Outpatient Psychotherapy for Borderline Personality Disorder

Giesen-Bloo, Josephine; Dyck, Richard van; Spinhoven, Philip; Tilburg, W. van; Dirksen, Carmen D.; Asselt, Thea van; Kremers, Ismay; Nadort, Marjon; Arntz, Arnoud

doi:10.1001/archpsyc.63.6.649

Cited by 1,090 publications

(321 citation statements)

References 48 publications

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“…Whether the results of the study would have been different if a substantial percentage of those with borderline personality disorder had participated in one of the psychotherapeutic approaches specifically developed for the treatment of borderline personality disorder (dialectical behavioral treatment or DBT [11], mentalization-based treatment or MBT [12], transference-focused psychotherapy or TFP [13], and schema-focused therapy or SFT [14]) is impossible to determine.…”

Section: Discussionmentioning

confidence: 99%

Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders

Hörz¹,

Zanarini²,

Frankenburg³

et al. 2010

Psychiatric Services

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Objective This study has two main objectives. The first is to detail the prevalence rates of three key treatment modalities reported by patients with borderline personality disorder and axis II comparison participants over a decade of follow-up. The second is to determine time-to-cessation and time-to resumption of these three treatment modalities reported by patients with borderline personality disorder. Methods The treatment history of 290 reliably diagnosed inpatients with borderline personality disorder and 72 axis II comparison participants was assessed using an interview of proven reliability during their index admission. Treatment history was reassessed at five contiguous two-year follow-up periods. Results In terms of prevalence rates, there was a significant decrease in the percentage of patients with borderline personality disorder (and axis II comparison participants) participating in the three treatment modalities studied. In terms of time-to-cessation and resumption, 52% of patients with borderline personality disorder stopped individual therapy and 44% stopped taking standing medications for a period of two years or more. However, 85% of those who had stopped psychotherapy resumed it and 67% of those who stopped taking medications later resumed taking them. In contrast, 88% had no hospitalizations for at least two years but almost half of these patients were subsequently rehospitalized. Conclusions Taken together, these results suggest that patients with borderline personality disorder tend to use outpatient treatment without interruption over prolonged periods of time. They also suggest that inpatient treatment is used far more intermittently and by only a relative small minority of those with borderline personality disorder.

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Section: Discussionmentioning

confidence: 99%

Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders

Hörz¹,

Zanarini²,

Frankenburg³

et al. 2010

Psychiatric Services

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“…The two best-established treatments for BPD are dialectical behaviour therapy and mentalisation-based treatment. 74 More recently, evidence has begun to emerge that Systems Training for Emotional Predictability and Problem Solving (STEPPS), 40 schema-focused therapy 75 and day therapeutic community treatment 76 can also improve the health of people with BPD. Clinicians who are working with people in secondary care mental health services should be aware of how they can help support people through mental health crises and how to access evidence-based psychological treatments when these are available.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

