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Time-limited psychotherapy for depression is effective. However, comorbid personality disorders affect therapy outcomes negatively. Studies of follow-up effects and results relating to the influence of comorbid personality disorder and treatment modality are scarce.
To determine the influence of comorbid personality disorder and treatment modality on outcomes after cognitive–behavioural therapy (CBT) or short-term psychodynamic supportive psychotherapy (SPSP) for depression.
This study draws on data from a previously published randomised clinical trial contrasting SPSP and CBT for depression (both 16 sessions). We compared the effectiveness of these psychotherapies for patients with and without personality disorder (n = 196). The primary measure was depression outcome; the secondary measurements were interpersonal functioning and quality of life. Collected data were analysed using multilevel analysis. Trial registration: ISRCTN31263312 (http://www.controlled-trials.com).
Although participants with and without comorbid personality disorder improved at treatment termination (d = 1.04, 95% CI 0.77–1.31 and d = 1.36, 95% CI 0.97–1.76, respectively) and at follow-up (d = 1.15, 95% CI 0.87–1.43 and d = 2.12, 95% CI 1.65–2.59 respectively), personality disorder had a negative effect on depression outcome at both measurement points (P < 0.05). A similar negative effect on interpersonal functioning was no longer apparent at follow-up. Comorbid personality disorder had no influence on social functioning or quality of life outcomes, irrespective of treatment modality.
CBT and SPSP contribute to the improvement of depressive symptoms and interpersonal problems in depressed patients with and without comorbid personality disorder. Both treatments are an effective first step in a stepped care approach, but – given remaining levels of depression in patients with personality disorder – they are probably inadequate for large numbers of patients with this comorbidity.
Day hospital mentalization-based treatment (MBT-DH) is a promising treatment for borderline personality disorder (BPD) but its evidence base is still limited. This multi-site randomized trial compared the efficacy of MBT-DH delivered by a newly set-up service v. specialist treatment as usual (S-TAU) tailored to the individual needs of patients, and offered by a well-established treatment service.
Two mental healthcare institutes in The Netherlands participated in the study. Patients who met DSM-IV criteria for BPD and had a score of ⩾20 on the borderline personality disorder severity index (BPDSI) were randomly allocated to MBT-DH (N = 54) or S-TAU (N = 41). The primary outcome variable was the total score on the BPDSI. Secondary outcome variables included symptom severity, quality of life, and interpersonal functioning. Data were collected at baseline and every 6 months until 18-month follow-up, and were analyzed using multilevel analyses based on intention-to-treat principles.
Both treatments were associated with significant improvements in all outcome variables. MBT-DH was not superior to S-TAU on any outcome variable. MBT-DH was associated with higher acceptability in BPD patients compared v. S-TAU, reflected in significantly higher early drop-out rates in S-TAU (34%) v. MBT-DH (9%).
MBT-DH delivered by a newly set-up service is as effective as specialist TAU in The Netherlands in the treatment of BPD at 18-month follow-up. Further research is needed to investigate treatment outcomes in the longer term and the cost-effectiveness of these treatments.
Patients with a severe mental illness (SMI) are more likely to experience
victimisation than the general population.
To examine the prevalence of victimisation in people with SMI, and the
relationship between symptoms, treatment facility and indices of
substance use/misuse and perpetration, in comparison with the general
Victimisation was assessed among both randomly selected patients with SMI
(n = 216) and the general population
Compared with the general population, a high prevalence of violent
victimisation was found among the SMI group (22.7% v.
8.5%). Compared with out-patients and patients in a sheltered housing
facility, in-patients were most often victimised (violent crimes: 35.3%;
property crimes: 47.1%). Risk factors among the SMI group for violent
victimisation included young age and disorganisation, and risk factors
for property crimes included being an in-patient, disorganisation and
cannabis use. The SMI group were most often assaulted by someone they
Caregivers should be aware that patients with SMI are at risk of violent
victimisation. Interventions need to be developed to reduce this
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