Borderline personality disorder

边缘性人格障碍
  • 文章类型: Published Erratum
    [这修正了文章DOI:10.3389/fpsyt.2024.1380532。].
    [This corrects the article DOI: 10.3389/fpsyt.2024.1380532.].
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  • 文章类型: Case Reports
    据报道,精神疾病与全身性炎症和自身免疫性疾病有关。抗磷脂综合征(APS)是一种罕见的疾病,在普通人群中的患病率和发病率知之甚少。病例报告描述了精神疾病和APS的共同发生。以前的病例报告表明,APS患者可能患有共病精神病,焦虑,抑郁症,和其他精神病。APS和精神疾病之间的联系,然而,在纵向研究中仍未得到充分研究。在这份报告中,我们介绍了一个40多岁的女性,她自愿进入精神科住院病房,在边缘性人格障碍的背景下治疗幻听。她报告了相当广泛的先前几种疾病的医疗和精神病史,肌肉骨骼损伤,和住院。由于巨大的社会压力和多种合并症,她可能更容易受到APS急性加重和短暂精神病发作的影响.在这个案例报告中,该患者有3例高凝状态事件的病史,随后不久就入院治疗.本报告强调了在患有精神疾病的患者中考虑诸如APS之类的全身性疾病的重要性。在精神病性发作的情况下,APS和伴随精神病的患者可能会从筛查APS耀斑中受益。
    Psychiatric disorders are reported to be associated with systemic inflammatory conditions and autoimmune diseases. Antiphospholipid syndrome (APS) is a rare condition with poorly understood prevalence and incidence in the general population. Case reports have described co-occurrences of psychiatric conditions and APS. Previous case reports have indicated that patients with APS can have comorbid psychosis, anxiety, depression, and other psychiatric conditions. The association between APS and psychiatric illness, however, remains under-investigated in longitudinal studies. In this report, we present the case of a woman in her 40s who was voluntarily admitted to the psychiatric inpatient unit for treatment of auditory hallucinations within the context of borderline personality disorder. She reported a rather extensive medical and psychiatric history of several previous illnesses, musculoskeletal injuries, and hospitalizations. Due to the significant social stress and multiple comorbidities, she may be at increased vulnerability to acute exacerbations of both APS and brief psychotic episodes. In this case report, the patient had a history of three hypercoagulability incidents that were shortly followed by psychiatric admissions. This report highlights the importance of considering systemic conditions such as APS in patients presenting with psychiatric illness. Patients with APS and concomitant psychosis may benefit from screening for APS flares in the case of a psychotic break.
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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
    早期生活逆境(ELA)的特征是在生命的早期阶段暴露于创伤事件,特别是涉及情感,童年时期的性和/或身体逆境。精神障碍受环境和生活方式相关风险因素(包括ELA)的强烈影响。然而,ELA与成人精神障碍风险之间的分子联系尚不完全清楚.有证据表明,调节基因表达的表观遗传过程会发生持久的变化,比如DNA甲基化,在连接ELA和精神障碍的生物学机制中发挥重要作用。根据最近的一项研究,在ELA的背景下,我们分析了一组精神疾病中血液中PXDN-cg10888111基因内特定CpG位点的DNA甲基化,即边缘性人格障碍(BPD),主要抑郁症(MDD)和社交焦虑症(SAD),及其对其发病机理的潜在贡献。我们发现,与ELA水平较低的患者相比,ELA水平较高的精神病患者存在明显的高甲基化,而健康对照个体的cg10888111甲基化不受ELA的影响。进一步的调查显示,这种影响是由MDD队列驱动的。在ELA的背景下,提供了三种精神障碍中血液中cg10888111DNA甲基化的直接比较,我们的结果表明PXDN调节在精神障碍发病机制中对ELA的反应中的作用,尤其是MDD。需要进一步的研究来验证这些结果并破译涉及ELA向成人精神障碍传播的相应生物网络。
