporting on CHR-P/psychotic symptoms and personality disorder(s) in the title/abstract/keywords, identified in Web of Science/PubMed/(EBSCO)PsycINFO until 23/08/2023.
    UNASSIGNED: 33 studies were included and categorized into four themes reflecting their respective clinical/research/preventive paradigm: (i) BPD as a comorbidity in CHR-P youth (k = 20), emphasizing early detection and intervention in psychosis; (ii) attenuated psychosis syndrome (APS) as a comorbidity among BPD inpatients (k = 2), with a focus on hospitalized adolescents/young adults admitted for non-psychotic mental disorders; (iii) mixed samples (k = 7), including descriptions of early intervention services and referral pathways; (iv) transdiagnostic approaches (k = 4) highlighting \"clinical high at risk mental state\" (CHARMS) criteria to identify a pluripotent risk state for severe mental disorders.
    UNASSIGNED: The scoping review reveals diverse approaches to clinical care for CHR-P and BPD, with no unified treatment strategies. Recommendations for future research should focus on: (i) exploring referral pathways across early intervention clinics to promote timely intervention; (ii) enhancing early detection strategies in innovative settings such as emergency departments; (iii) improving mental health literacy to facilitate help-seeking behaviors; (iv) analysing comorbid disorders as complex systems to better understand and target early psychopathology; (v) investigating prospective risk for BPD; (vi) developing transdiagnostic interventions; (vii) engaging youth with lived experience of comorbidity to gain insight on their subjective experience; (viii) understanding caregiver burden to craft family-focused interventions; (ix) expanding research in underrepresented regions such as Africa and Asia, and; (x) evaluating the cost-effectiveness of early interventions to determine scalability across different countries.
    UNASSIGNED: https://osf.io/8mz7a.
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  • 文章类型: Journal Article
    边缘性人格障碍(BPD)是一种常见的精神疾病,与自杀未遂的高风险相关,死于自杀,非自杀性自伤(NSSI)。系统全面地了解BPD与青少年自杀和自我伤害之间的联系对于有效的公共卫生预防策略至关重要。该协议概述了我们的方法来总结BPD诊断与自我伤害/自杀行为之间的关联的证据,包括自杀死亡。非致命的自杀企图,NSSI,和自我伤害行为通过系统评价和荟萃分析。
    该方案已注册(PROSPERO:CRD42022363329),并根据系统审查和荟萃分析方案的首选报告项目(PRISMA-P)-2015声明制定。我们将使用包括MEDLINE在内的电子数据库进行全面的文献检索,EMBASE,Scopus,WebofScience,CINHAL,和PsycINFO。审查将包括符合特定纳入标准的研究,并将使用多个数据库进行搜索。将使用基于异质性水平的固定效应或随机效应方法进行荟萃分析。必要时进行亚组分析和荟萃回归。
    这项研究是独一无二的,因为它是第一个这样的系统回顾和分析现有的文献在这一主题。这项研究的结果将为整体和不同亚组中这种关系的大小提供重要证据,可用于制定有效的预防和治疗策略。
    UNASSIGNED: Borderline personality disorder (BPD) is a common psychiatric disorder associated with a high risk of suicide attempts, death by suicide, and non-suicidal self-injury (NSSI). A systematic and comprehensive understanding of the link between BPD and suicide and self-injury in adolescents and young adults is crucial for effective public health prevention strategies. This protocol outlines our approach to summarize the evidence on the association between BPD diagnosis and self-injurious/suicidal behaviors including death by suicide, nonfatal suicide attempts, NSSI, and self-harm behavior through a systematic review and meta-analysis.
    UNASSIGNED: The protocol is registered (PROSPERO: CRD42022363329) and developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P)-2015 statement. We will conduct a comprehensive literature search using electronic databases including MEDLINE, EMBASE, SCOPUS, Web of Science, CINHAL, and PsycINFO. The review will include studies that meet the specific inclusion criteria and will be searched using multiple databases A meta-analysis will be conducted using a fixed-effects or random-effects approach based on the level of heterogeneity. Subgroup analysis and meta-regression will be performed if necessary.
