Refining Borderline Personality Disorder Using Flexible Latent Variable Modeling

使用灵活的潜变量模型改善边缘性人格障碍

基本信息

批准号：
8145562
负责人：
Michael Nelson Hallquist
金额：
$ 5.29万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-09-01 至 2012-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8145562
关键词：
Accounting Address Adult Affect Affective Aggressive behavior Alcohols Applied Research Behavior Behavior Therapy Behavioral Behavioral Genetics Bipolar Disorder Borderline Personality Disorder Case Management Chronic Classification Clinical Clinical Research Comorbidity Complex Conceptions DSM-IV Data Data Set Databases Diagnosis Diagnostic Diagnostic and Statistical Manual Diffuse Dimensions Disease Distal Distress Emotions Epidemiologic Studies Epidemiology Failure Family Feedback Functional disorder Future Genetic Heritability Heterogeneity Housing Hybrids Individual Inpatients Intention Interview Longitudinal Studies Measures Mental disorders Methods Modeling Mood Disorders National Institute of Mental Health Neurobiology Outcome Outpatients Participant Pathology Patient Self-Report Patients Personality Personality Disorders Phenotype Population Prevalence Process Property Psyche structure Psychiatric therapeutic procedure Psychopathology Psychophysiology Quality of life Questionnaires Reaction Time Recommendation Recording of previous events Relative (related person)Research Resolution Respondent Sampling Selection Bias Self-Injurious Behavior Severities Simulate Source Speed Statistical Models Strategic Planning Structure Suicide Surveys Syndrome Taxonomy Testing Treatment Cost Treatment outcome Twin Multiple Birth Validation Work base clinically significant design disease classification disorder subtype effective therapy flexibility improved longitudinal course neuroimaging novel patient population public health relevance repaired response simulation suicidal tool trait treatment strategy

项目摘要

DESCRIPTION (provided by candidate): Borderline Personality Disorder (BPD) is a complex psychiatric disorder associated with subjective misery, poor quality of life, and chronic suicidality, with estimates of suicide completion as high as 10%. Because of aggressive, suicidal, and self-injurious behaviors, treatment utilization among BPD patients is significantly higher than patients with mood disorders or other personality disorders, resulting in significant treatment costs. Although this disorder affects 1-2% of the population, individuals with BPD account for 10-20% of all outpatients and 15% of inpatients. Despite the significant societal burden, subjective distress, and poor psychiatric outcomes associated with BPD, the phenotype is not well understood relative to other forms of psychopathology. Improving the construct validity of BPD has been impeded, in part, by the considerable heterogeneity reflected in theoretical conceptualizations and the DSM diagnostic criteria. Existing diagnostic criteria define a meaningful, but diffuse, construct and future research efforts will be impeded if patients are selected using these criteria alone. The proposed research seeks to refine the BPD phenotype by exploring additional clinical and experimental markers, as well as using flexible latent variable modeling and statistical simulation to clarify the classification of the disorder. This work will result in an empirically derived taxonomy of BPD consisting of traits, subtypes, or both, as well as data-based thresholds for identifying clinically significant borderline pathology. This research has the potential to identify more homogeneous groups of BPD patients, which will increase the resolving power and replicability of future empirical work. Additionally, clarifying the heterogeneity among BPD patients will improve future treatment research, as clinical strategies can be tailored better to individual patients. The specific aims are: 1) to assess the efficiency of extant analytic methods for resolving the latent structure of BPD using Monte Carlo simulation methods, 2) to clarify within-BPD heterogeneity using hybrid latent variable models that integrate continuous and categorical conceptions, and 3) to refine the BPD phenotype by exploring additional clinical and experimental markers. This proposed research will be conducted using two major epidemiological datasets (the National Comorbidity Survey Replication and the National Epidemiologic Survey on Alcohol and Related Conditions) and a large sample of 616 participants aggregated from five prior studies, approximately 25% of whom have BPD. In addition, an experimental psychopathology measure of rejection sensitivity will be developed and validated using a smaller sample of 168 adult participants, and this measure will be integrated into classification models. We expect that the DSM-IV BPD features are best described by a single continuous dimension of severity, but that subtypes of the disorder will be identified on the basis of additional markers, including aggression, mistrustfulness, preoccupied attachment, and rejection sensitivity. Competing dimensional, categorical, and integrative models will be tested. PUBLIC HEALTH RELEVANCE: Borderline Personality Disorder (BPD) is a complex psychiatric disorder associated with aggressive, suicidal, and self-injurious behaviors that often require intensive long-term treatment, resulting in significant treatment costs. Although this disorder is disproportionately represented in inpatient and outpatient settings relative to its prevalence in the population, patients diagnosed with this condition are so heterogeneous that it has been difficult to identify its causes or to design effective treatments. The proposed research seeks to refine the prevailing conception of BPD using sophisticated statistical models and epidemiological samples, which will permit better classification of BPD, resulting in improved treatment outcomes for patients.

