Background:Using the same DSM-5 criteria as in adults, BPD in adolescents is defined as a 1-year pattern of immature personality development with disturbances in at least 5 of the 9 domains listed in the DSM-5. BPD can now be reliably diagnosed as young as 13 using one of several standardized clinician, or self-rated diagnostic instruments. Unfortunately published US and Canadian positions regarding pharmacological treatment have been, With regard to evidence-based studies, pharmacological treatment is not recommended and, if ultimately required, should be limited to second-generation antipsychotics. Fortunately, the last decade s extensive advancements in brain-mapping have provided more clarity about the various brain dysfunctions underlying the symptoms/traits presenting in BPD, providing new opportunities to address these primarily Fronto-Limbic dysfunctions neuropharmacologically and potentially, significantly ameliorate. Thus, in turn, likely enhancing the effectiveness of the newer available therapies.Objectives:The current study explores the feasibility of more effectively managing BPD symptoms/traits with a unique medication protocol consisting of two medications; an anticonvulsant (oxcarbazepine) and a dopaminergic (amantadine HCl), without use of an antipsychotic medication.Methods:Subjects were 147 females, ages 13-16, with the diagnosis of BPD treated with the described medication protocol in a residential facility. Positive outcome was described as achievement and maintenance of greater than 50% improvement from baseline admission state of functioning for 1 year. They were discharged when stable and having achieved greater than 50% improvement from baseline. Outpatient prescribers were requested to be compliant with the treatment protocol. However, some were non-compliant, substituting antipsychotic medication instead. Care givers were surveyed at 6 months and 1 year to determine whether their child was maintaining greater than 50% improvement.Results:The percent maintaining greater than 50% improvement was calculated for those whose caregivers reported continuation of the medications as prescribed, versus those whose prescribers changed the medications to the Community Standard. Of those compliant with the medication protocol, 61 of 86 (71%) maintained >50% improvement. Of those moved to the Community Standard approach, 19 of 61 (31%) maintained >50% improvement. Using Chi Square analysis, there was a significant relationship between maintenance of improvement and medication protocol compliance. Chi Square, Fisher’s exact test = p<0.001.Conclusion:The results indicate that, for adolescents 1 year post-discharge from residential treatment for BPD, continuation of the above described medication protocol provides significantly higher rates of maintenance of achieved symptom improvement. Further controlled studies are needed.Funding:None.

中文翻译：

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124 重新定义青少年边缘性人格障碍的诊断和治疗方法

背景：使用与成人相同的 DSM-5 标准，青少年的 BPD 被定义为 1 年的不成熟人格发展模式，在 DSM-5 中列出的 9 个领域中的至少 5 个领域存在障碍。现在可以使用几种标准化临床医生中的一种或自评诊断仪器可靠地诊断出年仅 13 岁的 BPD。不幸的是，美国和加拿大发表的关于药物治疗的立场是，关于循证研究，不推荐药物治疗，如果最终需要，应仅限于第二代抗精神病药物。幸运的是，过去十年在脑图谱上取得的广泛进步，让人们更清楚地了解了 BPD 症状/特征背后的各种脑功能障碍，为解决这些主要是额叶边缘功能障碍的神经药理学和潜在地显着改善提供了新的机会。因此，反过来，可能会提高新的可用疗法的有效性。一种抗惊厥药（奥卡西平）和一种多巴胺能药（盐酸金刚烷胺），不使用抗精神病药物。方法：受试者是 147 名女性，年龄在 13-16 岁，诊断为 BPD，在住宅设施中使用所述药物方案治疗。积极结果被描述为在 1 年内实现并维持从基线入院状态改善 50% 以上。他们在稳定并从基线改善超过 50% 时出院。要求门诊处方者遵守治疗方案。然而，有些人不依从，用抗精神病药物代替。在 6 个月和 1 年时对护理人员进行了调查，以确定他们的孩子是否保持超过 50% 的改善。结果：对于护理人员报告按规定继续用药的人，与那些处方者将药物更改为社区标​​准。在符合用药方案的患者中，86 人中有 61 人 (71%) 保持了 >50% 的改善。在转向社区标准方法的人中，61 人中有 19 人（31%）保持了 50% 以上的改善。使用卡方分析，维持改善与用药方案依从性之间存在显着关系。Chi Square，Fisher 精确检验 = p<0.001。结论：结果表明，对于 BPD 住院治疗出院后 1 年的青少年，继续上述药物方案可显着提高症状改善的维持率。需要进一步的对照研究。资金：无。