背景:据报道,患有反社会人格障碍(ASPD)和边缘性人格障碍(BPD)的人具有高度精神病性,对治疗工作构成严峻挑战。在这些人的样本中,两种治疗的效果,基于心理的治疗(MBT)和统一协议(UP),对三个结果进行了调查:(I)精神病特质领域,三位一体精神病模型(TPM)提出的大胆和抑制;(ii)反社会和临界症状严重程度;(iii)其共同特征的严重程度,包括冲动,愤怒的表达和自我伤害。
方法:对163名BPD+ASPD患者进行筛选,55例随机接受MBT治疗,53例随机接受UP治疗。以6个月至36个月的间隔评估治疗结果。
结果:两种治疗方法的精神病特征均出现短期减少,反社会和边缘性人格症状的严重程度,愤怒失调,冲动和自我伤害,但两个治疗组在36个月随访时症状几乎完全复发.UP比MBT具有更持久的效果。
结论:尽管治疗时间相当短,UP至少与MBT一样有效,并且在某些方面更优越。从长远来看,任何一种治疗都无法缓解症状。与之相关的精神病和边缘/反社会合并症在某种程度上可以通过心理治疗来补救,但只是在短期内。
结论:冲动性和去抑制性高的患者在心理治疗后可能复发,治疗后应密切监测。
BACKGROUND: Those with cooccurring antisocial personality disorder (ASPD) and borderline personality disorder (BPD) are reported to be highly psychopathic and to represent a severe challenge to treatment efforts. In a sample of such individuals, the effects of two treatments, mentalization-based therapy (MBT) and the unified protocol (UP), were investigated on three outcomes: (i) the psychopathy trait domains of meanness, boldness and disinhibition proposed by the triarchic psychopathy model (TPM); (ii) antisocial and borderline symptom severity; and (iii) the severity of their common features including impulsivity, anger expression and self-harm.
METHODS: Of 163 individuals with BPD + ASPD screened for eligibility, 55 were randomized to MBT treatment and 53 to UP treatment. Outcomes of treatment were assessed at 6-month intervals to 36 months.
RESULTS: Short-term reductions were seen following both treatments in traits of psychopathy, antisocial and borderline personality symptom severity, anger dysregulation, impulsivity and self-harm, but both treatment groups showed almost complete relapse of symptoms at the 36-month follow-up. UP had more durable effects than MBT.
CONCLUSIONS: Despite being a considerably shorter treatment, UP was at least as effective as MBT and in some respects superior. Remission of symptoms was not achieved by either treatment in the long term. Psychopathy and borderline/antisocial comorbidity with which it is associated are to some extent remediable through psychotherapy, but only in the short term.
CONCLUSIONS: Patients with high levels of impulsivity and disinhibition are likely to relapse following psychotherapy and should be closely monitored after treatment.