INTRODUCTION Borderline personality disorder (BPD) is a severe and prevalent psychiatric disorder. Mentalization-based therapy (MBT) is an evidence-based intervention for BPD, and several countries offer treatment programs for BPD lasting for years, which is resource demanding. No previous trial has compared short-term with long-term MBT. OBJECTIVE The aim of the study was to assess the efficacy and safety of short-term versus long-term MBT for outpatients with BPD. METHODS Adult outpatients (≥18 years) with subthreshold or diagnosed BPD were randomly assigned (1:1) to short-term MBT (5 months) or long-term MBT (14 months). The primary outcome was BPD symptoms assessed with the Zanarini Rating Scale for Borderline Personality Disorder. Secondary outcomes were functional impairment, quality of life, global functioning, and severe self-harm. All outcomes were primarily assessed at 16 months after randomization. This trial was prospectively registered at ClinicalTrials.gov, NCT03677037. RESULTS Between October 4, 2018, and December 3, 2020, we randomly assigned 166 participants to short-term MBT (n = 84) or long-term MBT (n = 82). Regression analyses showed no evidence of a difference when assessing BPD symptoms (MD 0.99; 95% CI: -1.06 to 3.03; p = 0.341), level of functioning (MD 1.44; 95% CI: -1.43 to 4.32; p = 0.321), quality of life (MD -0.91; 95% CI: -4.62 to 2.79; p = 0.626), global functioning (MD -2.25; 95% CI: -6.70 to 2.20; p = 0.318), or severe self-harm (RR 1.37; 95% CI: 0.70-2.84; p = 0.335). More participants in the long-term MBT group had a serious adverse event compared with short-term MBT (RR 1.63; 95% CI: 0.94-3.07; p = 0.088), primarily driven by a difference in psychiatric hospitalizations (RR 2.03; 95% CI: 0.99-5.09; p = 0.056). CONCLUSION Long-term MBT did not lead to lower levels of BPD symptoms, nor did it influence any of the secondary outcomes compared with short-term MBT.

中文翻译：

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边缘性人格障碍的短期与长期基于心理化的治疗：随机临床试验（MBT-RCT）。

简介 边缘性人格障碍（BPD）是一种严重且普遍的精神疾病。基于心理化的治疗（MBT）是一种针对边缘性人格障碍的循证干预措施，一些国家为边缘性人格障碍提供了持续数年的治疗方案，这需要大量的资源。之前没有任何试验对短期和长期 MBT 进行比较。目的 本研究的目的是评估短期与长期 MBT 对 BPD 门诊患者的疗效和安全性。方法 将阈下或诊断为 BPD 的成人门诊患者（≥18 岁）随机分配（1:1）至短期 MBT（5 个月）或长期 MBT（14 个月）。主要结果是使用 Zanarini 边缘性人格障碍评定量表评估 BPD 症状。次要结局是功能障碍、生活质量、整体功能和严重自残。所有结局均在随机分组后 16 个月时进行初步评估。该试验预期注册于临床试验网，NCT03677037。结果 2018 年 10 月 4 日至 2020 年 12 月 3 日期间，我们将 166 名参与者随机分配至短期 MBT（n = 84）或长期 MBT（n = 82）。回归分析显示，在评估 BPD 症状（MD 0.99；95% CI：-1.06 至 3.03；p = 0.341）和功能水平（MD 1.44；95% CI：-1.43 至 4.32；p = 0.321）时，没有证据表明存在差异。 、生活质量（MD -0.91；95% CI：-4.62 至 2.79；p = 0.626）、整体功能（MD -2.25；95% CI：-6.70 至 2.20；p = 0.318）或严重自残（ RR 1.37；95% CI：0.70-2.84；p = 0.335）。与短期 MBT 相比，长期 MBT 组中有更多参与者出现严重不良事件（RR 1.63；95% CI：0.94-3.07；p = 0.088），这主要是由于精神病住院治疗的差异（RR 2.03；95） % CI：0.99-5.09；p = 0.056）。结论 与短期 MBT 相比，长期 MBT 不会降低 BPD 症状，也不会影响任何次要结果。