Short-term psychotherapy of personality disorders

Background: No previous studies have compared the effectiveness of different modalities of psychotherapeutic treatment, as defined by different settings and durations, for patients with cluster C personality disorders. The aim of this multicentre study was to compare the effectiveness of 5 treatment modalities for patients with cluster C personality disorders in terms of psychiatric symptoms, psychosocial functioning, and quality of life. The following treatment modalities were compared: long-term outpatient (more than 6 months), short-term day hospital (up to 6 months), long-term day hospital, short-term inpatient, and long-term inpatient psychotherapy. Methods: The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 371 patients with a DSM-IV-TR axis-II cluster C diagnosis. Patients were assigned to 5 different modalities of psychotherapeutic treatment, and effectiveness was assessed at 12 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45), and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. Results: Patients in all treatment groups had improved on all outcomes 12 months after baseline. Patients receiving short-term inpatient treatment showed more improvement than patients receiving other treatment modalities. Conclusions: Psychotherapeutic treatment, especially in the short-term inpatient modality, is an effective treatment for patients with cluster C personality disorders.

“…Yet, several previous studies showed that specialised psychotherapeutic treatment yields better outcomes than various control conditions (for example waiting list controls) [8,9,13]. …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness of Different Modalities of Psychotherapeutic Treatment for Patients with Cluster C Personality Disorders: Results of a Large Prospective Multicentre Study

Bartak

Spreeuwenberg

Andrea

et al. 2009

“…Although several findings may indicate the efficacy of ‘specific factors’ in brief dynamic psychotherapy (BDT) [1, 2, 3, 4, 5], these treatment techniques have rarely been studied systematically as treatment for depressive disorders. Several authors who studied the efficacy of BDT in combined treatment with antidepressants reported a higher improvement compared to pharmacological monotherapy [6, 7].…”

Section: Introductionmentioning

confidence: 99%

Randomized Controlled Trial Comparing Brief Dynamic and Supportive Therapy with Waiting List Condition in Minor Depressive Disorders

Maina

Forner

Bogetto³

2004

Background: Although many evidences suggest the presence of specific therapeutic factors in brief dynamic therapy (BDT), few studies have investigated its efficacy in the treatment of depressive disorders in comparison to other psychotherapies. The aim of this study was to determine whether BDT is more effective than brief supportive psychotherapy (BSP) and waiting list condition in the treatment of minor depressive disorders. Method: Thirty patients with primary DSM-IV dysthymic disorder, depressive disorder not otherwise specified or adjustment disorder with depressed mood completed a randomized controlled trial with three treatment groups (BDT, BSP, waiting list condition). A 6-month follow-up was performed for patients treated with both psychotherapeutic approaches. Other psychiatric treatments were not permitted throughout the treatment period and the 6-month follow-up. Symptoms were assessed at baseline, at the end of treatment, and after 6 months of follow-up. Results: Patients treated with both psychotherapeutic approaches showed a significant improvement after treatment in comparison to non-treated controls, but BDT was more effective at follow-up evaluation. Conclusions: BDT is a promising treatment for minor depressive disorders. This study also suggests that BDT is more effective than supportive psychotherapy in improving the long-term outcome of depressive disorders.

“…Their study sample also included patients with paranoid PD (n = 4) and schizoid PD (n = 5), but their results were not reported separately. The same holds true for the small group of cluster A PD patients (n = 4) in a study of Winston et al [36]. On the other hand, Gude and Vaglum [37] in their study on inpatients found no differences in improvement of psychiatric symptoms and occupational status between pure cluster A PD patients (n = 21) and both pure cluster B and pure cluster C patients.…”

Section: Introductionmentioning

confidence: 64%

Patients with Cluster A Personality Disorders in Psychotherapy: An Effectiveness Study

Bartak

Andrea²,

Spreeuwenberg

et al. 2010

Background: While psychopharmacological studies are common in patients with cluster A personality disorders, the effects of psychotherapy have received little attention. The aim of this study is to explore whether psychotherapeutic treatment yields health gains for these patients. Methods: The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 57 patients with a DSM-IV-TR axis II cluster A diagnosis. Patients were assigned to 3 settings of psychotherapeutic treatment (outpatient, day hospital, inpatient), and effectiveness was assessed at 18 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45) and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. Results: Patients in the day hospital and inpatient group improved substantially in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life. Patients in the outpatient group showed less improvement. Direct comparison of the improvement of psychiatric symptoms showed significant results in favour of day hospital (p = 0.046) and inpatient (p = 0.01) treatment, as compared to outpatient treatment. However, due to substantial baseline differences, this direct comparison should be judged carefully. Conclusions: Cluster A psychopathology is not a contraindication to benefit from psychotherapy. This is especially true for more intensive forms like inpatient and day hospital treatment. Future research should focus more on psychotherapeutic treatment to gain further insight into effective treatment options for this patient group.