    UNASSIGNED: This study is unique, as it is the first of its kind to systematically review and analyze the existing literature on this topic. The results of this study will provide important evidence on the magnitude of this relationship overall and in different subgroups, which can be used to inform the development of effective prevention and treatment strategies.
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  • 文章类型: Journal Article
    在这次审查中,良好的精神病管理(GPM)是否有足够的问题,或者足够好,从两个互补的角度考察证据基础。首先,作者回顾了调查GPM是否能减轻边缘性人格障碍症状的研究。在群体和个体水平上的分析表明,接受GPM的患者症状可能会减轻。第二,作者回顾了调查GPM变化发生过程的研究。研究表明,过程会朝着情绪平衡的方向变化,人际有效运作,并讨论了更加连贯和基于现实的自传叙事。为了充分回答GPM是否足够好的问题,需要更多的对照试验来证明有效性,变革的机制,以及在文化多样性人群中的广泛实施。
    In this review, the question of whether good psychiatric management (GPM) has a sufficient, or good-enough, evidence base is examined from two complementary perspectives. First, the author reviews research that has investigated whether GPM reduces symptoms of borderline personality disorder. Analyses at the group and individual levels have indicated that symptoms may decrease among patients receiving GPM. Second, the author reviews research that has investigated the processes through which change occurs in GPM. Studies that have shown process changes toward emotional balance, interpersonally effective functioning, and a more coherent and reality-based autobiographical narrative are discussed. To fully answer the question of whether GPM is good enough, more controlled trials are needed to demonstrate effectiveness, mechanisms of change, and broad implementation in culturally diverse populations.
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  • 文章类型: Systematic Review
    复杂的创伤后应激障碍(CPTSD)在国际疾病分类-11中的特征是影响失调,消极的自我概念,和关系受损,症状也出现在边缘性人格障碍(BPD)中。一些研究表明,CPTSD是一种独特的疾病,其他作为BPD的亚组或替代。目前尚无评论将CPTSD是否与BPD表现得过于相似而成为独立疾病的发现合并在一起。本文系统地回顾了这两种疾病的症状表现的异同。搜索了六个数据库(PsycINFO,EMBASE,PubMed,WebofScience,PsycEXTRA,和开放获取论文和论文),并对确定的论文进行了叙述式总结。大多数研究发现了CPTSD和BPD的不同特征。一项研究发现这些结构之间没有差异;然而,这使用了没有严重创伤的人群。CPTSD和BPD可以同时出现,这些人可能会经历更早和更频繁的人际创伤,并表现出更大的功能障碍。(PsycInfo数据库记录(c)2024APA,保留所有权利)。
    Complex posttraumatic stress disorder (CPTSD) is characterized in the International Classification of Diseases-11 by affect dysregulation, negative self-concept, and relationship impairments, symptoms also presented in borderline personality disorder (BPD). Some research shows CPTSD as a distinct disorder, others as a subgroup or a replacement for BPD. No review currently amalgamates the findings on whether CPTSD presents too similarly to BPD to be a standalone disorder. This article systematically reviewed similarities and differences in symptom presentations of the two disorders. Six databases were searched (PsycINFO, EMBASE, PubMed, Web of Science, PsycEXTRA, and Open Access Theses and Dissertations) and identified papers were summarized narratively. The majority of studies found distinct profiles for CPTSD and BPD. One study found no differences between the constructs; however, this used a population without severe trauma. CPTSD and BPD can present comorbidly, these individuals will have likely experienced earlier and more frequent interpersonal trauma and display greater functional impairment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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  • 文章类型: Journal Article
