Prävalenz und Phänomenologie fraglich psychotischer Symptome bei Borderline Persönlichkeitsstörungen

Zusammenfassung

Hintergrund Eine Subgruppe von Patientinnen mit Borderline Persönlichkeitsstörung (BPS) berichtet von fraglich psychotischen Symptomen. Die Angaben zur Häufigkeit variieren beträchtlich (bis zu 50% Betroffene). Untersuchungen in Deutschland stehen bislang aus. Weiterhin sind die genaue Phänomenologie dieser Symptome und die Auswirkungen auf Suizidalität und Inanspruchnahme stationärer psychiatrischer Behandlung bisher unklar.

Ziel der Arbeit Es erfolgte die Untersuchung der Prävalenzen und Phänomenologie der fraglich psychotischen Symptome. Assoziationen zwischen letzteren und Suizidalität sowie Inanspruchnahme stationärer psychiatrischer Behandlung wurden unter Berücksichtigung weiterer Einflussfaktoren überprüft.

Methodik Fraglich psychotische Symptome wurden bei 95 BPS-Patientinnen mit dem Strukturierten Klinischen Interview-I erhoben. Zur Überprüfung der Assoziationen zwischen diesen Symptomen und Suizidalität sowie Inanspruchnahme stationärer psychiatrischer Behandlung wurden Korrelations- und Regressionsanalysen berechnet. PTBS-Symptomatik, Ausprägung der BPS und Depressivität wurden berücksichtigt.

Ergebnisse 36% der Pat. berichteten von vielgestaltigen und langanhaltenden Wahrnehmungsveränderungen (WV) und 21% von ebensolchen Wahnvorstellungen. Die Anzahl der Suizidversuche war mit Wahnerleben, WV und Schwere der PTBS-Symptomatik, Ausprägung der BPS und Depressivität assoziiert. 25,8% der Varianz zur Vorhersage der Anzahl der Suizidversuche wurde durch Wahnerleben und PTBS-Symptomschwere erklärt. Für das Alter bei Ersthospitalisation zeigten sich weniger und für die Anzahl der Hospitalisationen keine Assoziationen.

Diskussion Fraglich psychotische Symptome sollten nicht trivialisiert werden, was möglicherweise durch die Nutzung von Begrifflichkeiten wie Pseudohalluzinationen oder vorübergehende paranoide Vorstellungen geschieht und können insbesondere mit Suizidalität assoziiert sein, wodurch das klinische Bild erschwert wird.

Abstract

Background Psychotic-like symptoms are found in a subgroup of borderline patients (BPD). Reported prevalence is heterogeneous (up to 50% affected). Investigations in Germany have not been conducted so far. Furthermore, the precise phenomenology of the psychotic symptoms and the effects on suicidal behavior and the use of inpatient psychiatric treatment are unclear.

Objectives The aim of the study was to investigate prevalence rates and phenomenology of psychotic-like symptoms. Associations between the latter and suicidality as well as the use of inpatient psychiatric treatment were examined. Further influencing factors were taking into account.

Methods Psychotic-like symptoms were assessed with the Structured Clinical Interview-I in 95 BPD patients. To investigate the associations between psychotic-like symptoms and suicidality as well as the use of inpatient psychiatric treatment, correlation and regression analyzes were calculated, considering severity of PTSD, BPD and depression.

Results 36% of the patients reported alterations of perception and 21% delusions, both multiform and long lasting. The number of suicide attempts was associated with delusions, alterations of perception and severity of PTSD, BPS, and depression. Only delusions and severity of PTSD explained together 25.8% of the variance for the prediction of the number of suicide attempts. Age of initial hospitalization showed fewer and number of hospitalizations no associations at all.

Discussion Psychotic-like symptoms should not be trivialized, which may happen by using terms such as pseudo-hallucinations or transient paranoid ideas, and may be particularly associated with suicidal tendencies complicating the clinical course.

Schlüsselwörter

Borderline Persönlichkeitsstörung - psychotische Symptome - Wahn - Suizidalität - Wahrnehmungsveränderungen

Key words

psychotic symptoms - delusion - suicidality - alterations of perception - borderline personality disorder

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