Comparing Treatments for Self-Injury and Suicidal Behavior in People With Borderline Personality Disorder
|ClinicalTrials.gov Identifier: NCT00834834|
Recruitment Status : Completed
First Posted : February 3, 2009
Results First Posted : August 18, 2017
Last Update Posted : August 18, 2017
|Condition or disease||Intervention/treatment||Phase|
|Borderline Personality Disorder Suicide||Drug: Fluoxetine Behavioral: DBT Drug: Citalopram||Phase 4|
Borderline personality disorder (BPD) is a chronic disorder in emotional regulation and is characterized by instability in self-image, mood, relationships, and behavior. People suffering from BPD have a high rate of self-injury and suicide attempts. This study will compare the effectiveness of two treatments for preventing self-injury and suicide in people with BPD: dialectical behavior therapy (DBT) and fluoxetine with clinical management. DBT is a behavioral therapy that teaches new coping skills to replace old strategies, including self-injury and attempted suicide. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) medication that has been used to treat BPD. Clinical management of fluoxetine, which is involved in administering the medication under normal conditions, refers to regular visits with a psychiatrist who will monitor medication effectiveness and side effects. Clinical management in this study may include adjusting the dosage of fluoxetine or prescribing a change in medication to citalopram, another SSRI.
Participation in this study will last 12 months, including all follow-up assessments. During the first study visit, participants will undergo baseline testing and be randomly assigned to receive either DBT or fluoxetine with clinical management. After a washout period, in which participants will transition off any medications they are currently taking, participants will receive 6 months of their assigned treatment. Participants receiving DBT will attend one 60-minute individual therapy session and one 90-minute group session every week. Participants assigned to the fluoxetine with clinical management condition will begin receiving 20 mg of fluoxetine daily and have their dose increased over the course of 4 weeks, based on tolerance, up to 40 mg. Participants assigned to fluoxetine may also be switched to citalopram, if the study psychiatrist thinks it will be more effective. Participants assigned to either fluoxetine or citalopram will undergo monthly blood tests to monitor the level of medication in their bodies.
Every 2 weeks, participants will undergo assessments of treatment effectiveness and side effects. After 2, 4, 6, 9, and 12 months, participants will undergo various neuropsychological tests and clinical interviews and self-report questionnaires about mood and life experiences. At study entry and at Weeks 12 and 24, participants will use a handheld computer to complete a week-long assessment of emotions. Fully healthy female participants will be asked to complete a functional magnetic resonance imaging (fMRI) scan, which will assess their ability to regulate emotions at the neural level. The fMRI scan and a stress test (for both men and women) will be performed at baseline and after 6 months.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||84 participants|
|Intervention Model:||Parallel Assignment|
|Official Title:||Treating Suicidal Behavior and Self-Mutilation in Borderline Personality Disorder: Predictors of Change|
|Study Start Date :||March 2009|
|Primary Completion Date :||August 2015|
|Study Completion Date :||August 2015|
Active Comparator: Fluoxetine
Participants will receive fluoxetine with clinical management, which may involve switching medication to citalopram, another SSRI.
Starting dose of 20 mg daily will increase over 4 weeks, depending on tolerability, up to 40 mg daily. Treatment will last 6 months.
Other Name: ProzacDrug: Citalopram
Dose set by study psychiatrist, up to 60 mg daily. Treatment will last 6 months.
Other Name: Celexa
Active Comparator: Dialectical behavior therapy
Participants will receive dialectical behavioral therapy (DBT).
One 60-minute individual therapy session and one 90-minute group therapy session every week. Treatment will last 6 months.
- Suicide Events [ Time Frame: Measured after 6 months of treatment ]Data on suicidal behavior was collected with the Columbia Suicide History Interview (CSHI), a semi-structured interview developed by our group. It is used to elicit history of the individual's actual suicide attempts , as well as specific questions concerning the circumstances surrounding any suicidal behavior and its degree of medical lethality. In addition to obtaining measurements of actual suicide attempts, the CSHI also captures suicide-related behaviors such as aborted and interrupted suicide attempts. An actual suicide attempt is operationally defined by the CSHI as a self-injurious act performed with at least some intent to die.
- Number of Participants With Suicide Events [ Time Frame: measured after 6 months of treatment ]Data on suicidal behavior was collected with the Columbia Suicide History Interview (CSHI), a semi-structured interview developed by our group. It is used to elicit history of the individual's actual suicide attempts , as well as specific questions concerning the circumstances surrounding any suicidal behavior and its degree of medical lethality. In addition to obtaining measurements of actual suicide attempts, the CSHI also captures suicide-related behaviors such as aborted and interrupted suicide attempts. An actual suicide attempt is operationally defined by the CSHI as a self-injurious act performed with at least some intent to die.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00834834
|United States, New York|
|New York State Psychiatric Institute|
|New York, New York, United States, 10032|
|Principal Investigator:||Barbara H. Stanley, PhD||New York State Psychiatric Institute|