BMC Psychiatry最新文献

Background: Borderline personality disorder (BPD) is a significant cause of morbidity with no approved pharmacological treatment. We assessed treatment trajectories of patients with BPD in real-world clinical practice to help identify treatment gaps.

Methods: This retrospective, observational, cohort study used de-identified MindLinc electronic health records data from the Holmusk NeuroBlu database (Version 21R2) to analyse the treatment journey of patients with BPD (aged ≥ 12 years with ≥1 diagnosis of BPD) that were prescribed pharmacological treatment within 14 days of diagnosis (baseline) and had treatment data for ≥12 months.

Results: Of those prescribed pharmacological treatment at baseline, 1461 patients (16.1%) had 12 months of follow-up data. Antidepressants were the most frequently prescribed medication at baseline (80.4%) either alone or in combination with other medication classes, followed by second-generation antipsychotics (SGAs), anxiolytics and mood stabilisers. In the 12 months post-baseline, the most frequently recorded treatment pathway was a switch from 1 antidepressant to another. Sertraline (5.5%), fluoxetine (5%), and citalopram (5%) were the most-prescribed antidepressants; lamotrigine (24.9%), gabapentin (15.4%), and valproate (7.1%) were the most prescribed mood stabilisers; and quetiapine (22.1%) and aripiprazole (19.0%) were the most prescribed SGAs. Polypharmacy (defined as the prescription of ≥ 1 psychotropic medication) was observed in 83.1% of patients at baseline and increased with follow-up time and age.

Conclusion: The high rates of polypharmacy observed suggest that current clinical practices may not fully align with treatment guidelines for BPD, and that patients with BPD experience a considerable treatment burden. Limitations of this study include the absence of psychotherapy data and the use of prescription records without information on treatment adherence. Nonetheless, the diversity of treatment patterns observed reflects the complex symptomatology of BPD and highlights the need to deepen our understanding of its neurobiology to improve pharmacological treatment strategies and translate to meaningful patient outcomes.

Clinical trial number: Not applicable.

Objectives: To explore the efficacy and potential neurophysiological mechanisms of 77.5 Hz transcranial alternating current stimulation (tACS) in the treatment of female adolescent non-suicidal self-injury (NSSI).

Methods: Six female NSSI patients received 21 days of 77.5 Hz, 15 mA tACS treatments. Neuropsychological scales were assessed at baseline (W0), after treatment (W3), and 4-week (W7) and 8-week (W11) follow-ups. Transcranial magnetic stimulation with EEG evaluated changes in source-level brain activity and phase-synchronous functional connectivity. Mixed repeated-measures ANOVA with Bonferroni correction (p < 0.017) was used for behavioral data analysis to correct for multiple comparisons. Effect sizes (Cohen's d) was reported for all statistical results.

Results: Significant improvements were observed in depressive symptoms and self-injury behaviors after treatment (OSIC: W7: P = 0.009, Cohen's d=-1.682; HAMD-24: W3: P = 0.006, Cohen's d=-1.892; W7: P = 0.001, Cohen's d=-2.839; W11: P = 0.001, Cohen's d=-2.738; all P < 0.017). Electrophysiological analysis revealed that 77.5 Hz tACS might decrease Default network activity, increased Limbic, SalVAttn and Control network activity, and enhanced the functional connectivity in high-gamma band between Control and SalVAttn/Default network. A positive correlation was found between increased C100 activity in the SalVAttn (left frontal-insula) region and reduced HAMD-24 scores (R = 0.826, p = 0.043), this correlation analysis was based on a small sample size (n = 6), and the correlation coefficient was unstable, with results only for preliminary exploratory reference.

Conclusion: 77.5 Hz tACS may alleviate NSSI symptoms in female adolescents potentially by regulating brain activity and functional connectivity in emotional-control networks.