描述（由候选人提供）：边缘性人格障碍（BPD）是一种复杂的精神障碍，与主观痛苦，生活质量差和慢性自杀相关，自杀的估计高达10％。由于侵略性，自杀和自我伤害行为，BPD患者的治疗利用显着高于情绪障碍或其他人格障碍的患者，导致巨大的治疗成本。尽管这种疾病影响了1-2％的人口，但BPD的个体占所有门诊病人的10-20％，15％的住院病人占了15％。尽管社会负担很大，主观困扰和与BPD相关的精神病结果差，但相对于其他形式的心理病理学，表型尚未得到很好的理解。在理论概念化和DSM诊断标准中反映的相当大的异质性，一定程度地阻碍了BPD的结构有效性。现有的诊断标准定义了一个有意义但分散，构造和未来的研究工作，如果仅使用这些标准选择患者。拟议的研究旨在通过探索其他临床和实验标记，并使用灵活的潜在可变建模和统计模拟来阐明该疾病的分类，从而完善BPD表型。这项工作将导致BPD的经验分类学分类法包括特征，亚型或两者兼而有之，以及基于数据的阈值，以识别临床上重要的边缘性病理学。这项研究有可能确定BPD患者的均匀群体，这将提高未来经验工作的解决能力和可复制性。此外，阐明BPD患者的异质性将改善未来的治疗研究，因为临床策略可以更好地针对个别患者定制。具体目的是：1）评估使用Monte Carlo模拟方法解决现有分析方法来解决BPD潜在结构的效率，2）使用混合潜在可变模型在BPD异质性内澄清，以整合持续和分类概念的混合可变模型，以及3）通过探索BPD现象的临时和实验标记。这项拟议的研究将使用两个主要的流行病学数据集（全国合并症调查复制和国家酒精及相关条件的国家流行病学调查），以及来自五项先前研究的616名参与者的大量样本，其中大约25％的BPD患有BPD。此外，将使用较小的168名成年参与者的样本来开发和验证一种实验性心理病理学测量，并将此措施集成到分类模型中。我们预计DSM-IV BPD特征最好通过一个连续的严重程度来描述，但是该疾病的亚型将根据其他标记，包括侵略性，不信任性，综合依恋和拒绝敏感性来识别该疾病的亚型。将测试竞争维度，分类和集成模型。公共卫生相关性：边缘性人格障碍（BPD）是一种复杂的精神障碍，与侵略性，自杀和自我伤害行为相关，通常需要大量的长期治疗，从而带来巨大的治疗费用。尽管这种疾病在住院和门诊环境中相对于人群的患病率不成比例，但诊断患有这种疾病的患者是如此异质，以至于很难识别其原因或设计有效的治疗方法。拟议的研究旨在使用复杂的统计模型和流行病学样本来完善BPD的主要概念，这将允许更好地分类BPD，从而改善患者的治疗结果。