Integrated treatment for patients with comorbid depression and personality disorders

Van, Henricus L.; Kool, Marit

doi:10.1097/yco.0000000000000557

Cited by 6 publications

(5 citation statements)

References 32 publications

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“…However, we cannot draw any conclusions with regard to the exact costs that were attributable to combination or more intensive treatment in case of comorbidities. Given the excess costs and care utilization, disease management programs should target both PD and MDD, maybe more than is currently done, for example, integrated treatment or combined treatment instead of several disorderspecific or consecutive treatments [44]. Conceptualizing and treating MDD as an isolated disorder may underestimate the prognosis of the majority of patients and the type of care that is appropriate [45].…”

Section: Discussionmentioning

confidence: 99%

Real-World Treatment Costs and Care Utilization in Patients with Major Depressive Disorder With and Without Psychiatric Comorbidities in Specialist Mental Healthcare

et al. 2021

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Background The majority of patients with major depressive disorder (MDD) have comorbid mental conditions. Objectives Since most cost-of-illness studies correct for comorbidity, this study focuses on mental healthcare utilization and treatment costs in patients with MDD including psychiatric comorbidities in specialist mental healthcare, particularly patients with a comorbid personality disorder (PD). Methods The Psychiatric Case Register North Netherlands contains administrative data of specialist mental healthcare providers. Treatment episodes were identified from uninterrupted healthcare use. Costs were calculated by multiplying care utilization with unit prices (price level year: 2018). Using generalized linear models, cost drivers were investigated for the entire cohort. Results A total of 34,713 patients had MDD as a primary diagnosis over the period 2000-2012. The number of patients with psychiatric comorbidities was 24,888 (71.7%), including 13,798 with PD. Costs were highly skewed, with an average ± standard deviation cost per treatment episode of €21,186 ± 74,192 (median €2320). Major cost drivers were inpatient days and daycare days (50 and 28% of total costs), occurring in 12.7 and 12.5% of episodes, respectively. Compared with patients with MDD only (€11,612), costs of patients with additional PD and with or without other comorbidities were, respectively, 2.71 (p < .001) and 2.06 (p < .001) times higher and were 1.36 (p < .001) times higher in patients with MDD and comorbidities other than PD. Other cost drivers were age, calendar year, and first episodes. Conclusions Psychiatric comorbidities (especially PD) in addition to age and first episodes drive costs in patients with MDD. Knowledge of cost drivers may help in the development of future stratified disease management programs.

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Section: Discussionmentioning

confidence: 99%

Real-World Treatment Costs and Care Utilization in Patients with Major Depressive Disorder With and Without Psychiatric Comorbidities in Specialist Mental Healthcare

et al. 2021

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“…Depression is characterized by the experience of persistent negative emotions (e.g., low mood, hopelessness) and difficulties managing, appraising, and coping with such challenging emotions (Otte et al, 2016 ). Depression contributes substantially to the global burden of disease (Lépine & Briley, 2011 ), and is a commonly occurring comorbid condition that develops alongside other psychiatric disorders (Aina & Susma, 2006 ; Conner et al, 2009 ; Van & Kool, 2020 ), as well as chronic medical conditions (e.g., Nouwen et al, 2019 ). Further, depressed mood is associated with poorer quality of life, reduced social functioning, and poorer vocational functioning (Greenberg et al, 2003 ; Kupferberg et al, 2016 ).…”

Section: Dt and Depressionmentioning

confidence: 99%

The relationship between distress tolerance and symptoms of depression: Validation of the Distress Tolerance Scale (DTS) and short‐form (DTS‐SF)

2022

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Objective: Distress tolerance (DT) has been found to be implicated in the development and maintenance of depressive symptomatology and various other significant psychological conditions. As such, it is critical to have measures of DT that are effective and easy to administer. This study aimed to examine the factor structure, psychometric properties, and clinical utility of the Distress Tolerance Scale (DTS) and the short‐form version, the Distress Tolerance Scale Short‐form (DTS‐SF), in a large population of individuals with varying levels of self‐reported depressive symptoms. Method: A total of 959 participants completed an online battery of questionnaires which included an assessment of depressive symptoms as well as the DTS and related measures. Results: Confirmatory factor analyses validated the four‐factor structure of the DTS and the one‐factor structure of the DTS‐SF. Good construct validity and good internal consistency were observed across both the DTS and DTS‐SF. Conclusion: Overall, this paper provides new evidence for the validity, reliability and discriminative ability of the DTS and the brief version of the questionnaire, the DTS‐SF.

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“…Treatment studies have led to optimism about the prognosis of personality disorder, but factor analytic studies have failed to support the DSM's putative personality disorder structure producing little evidence that BPD is a categorically defined diagnosis [10]. Comorbid PDs are frequent in patients with depression and they are consistently associated with a higher burden of psychopathology, more psychosocial impairment and poorer treatment response [11]. Most treatments for personality disorders are based on a duration of at least 1 year and session intensity enhances effectiveness in depression (twice-weekly sessions are preferable to sessions once a week) [11].…”

Section: Contemporary Psychological Perspectivesmentioning

confidence: 99%

“…Comorbid PDs are frequent in patients with depression and they are consistently associated with a higher burden of psychopathology, more psychosocial impairment and poorer treatment response [11]. Most treatments for personality disorders are based on a duration of at least 1 year and session intensity enhances effectiveness in depression (twice-weekly sessions are preferable to sessions once a week) [11]. A randomized clinical trial (RCT) is currently being conducted to compare 25 versus 50 sessions of either psychodynamic or schema therapy in a sample of patients with comorbid personality disorders and depression [12].…”

Section: Contemporary Psychological Perspectivesmentioning

confidence: 99%

Contemporary psychological perspectives of personality disorders

Marčinko

Jakšić

Filipčić

et al. 2021

Current Opinion in Psychiatry

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Purpose of review The aim of this study was to review the recent literature on contemporary psychological perspectives of personality disorders, including novel psychotherapeutic interventions aimed at these vulnerable individuals. Recent findings Among the various psychological theories and models of personality disorders, still the most popular and researched are psychodynamic, cognitive and interpersonal perspectives. More specifically, object relations theory, cognitive schema conceptualization and interpersonal circumplex model have produced the most empirical investigations of personality disorders in recent years. Latest work has suggested that all three perspectives have contributed to and are compatible with the dimensional personality disorders framework in DSM-5-AMPD and ICD-11 (including level of personality functioning and personality traits). These models have yielded specific psychological treatments of personality disorders; although most psychotherapies have been constructed for patients with borderline personality disorder (BPD), there is an increasing number of treatment modalities aimed at individuals with other forms of personality disorder, such as those with narcissistic or antisocial traits/disorders. More research into their effectiveness and long-term benefits is necessary. Summary Novel research keeps updating our knowledge on the cause, manifestations and psychological treatments of personality disorders, particularly from psychodynamic, cognitive and interpersonal perspectives.

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Integrated treatment for patients with comorbid depression and personality disorders

Cited by 6 publications

References 32 publications

Real-World Treatment Costs and Care Utilization in Patients with Major Depressive Disorder With and Without Psychiatric Comorbidities in Specialist Mental Healthcare

Real-World Treatment Costs and Care Utilization in Patients with Major Depressive Disorder With and Without Psychiatric Comorbidities in Specialist Mental Healthcare

The relationship between distress tolerance and symptoms of depression: Validation of the Distress Tolerance Scale (DTS) and short‐form (DTS‐SF)

Contemporary psychological perspectives of personality disorders

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