    Early-life adversity (ELA) is characterized by exposure to traumatic events during early periods of life, particularly involving emotional, sexual and/or physical adversities during childhood. Mental disorders are strongly influenced by environmental and lifestyle-related risk factors including ELA. However, the molecular link between ELA and the risk of an adult mental disorder is still not fully understood. Evidence is emerging that long-lasting changes in the epigenetic processes regulating gene expression, such as DNA methylation, play an important role in the biological mechanisms linking ELA and mental disorders. Based on a recent study, we analyzed the DNA methylation of a specific CpG site within the gene PXDN-cg10888111-in blood in the context of ELA across a set of psychiatric disorders, namely Borderline Personality Disorder (BPD), Major Depressive Disorder (MDD) and Social Anxiety Disorder (SAD), and its potential contribution to their pathogenesis. We found significant hypermethylation in mentally ill patients with high levels of ELA compared to patients with low levels of ELA, whereas cg10888111 methylation in healthy control individuals was not affected by ELA. Further investigations revealed that this effect was driven by the MDD cohort. Providing a direct comparison of cg10888111 DNA methylation in blood in the context of ELA across three mental disorders, our results indicate the role of PXDN regulation in the response to ELA in the pathogenesis of mental disorders, especially MDD. Further studies will be needed to validate these results and decipher the corresponding biological network that is involved in the transmission of ELA to an adult mental disorder in general.
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  • 文章类型: Journal Article
    开发了临床高风险(CHR)方法,以通过检测精神病风险来预防精神病。CHR服务本质上是诊断性的,因此,合并症的适当管理是护理的核心部分。鉴别诊断在3种常见合并症中尤其具有挑战性,分裂型人格障碍(SPD),自闭症谱系障碍(ASD),和边缘性人格障碍(BPD)。现象学研究表明,“基本自我”的干扰可能会区分这些常见的合并症,并且可以通过Huber的基本症状(BS)概念来捕获。我们调查了BS是否在这些疾病中有所不同,并可能为符合CHR标准的年轻人提供鉴别诊断。
    来自NAPLS-3队列的符合CHR标准的685名参与者完成了精神分裂症倾向性工具的COGDIS项目,BS的度量,以及DSM-5(SCID-5)的结构化访谈。使用逻辑回归模型来研究COGDIS在SPD中的变化,ASD,还有BPD,同时控制年龄和SIPs阳性严重程度。
    符合COGDIS标准与SPD呈正相关(OR=1.72,CI=[1.31-2.28],P=.001),但不包括ASD和BPD。
    我们的结果表明,由COGDIS表示的“基本自我干扰”在SPD中有所不同,ASD,还有BPD.COGDIS可能有助于告知CHR服务中合并症的管理,通过提供对可能受益于特定疾病干预的微妙主观体验的洞察力。
    UNASSIGNED: The clinical-high-risk (CHR) approach was developed to prevent psychosis through the detection of psychosis risk. CHR services are transdiagnostic in nature, therefore the appropriate management of comorbidity is a central part of care. Differential diagnosis is particularly challenging across 3 common comorbidities, schizotypal personality disorder (SPD), autism spectrum disorder (ASD), and borderline personality disorder (BPD). Phenomenological research indicates a disturbance of \"basic self\" may differentiate between these commonly comorbid disorders and can be captured by Huber\'s basic symptoms (BS) concept. We investigated whether BS vary across these disorders and may inform differential diagnosis in young person\'s meeting CHR criteria.
    UNASSIGNED: A total of 685 participants meeting CHR criteria from the NAPLS-3 cohort completed the COGDIS items of the schizophrenia proneness instrument, a measure of BS, as well as the structured interview for DSM-5 (SCID-5). A logistic regression model was used to investigate the variation of COGDIS across SPD, ASD, and BPD, while controlling for age and SIPs positive severity.
    UNASSIGNED: Meeting COGDIS criteria was positively associated with SPD (OR = 1.72, CI = [1.31-2.28], P = .001) but not ASD nor BPD.
