Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:4.2.3.23 (GAS)
 957 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper reviews the current state of research results on borderline disorders in terms of course and outcome, variables predisposing to good or poor outcome, suicide rates and the influence of psychotherapeutical and pharmacotherapeutical strategies. It turned out that course and outcome of borderline disorders depend on the applied diagnostic criteria and on the length of the follow-up period. The outcome of the follow-up studies of borderline schizophrenia and of the borderline syndrome according to Grinker was on the whole worse compared to those of borderline personality disorder defined by DSM-III/III-R or DIB according to Gunderson or Kernberg's criteria. Further, it could be shown that the GAS or HSRS values of the short-term follow-up studies (up to five years) ranged from 46.4 to 59.2 points whereas those of the long-term studies with an average period of 13.6 till 20 years were measured in the lower and in the mid-60 s that reflects only mild difficulties in psychosocial functioning. However, the high rate of completed suicide in BPD was to be respected: The most extensive follow-up investigation with the highest trace-rate (PI-500) revealed a suicide rate of 9% till now, and the most lethal combination of circumstances was BPD x MAD x alcohol abuse (suicide rate of 38%). Prognostic factors predisposing to poor outcome were substance abuse, admixture with antisocial and schizotypal elements, chronic hostility and affective instability with depressive and anxious features. Prognostic factors predisposing to good outcome were high IQ, extraordinary talent, high attractiveness, likeability and regular appointments with the Alcoholics Anonymous. Finally, the influence of psycho- and pharmacotherapeutical interventions were controversially debated. Several psychodynamic therapy studies resulted in satisfactory outcome scores concerning a subgroup of patients with personality traits like warmth, likeability, reliability, talent. Behavioral treatment strategies such as dialectical behavior therapy by Linehan significantly diminished parasuicidality and impulsiveness. Psychopharmacotherapy should target predominating psychopathological features: Low-dose antipsychotics against micropsychosis and prolonged severe dissociative symptoms, SSRIs and MAOIs against affective instability, and, lithium, carbamazepine or valproate against severe impulsiveness and aggressiveness.
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PMID:[Outcome in borderline disorders. A literature review]. 1036 12

Efforts to identify reliable predictors of suicidal behavior in Borderline Personality Disorder have been confounded by the marked dimensional heterogeneity of the disorder, frequent comorbidity with other high risk disorders, debilitating social and vocational consequences of BPD over time. Using survival analyses, we assessed the predictive association between risk factors in each of these symptom domains and suicide attempts in BPD subjects followed for 12 months, 18-24 months and 2-5 years. The suicide attempt rate was 19% in the first year, 24.8% through the second year. The risk of suicidal behavior among 137 BPD subjects completing the first 12 months was increased by comorbid MDD and poor social adjustment. Outpatient treatment decreased short-term risk. Among 133 subjects completing 18-24 months in the study, the relative risk of a suicide attempt was increased by hospitalization (prior to any attempt), and poor social adjustment. Among 122 subjects followed for 2-5 years, increased risk was associated with hospitalization and medication visits (prior to any attempt), an attempt in the first year, and a low GAS score at baseline. Long term risk was decreased by "any outpatient treatment." Predictors of suicidal behavior in BPD change over time. MDD has a short-term effect on suicide risk, while poor social adjustment may increase risk throughout each follow-up interval. Assessing and supporting family, work, and social relationships may decrease suicidal behavior in BPD, and should be a principal focus of long-term treatment.
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PMID:Prospective predictors of suicide attempts in borderline personality disorder at one, two, and two-to-five year follow-up. 1918 9