Adaptation of Interpersonal Psychotherapy to Borderline Personality Disorder: A Comparison of Combined Therapy and Single Pharmacotherapy

Abstract

W La Revue canadienne de psychiatrie, vol 55, no 2, février 2010 74Objective: Combined treatment with interpersonal psychotherapy (IPT) and antidepressants (ADs) has been found more effective than single pharmacotherapy in patients with major depression and concomitant borderline personality disorder (BPD). The aim of our study is to investigate whether combined treatment with a modified version of IPT is still superior to ADs when treating patients with a single diagnosis of BPD.Method: Fifty-five consecutive outpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnosis of BPD were enrolled. They were randomly assigned to 2 treatment arms for 32 weeks: fluoxetine 20 to 40 mg per day plus clinical management; and fluoxetine 20 to 40 mg per day plus IPT adapted to BPD (IPT-BPD). Eleven patients (20%) discontinued treatment owing to noncompliance. Forty-four patients completed the treatment period. They were assessed at baseline, and at week 16 and 32 with: a semi-structured interview for demographic and clinical variables; Clinical Global Impression Scale (CGI-S); Hamilton Depression Rating Scale (HDRS); Hamilton Anxiety Rating Scale (HARS); Social and Occupational Functioning Assessment Scale (SOFAS); BPD Severity Index (BPD-SI); and a questionnaire for quality of life (Satisfaction Profile [SAT-P]). A univariate general linear model was performed with 2 factors: duration and type of treatment. P values of less than 0.05 were considered significant. Results:Remission rates did not differ significantly between subgroups. Duration, but not type of treatment, had a significant effect on CGI-S, HDRS, SOFAS, and total BPD-SI score changes. Combined therapy was more effective on the HARS; the items: interpersonal relationships, affective instability, and impulsivity of BPD-SI; and the factors: psychological functioning and social functioning of SAT-P. Conclusions:Combined therapy with adapted IPT was superior to fluoxetine alone in BPD patients, concerning a few core symptoms of the disorder, anxiety, and quality of life.Can J Psychiatry. 2010;55(2):74-81. Clinical Implications· IPT adapted to BPD can be an efficacious model of intervention that responds to the growing demand for manualized and time-limited treatment of BPD patients. · Pharmacotherapy (selective serotonin reuptake inhibitors) and combined treatment with IPT-BPD are both efficacious in treating BPD patients without Axis I comorbidity. · Combined treatment with IPT-BPD is more efficacious than single pharmacotherapy on a few core symptoms of BPD, anxiety symptoms, and subjective quality of life. Limitations· Owing to the exclusion of patients with Axis I comorbidity, clinical characteristics of our BPD patients can be different from clinical practice. · Assessment scales did not include an assessment instrument designed to investigate the specific mechanisms of action of IPT on BPD psychopathology. · This initial trial of IPT-BPD did not include intention-to-treat analyses.

Combined treatment of borderline personality disorder with interpersonal psychotherapy and pharmacotherapy: Predictors of response

“…We analyzed data concerning the twenty-seven patients allocated to the arm of combined therapy in our previous study (Bellino et al, 2010). Five drop-outs (18.5% of the initial sample) were due to non-compliance.…”

“…The present study is a further evaluation of the same BPD patients already included in our previous investigation (Bellino et al, 2010). The subgroup of twenty-seven patients randomly allocated to combined therapy with fluoxetine 20 to 40 mg/day plus IPT adapted to BPD was analyzed.…”

“…The aim of the present study was to examine what demographical and clinical characteristics predicted response to combined therapy with IPT-BPD in the sample of BPD patients assessed in our previous study of efficacy (Bellino et al, 2010). Our hypothesis is that the association of the two treatments has more chances to induce a clinical response in patients with specific BPD symptoms, independently of general psychopathology and symptoms of anxiety and depression.…”

“…As for transference focused therapy (Clarkin et al, 2007;Yeomans et al, 2007), efficacy in BPD patients can be questioned as results of two controlled trials lead to divergent conclusions (Doering et al, 2010;Giesen-Bloo, 2006). A recent addition to these proposals is represented by interpersonal psychotherapy adapted to BPD (IPT-BPD), an intervention specifically designed for BPD patients to deal with problems in interpersonal contexts (Markowitz, 2005;Markowitz et al, 2006;Bellino et al, 2010). …”

“…In a randomized controlled study (Bellino et al, 2010) we compared single pharmacotherapy with fluoxetine 20-40 mg/day and combined therapy with IPT-BPD plus fluoxetine at the same dose in a sample of BPD outpatients with no psychiatric comorbidity. Results highlighted that combined therapy with IPT-BPD was superior than fluoxetine monotherapy with respect to three of the core symptoms of BPD (interpersonal relationships, affective instability, and impulsivity), anxiety symptoms and subjective quality of life (subjective perception of psychological and social functioning).…”