    UNASSIGNED: Our results indicate that \"basic self-disturbance\" as indicated by COGDIS differs across SPD, ASD, and BPD. COGDIS may be useful to inform the management of comorbidities in CHR services, by providing insight into subtle subjective experiences that may benefit from disorder-specific interventions.
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  • 文章类型: Journal Article
    背景:尽管是青少年中最流行的临界病理学指标之一,只有一项研究使用没有健康对照组的小样本(ChangB,夏普C,青少年住院儿童边缘人格特征量表的标准有效性。J个人异言。2011;25(4):492-503。https://doi.org/10.1521/pedi.2011.25.4.492.).本研究的目的是复制和改进Chang等人先前研究的局限性。为了更明确地建立BPFS-C的自我和父母报告版本的临床截止分数,以检测大量BPD青少年样本中的临床和亚临床边缘性人格障碍(BPD),其他精神病理学,也没有精神病理学.
    方法:共有900名12-17岁的青少年参加了这项研究。临床样本包括从住院精神病院招募的622名青少年,健康对照样本包括从社区招募的278名青少年。所有参与者都完成了BPFS-C,并接受了DSM-IV边缘性人格障碍(CI-BPD)的儿童访谈。
    结果:使用三向ROC分析,BPFS-C的自我和父母报告版本的截止分数,将患有BPD的青少年与患有亚临床BPD的青少年区分开来,并建立了来自健康青少年的亚临床BPD患者。
    结论:这些发现支持使用两种版本的BPFS-C来检测患有BPD和亚临床BPD的青少年。
    BACKGROUND: Despite being one of the most popular measures of borderline pathology in adolescents, only one study has evaluated clinical cut-off scores for the Borderline Personality Features Scale for Children (BPFS-C) using a small sample without a healthy comparison group (Chang B, Sharp C, Ha C. The Criterion Validity of the Borderline Personality Features Scale for Children in an Adolescent Inpatient Setting. J Personal Disord. 2011;25(4):492-503. https://doi.org/10.1521/pedi.2011.25.4.492 .). The purpose of the current study was to replicate and improve on the limitations of the prior study conducted by Chang et al. to more definitively establish clinical cut-off scores for the self- and parent-report versions of the BPFS-C to detect clinical and sub-clinical borderline personality disorder (BPD) in a large sample of adolescents with BPD, other psychopathology, and no psychopathology.
    METHODS: A total of 900 adolescents ranging from ages 12-17 participated in this study. The clinical sample consisted of 622 adolescents recruited from an inpatient psychiatric facility, and the healthy control sample consisted of 278 adolescents recruited from the community. All participants completed the BPFS-C and were administered the Child Interview for DSM-IV Borderline Personality Disorder (CI-BPD).
    RESULTS: Using three-way ROC analyses, cut-off scores on the self- and parent-report versions of the BPFS-C distinguishing adolescents with BPD from those with subclinical BPD, and those with subclinical BPD from healthy adolescents were established.
    CONCLUSIONS: These findings support the use of both versions of the BPFS-C to detect adolescents with BPD and sub-clinical BPD.
