Please select the eligibility criteria that correspond to the clinical trial below.
Title: Changes in Methylation Status of BDNF Gene After Receiving Dialectical Behavior Therapy in Patients With Borderline Personality Disorder
Brief Summary: Borderline personality disorder (BPD) is a chronic and debilitating syndrome associated with considerable morbidity, mortality, and high rates of medical and psychiatric utilization services. Research focusing on finding a biological observable marker for the purpose of monitoring treatment effects has started to draw attention. Recent research has implicated that brain-derived neutrophilic factor (BDNF) might be a natural candidate for a biological correlate of early life stress. The alterations in levels of BDNF or BDNF methylation in BPD patients compared to general population, or pre- and post- psychotherapeutic treatment might indicate the consequence of epigenetic modification associated with stressful experience or suicide, and may later be able to explain the psychopathology or neuro-development of BPD.

Method: The investigators therefore propose this current randomized control trial to test whether epigenetic changes happen during and after DBT treatments, and not TAU. Proportions having suicide or non-suicidal self injurious behaviors will be followed and tested against changes in BDNF methylation levels. Other clinical symptoms will as be assessed, including suicidality, depression, hopelessness, quality of life, disability, service utilization, and function.

In the first to third years of this study, the investigators will aim to recruit 180 study and control subjects, to gather information, to collect biological samples, to give out one-year of psychotherapy per subject, to evaluate results before, during, and after treatment. In addition, the investigators also hope to explore the effects of known or unknown drugs associated with the change of DNA methylation at cell level.

Hypothesis:

Responders of participants who receive DBT will show greater decrease in BDNF methylation levels than patients receiving TAU.


Options:
A: Inclusion Criteria:

1. patients meeting DSM-IV criteria for borderline personality disorder,
2. 18-60 years of age
3. have had at least two episodes of suicidal or non-suicidal self-injurious episodes in the past 5 years
4. at least one of which is in the 3 months preceding enrollment
5. agreement to participate in evaluation of the program

Exclusion Criteria:

1. having a DSM-IV diagnosis of a psychotic disorder, bipolar I disorder, delirium, dementia, mental retardation, or a diagnosis of substance dependence in the preceding 30 days
2. living outside of Taipei area
3. having any serious medical condition likely to require hospitalization within the next year (e.g. cancer)
4. having plans to leave the Taipei area in the next 1 year
B: Inclusion Criteria:

* Diagnosis of AD
* Diagnosis of BPD

Exclusion Criteria:

* Serious or unstable medical condition
* Opiate dependence
* Major Axis I disorder (bipolar disorder, schizophrenia)
* Taking mood stabilizers and antipsychotic medications
* LFT abnormalities that do not exceed 3 times normal values
C: Inclusion Criteria:

* Patients admitted in the period of January 2013 until January 2014
* patients who fulfill the Diagnostic and Statistical Manual-IV Text Revision criteria for BPD,
* patients who have shown suicidal and/or self-harming behavior in the year preceding the admission/ start of DBT treatment, including the last month preceding baseline measurement,
* patients who show a severe level of borderline symptomatology ( \> 24 on the BPDSI),
* patients who are in sufficient command of the Dutch language

Exclusion Criteria::

* Intelligence Quotient \< 80,
* a chronic psychotic condition,
* bipolar disorder,
* hard drug abuse that requires inpatient detoxification,
* forced treatment framework,
* DBT in the year preceding intake.
D: Inclusion Criteria:

* Meets criteria for diagnosis of borderline personality disorder
* History of at least one suicide attempt or self-mutilation episode 12 months prior to study entry
* Experiences continued urges to self-mutilate or attempt suicide
* Stable living situation
* Use of effective birth control if sexually active
* Clinically stable enough to tolerate placebo condition
* Not participating in other forms of treatment during the study

Exclusion Criteria:

* Any current organic mental syndromes, lifetime schizophrenic or bipolar disorders, psychotic disorders, or mental retardation
* Inability to complete psychiatric interview due to lack of cooperation or lack of comprehension
* Unable to tolerate fluoxetine or DBT
* Currently receiving treatment for an acute medical illness or other debilitating problem, including substance abuse or anorexia nervosa
* History of major depression lasting more than 3 months
* Current Hamilton depression score above 22 and not receiving treatment
* Pregnant or breastfeeding

Answer: A