    心理治疗是大多数精神障碍的一线治疗方法,但它们的绝对结果(即,反应和缓解率)没有得到很好的研究,尽管这些信息与医疗保健用户相关,供应商和政策制定者。我们旨在检查八种精神疾病的心理治疗的绝对和相对结果:重度抑郁症(MDD),社交焦虑障碍,恐慌症,广泛性焦虑症(GAD),特定的恐惧症,创伤后应激障碍(PTSD),强迫症(强迫症),和边缘性人格障碍(BPD)。我们使用了Metapsy计划中包含的一系列实时系统评论(www。metapsy.org),有了一个共同的文献检索策略,纳入研究和数据提取,和分析的通用格式。文献检索在主要书目数据库中进行(PubMed,PsycINFO,Embase,和Cochrane受控试验登记册)至2023年1月1日。我们纳入了随机对照试验,比较了八种精神障碍中任何一种的心理治疗方法,由诊断性访谈确定,带有一个控制组(waitlist,照常护理,或药丸安慰剂)。我们进行了随机效应模型成对荟萃分析。主要结果是治疗和对照条件下的绝对反应率(基线和试验后症状减少至少50%)。次要结果包括反应的相对风险(RR),以及需要治疗的数量(NNT)。纳入的441项试验(33,881名患者)的随机效应荟萃分析显示,心理治疗的缓解率适中:MDD为0.42(95%CI:0.39-0.45);PTSD为0.38(95%CI:0.33-0.43);OCD为0.38(95%CI:0.30-0.47);0.38(95%CI:0.33-0.43);0.36(95%GphCI为大多数敏感性分析广泛支持这些发现。RR对所有疾病都很重要,除了BPD.我们的结论是,与对照条件相比,八种精神障碍的大多数心理治疗都是有效的,但绝对反应率是适度的。对于那些对一线治疗没有反应的人,需要更有效的治疗和干预措施。
    Psychotherapies are first-line treatments for most mental disorders, but their absolute outcomes (i.e., response and remission rates) are not well studied, despite the relevance of such information for health care users, providers and policy makers. We aimed to examine absolute and relative outcomes of psychotherapies across eight mental disorders: major depressive disorder (MDD), social anxiety disorder, panic disorder, generalized anxiety disorder (GAD), specific phobia, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and borderline personality disorder (BPD). We used a series of living systematic reviews included in the Metapsy initiative (www.metapsy.org), with a common strategy for literature search, inclusion of studies and extraction of data, and a common format for the analyses. Literature search was conducted in major bibliographical databases (PubMed, PsycINFO, Embase, and the Cochrane Register of Controlled Trials) up to January 1, 2023. We included randomized controlled trials comparing psychotherapies for any of the eight mental disorders, established by a diagnostic interview, with a control group (waitlist, care-as-usual, or pill placebo). We conducted random-effects model pairwise meta-analyses. The main outcome was the absolute rate of response (at least 50% symptom reduction between baseline and post-test) in the treatment and control conditions. Secondary outcomes included the relative risk (RR) of response, and the number needed to treat (NNT). Random-effects meta-analyses of the included 441 trials (33,881 patients) indicated modest response rates for psychotherapies: 0.42 (95% CI: 0.39-0.45) for MDD; 0.38 (95% CI: 0.33-0.43) for PTSD; 0.38 (95% CI: 0.30-0.47) for OCD; 0.38 (95% CI: 0.33-0.43) for panic disorder; 0.36 (95% CI: 0.30-0.42) for GAD; 0.32 (95% CI: 0.29-0.37) for social anxiety disorder; 0.32 (95% CI: 0.23-0.42) for specific phobia; and 0.24 (95% CI: 0.15-0.36) for BPD. Most sensitivity analyses broadly supported these findings. The RRs were significant for all disorders, except BPD. Our conclusion is that most psychotherapies for the eight mental disorders are effective compared with control conditions, but absolute response rates are modest. More effective treatments and interventions for those not responding to a first-line treatment are needed.
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