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  • 文章类型: Journal Article
    背景:归因是个体解释正面和负面事件原因的过程。适应不良的归因方式与自尊降低有关,社会心理功能,和心理健康。虽然许多心理社会干预针对精神障碍中的个人归因方式,对其在边缘性人格障碍(BPD)中的改变的研究很少。这项研究旨在调查BPD患者与健康对照者(HC)的归因方式及其与自尊和社会心理功能的关系。
    方法:参与者(32例诊断为BPD的患者,32HC,性别群体是平衡的,年龄和教育)评估了他们在控制源方面的归因风格,积极和消极情景的稳定性和全球性。在群体之间比较归因方式,并与自尊的自我报告相关联,在控制BPD和抑郁症状严重程度的同时,不同社会领域的孤独感和心理社会功能。
    结果:诊断为BPD的个体报告了阳性和阴性事件的适应不良归因方式。发现这与较低的自尊和较高的孤独感密切相关,但不是在不同的社会领域评估的心理社会功能障碍。BPD和抑郁症状的严重程度并不能完全解释归因方式与自尊和孤独感的关系。相比之下,纠正急性精神病理学实际上加强了自尊与适应不良推断积极事件因果关系之间的关系。
    结论:正面和负面事件的归因方式与自尊和社会心理功能的差异关联凸显了在社会心理干预中考虑因果关系推断的不同方面的重要性。我们的发现表明,认知改变的意义可能随着急性BPD和抑郁精神病理学的缓解而改变,取决于事件的效价。
    BACKGROUND: Attributions are the processes by which individuals explain the causes of positive and negative events. A maladaptive attributional style has been associated with reduced self-esteem, psychosocial functioning, and mental health. Although many psychosocial interventions target an individual\'s attributional style in mental disorders, studies of its alterations in Borderline Personality Disorder (BPD) are sparse. This study aimed to investigate the attributional style in patients with BPD in comparison to healthy control individuals (HC) and its association with self-esteem and psychosocial functioning.
    METHODS: The participants (32 patients with a diagnosis of BPD, 32 HC, groups were balanced for sex, age and education) assessed their attributional style in regard to locus of control, stability and globality for positive and negative scenarios. Attributional style was compared between groups and linked to self-reports of self-esteem, loneliness and psychosocial functioning in different social domains while controlling for BPD and depressive symptom severity.
    RESULTS: Individuals diagnosed with BPD reported a maladaptive attributional style for both positive and negative events. This was found to be strongly related with lower self-esteem and higher levels of loneliness, but not with psychosocial dysfunctions assessed in different social domains. The severity of BPD and depressive symptoms did not fully explain the association of attributional style with self-esteem and loneliness. In contrast, correcting for acute psychopathology actually strengthened the relationship between self-esteem and maladaptive inferring causality for positive events.
    CONCLUSIONS: The differential association of attributional style for positive and negative events with self-esteem and psychosocial functioning highlights the importance of considering the different facets of inferring causality during psychosocial interventions. Our findings suggest that the significance of cognitive alterations may change with remission of acute BPD and depressive psychopathology, depending on the valence of an event.
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  • 文章类型: Journal Article
    背景:双相情感障碍(BD)是一种严重的精神疾病。BD常与边缘性人格障碍并存,使情况变得更加复杂。
    目的:探讨BD患者与BD合并边缘性人格障碍患者认知功能损害的差异。
    方法:将80例BD合并边缘性人格障碍患者和80例单纯BD患者作为A组和B组,分别,80名健康志愿者作为对照.使用中文版的可重复电池评估每个组的认知功能,以评估神经心理学状态(RBANS),Stroop颜色词测试,和韦氏情报量表修订(WAIS-RC)。
    结果:RBANS的指数,Stroop颜色词测试,A、B组WAIS-RC明显低于对照组(P<0.05)。A组单个字符的Stroop颜色词测试时间明显更长,单色,双字符,和双色,即时记忆得分较低,视觉广度,RBANS的言语功能维度和总分,以及较低的言语智商,性能IQ,WAIS-RC总体智商与B组比较(P<0.05)。与B组相比,A组表现出明显更长的单字符时间,单色时间,双字符时间,Stroop颜色词检验中的双色时间(P<0.05)。
    结论:BD合并边缘性人格障碍患者的认知功能低于BD患者。
    BACKGROUND: Bipolar disorder (BD) is a severe mental illness. BD often coexists with borderline personality disorders, making the condition more complex.
    OBJECTIVE: To explore the differences in cognitive impairment between patients with BD and those with BD comorbid with borderline personality disorder.
    METHODS: Eighty patients with BD and comorbid borderline personality disorder and 80 patients with BD alone were included in groups A and B, respectively, and 80 healthy volunteers were included as controls. Cognitive function in each group was evaluated using the Chinese version of the repeatable battery for the assessment of neuropsychological status (RBANS), the Stroop color-word test, and the Wechsler intelligence scale-revised (WAIS-RC).