Lamotrigine for people with borderline personality disorder: a RCT

Crawford

Sanatinia

Barrett

et al. 2018

Health Technol Assess

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BackgroundNo drug treatments are currently licensed for the treatment of borderline personality disorder (BPD). Despite this, people with this condition are frequently prescribed psychotropic medications and often with considerable polypharmacy. Preliminary studies have indicated that mood stabilisers may be of benefit to people with BPD.ObjectiveTo examine the clinical effectiveness and cost-effectiveness of lamotrigine for people with BPD.DesignA two-arm, double-blind, placebo-controlled individually randomised trial of lamotrigine versus placebo. Participants were randomised via an independent and remote web-based service using permuted blocks and stratified by study centre, the severity of personality disorder and the extent of hypomanic symptoms.SettingSecondary care NHS mental health services in six centres in England.ParticipantsPotential participants had to be aged ≥ 18 years, meet diagnostic criteria for BPD and provide written informed consent. We excluded people with coexisting psychosis or bipolar affective disorder, those already taking a mood stabiliser, those who spoke insufficient English to complete the baseline assessment and women who were pregnant or contemplating becoming pregnant.InterventionsUp to 200 mg of lamotrigine per day or an inert placebo. Women taking combined oral contraceptives were prescribed up to 400 mg of trial medication per day.Main outcome measuresOutcomes were assessed at 12, 24 and 52 weeks after randomisation. The primary outcome was the total score on the Zanarini Rating Scale for Borderline Personality Disorder (ZAN-BPD) at 52 weeks. The secondary outcomes were depressive symptoms, deliberate self-harm, social functioning, health-related quality of life, resource use and costs, side effects of treatment and adverse events. Higher scores on all measures indicate poorer outcomes.ResultsBetween July 2013 and October 2015 we randomised 276 participants, of whom 195 (70.6%) were followed up 52 weeks later. At 52 weeks, 49 (36%) of those participants prescribed lamotrigine and 58 (42%) of those prescribed placebo were taking it. At 52 weeks, the mean total ZAN-BPD score was 11.3 [standard deviation (SD) 6.6] among those participants randomised to lamotrigine and 11.5 (SD 7.7) among those participants randomised to placebo (adjusted mean difference 0.1, 95% CI –1.8 to 2.0;p = 0.91). No statistically significant differences in secondary outcomes were seen at any time. Adjusted costs of direct care for those prescribed lamotrigine were similar to those prescribed placebo.LimitationsLevels of adherence in this pragmatic trial were low, but greater adherence was not associated with better mental health.ConclusionsThe addition of lamotrigine to the usual care of people with BPD was not found to be clinically effective or provide a cost-effective use of resources.Future workFuture research into the treatment of BPD should focus on improving the evidence base for the clinical effectiveness and cost-effectiveness of non-pharmacological treatments to help policy-makers make better decisions about investing in specialist treatment services.Trial registrationCurrent Controlled Trials ISRCTN90916365.FundingFunding for this trial was provided by the Health Technology Assessment programme of the National Institute for Health Research (NIHR) and will be published in full inHealth Technology Assessment; Vol. 22, No. 17. See the NIHR Journals Library website for further project information. The Imperial Biomedical Research Centre Facility, which is funded by NIHR, also provided support that has contributed to the research results reported within this paper. Part of Richard Morriss’ salary during the project was paid by NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands.

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“…They are seen as vulnerable to the development of mental health problems. Early treatment can reduce the consequent development of addictive behavior (66). Furthermore, it is possible to hypothesize that gambling disorder and certain psychiatric diseases, such as substances abuse and suicidality, are different aspects of the same psychopathological mechanism; impulsivity.…”

Section: Discussionmentioning

confidence: 99%

Gambling Disorder and Suicide: An Overview of the Associated Co-Morbidity and Clinical Characteristics

Martinotti

Sarchione

Fiori

et al. 2016

Int J High Risk Behav Addict

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Context: A high prevalence of suicide and attempted suicide in relation to gambling disorder is in increasing evidence in current scientific data. The objective of this review was to explore if there was a primary correlation between psychiatric co-morbidities and gambling and/or a secondary correlation with suicide acts. Evidence Acquisition: We performed a critical analysis of the most recent papers in the scientific literature in this regard and report on the most significant findings. Results: A direct relationship between gambling and suicidality was highlighted in a number of European, American, and Asian countries. However, it was not clear whether or not gambling increased the risk of suicidal behavior. Two general trends were noted. The first was that gamblers with extreme gambling behavior incurred economic losses and debts to such an extent that suicidal acts appeared to be the only solution. The second was that suicidal acts by gamblers were precipitated by interpersonal and/or working challenges, in conjunction with personality traits of impulsivity and psychiatric co-morbidities. Conclusions: A combination of impulsivity, certain psychiatric disorders, and social factors may explain the frequent occurrence of suicidal behavior in gamblers.

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Outpatient Psychotherapy for Borderline Personality Disorder

Abstract: Three years of SFT or TFP proved to be effective in reducing borderline personality disorder-specific and general psychopathologic dysfunction and measures of SFT/TFP concepts and in improving quality of life; SFT is more effective than TFP for all measures.

Cited by 1,090 publications

References 48 publications

Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders

Ten-Year Use of Mental Health Services by Patients With Borderline Personality Disorder and With Other Axis II Disorders

Lamotrigine for people with borderline personality disorder: a RCT

Gambling Disorder and Suicide: An Overview of the Associated Co-Morbidity and Clinical Characteristics

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