    RESULTS: The indices of the RBANS, Stroop color-word test, and WAIS-RC in groups A and B were significantly lower than those of the control group (P < 0.05). Group A had significantly longer Stroop color-word test times for single-character, single-color, double-character, and double-color, lower scores of immediate memory, visual breadth, verbal function dimensions and total score of the RBANS, as well as lower scores of verbal IQ, performance IQ, and overall IQ of the WAIS-RC compared with group B (P < 0.05). Compared to group B, group A exhibited significantly longer single-character time, single-color time, double-character time, and double-color time in the Stroop color-word test (P < 0.05).
    CONCLUSIONS: The cognitive function of patients with BD complicated with borderline personality disorder is lower than that of patients with BD.
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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
    背景:边缘性人格障碍(BPD)是一种严重的精神疾病,并发抑郁症和自杀率很高。尽管优化BPD治疗的重要性,关于神经过程与个体治疗反应的关系知之甚少。这项研究研究了在进行为期六个月的辩证行为疗法(DBT)或选择性5-羟色胺再摄取抑制剂(SSRI)治疗的随机临床试验后,情绪调节的功能磁共振成像(fMRI)任务期间基线区域脑血氧水平依赖性(BOLD)激活与治疗反应的关系。
    方法:未用药的BPD女性(N=37),最近的自杀行为或自我伤害,接受了功能磁共振成像任务,其中呈现了负面的个人记忆,并要求他们保持距离(即,下调他们的情绪反应)或沉浸(即自由体验情感)。然后患者随机接受DBT(N=16)或SSRI(N=21)治疗,评估基线和治疗后抑郁和BPD严重程度。
    结果:前额叶皮层的BOLD活动,前扣带,岛与距离有关。背外侧距离时的基线BOLD,腹外侧,和眶前额叶皮质(dlPFC,vlPFC,OFC)差异预测各治疗组的抑郁反应,在SSRI组中,活性越高,反应越好,较低的活性预测DBT组的反应更好。
    结论:所有女性样本。
    结论:研究结果表明,情绪调节期间更多的前额叶参与可能会预测SSRIs带来更多的抗抑郁益处,而较低的参与度可能预测对DBT的反应更好。这些结果表明SSRI和DBT治疗的不同作用机制,这可能允许fMRI指导个体化治疗选择。
    BACKGROUND: Borderline personality disorder (BPD) is a severe mental illness, with high rates of co-morbid depression and suicidality. Despite the importance of optimizing treatment in BPD, little is known about how neural processes relate to individual treatment response. This study examines how baseline regional brain blood oxygen level dependent (BOLD) activation during a functional magnetic resonance imaging (fMRI) task of emotion regulation is related to treatment response following a six-month randomized clinical trial of Dialectical Behavior Therapy (DBT) or Selective Serotonin Reuptake Inhibitor (SSRI) treatment.
    METHODS: Unmedicated females with BPD (N = 37), with recent suicidal behavior or self-injury, underwent an fMRI task in which negative personal memories were presented and they were asked to distance (i.e., downregulate their emotional response) or immerse (i.e., experience emotions freely). Patients were then randomized to DBT (N = 16) or SSRI (N = 21) treatment, with baseline and post-treatment depression and BPD severity assessed.
    RESULTS: BOLD activity in prefrontal cortex, anterior cingulate, and insula was associated with distancing. Baseline BOLD during distancing in dorsolateral, ventrolateral, and orbital prefrontal cortex (dlPFC, vlPFC, OFC) differentially predicted depression response across treatment groups, with higher activity predicting better response in the SSRI group, and lower activity predicting better response in the DBT group.
    CONCLUSIONS: All female samples.
    CONCLUSIONS: Findings indicate that greater prefrontal engagement during emotion regulation may predict more antidepressant benefit from SSRIs, whereas lower engagement may predict better response to DBT. These results suggest different mechanisms of action for SSRI and DBT treatment, and this may allow fMRI to guide individualized treatment selection.
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