Abandonment Psychotherapy and Psychosocial Functioning Among Suicidal Patients With Borderline Personality Disorder: A 3-Year Naturalistic Follow-Up

2019 ◽  
pp. 1-11
Author(s):  
Antonio Andreoli ◽  
Yvonne Burnand ◽  
Laura Frambati ◽  
Donna Manning ◽  
Allen Frances
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Randomized Study ◽  
Borderline Personality ◽  
Psychotic Symptoms ◽  
Global Functioning ◽  
Treatment As Usual ◽  
Treatment Conditions

The authors present the results from a 3-year follow-up among 170 patients who had participated in the original randomized study, which consisted of three treatment conditions: (a) 3-month abandonment psychotherapy (AP) delivered by certified psychotherapists, (b) AP delivered by nurses, and (c) treatment as usual in a psychiatric crisis center. All subjects were recruited at the emergency room after a suicide attempt and met diagnostic criteria for borderline personality disorder and major depression. Psychotic symptoms, bipolar disorder, and mental retardation were exclusion criteria. At 3-year follow-up, 134 (78.8%) subjects had blind, reliable assessment by clinical psychologists. The intent-to-treat analysis indicated that those patients who had received AP during acute treatment had better global functioning, improved work adjustment, and less unemployment/disability at 3-year follow-up. No differences were found as a function of type of therapist delivering AP. The data confirm that short-term AP gains in psychosocial functioning are sustained over the longer term.

scholarly journals Cognitive therapy v. usual treatment for borderline personality disorder: prospective 6-year follow-up

2010 ◽  
Vol 197 (6) ◽  
pp. 456-462 ◽  
Author(s):  
Kate M. Davidson ◽  
Peter Tyrer ◽  
John Norrie ◽  
Stephen J. Palmer ◽  
Helen Tyrer
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Repeated Measures ◽  
Linear Models ◽  
Randomised Trial ◽  
Behavioural Therapy ◽  
Borderline Personality ◽  
Treatment As Usual

BackgroundLonger-term follow-up of patients with borderline personality disorder have found favourable clinical outcomes, with long-term reduction in symptoms and diagnosis.AimsWe examined the 6-year outcome of patients with borderline personality disorder who were randomised to 1 year of cognitive–behavioural therapy for personality disorders (CBT–PD) or treatment as usual (TAU) in the BOSCOT trial, in three centres across the UK (trial registration: ISRCTN86177428).MethodIn total, 106 participants met criteria for borderline personality disorder in the original trial. Patients were interviewed at follow-up by research assistants masked to the patient's original treatment group, CBT–PD or TAU, using the same measures as in the original randomised trial. Statistical analyses of data for the group as a whole are based on generalised linear models with repeated measures analysis of variance type models to examine group differences.ResultsFollow-up data were obtained for 82% of patients at 6 years. Over half the patients meeting criteria for borderline personality disorder at entry into the study no longer did so 6 years later. The gains of CBT–PD over TAU in reduction of suicidal behaviour seen after 1-year follow-up were maintained. Length of hospitalisation and cost of services were lower in the CBT–PD group compared with the TAU group.ConclusionsAlthough the use of CBT–PD did not demonstrate a statistically significant cost-effective advantage, the findings indicate the potential for continued long-term cost-offsets that accrue following the initial provision of 1 year of CBT–PD. However, the quality of life and affective disturbance remained poor.

scholarly journals Day hospital mentalization-based treatment v. specialist treatment as usual in patients with borderline personality disorder: randomized controlled trial

2018 ◽  
Vol 48 (15) ◽  
pp. 2522-2529 ◽  
Author(s):  
Elisabeth M. P. Laurenssen ◽  
Patrick Luyten ◽  
Martijn J. Kikkert ◽  
Dieuwertje Westra ◽  
Jaap Peen ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
The Netherlands ◽  
Borderline Personality ◽  
Outcome Variable ◽  
Day Hospital ◽  
Treatment As Usual ◽  
Specialist Treatment ◽  
Set Up

AbstractBackgroundDay 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.MethodsTwo 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.ResultsBoth 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%).ConclusionsMBT-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.

scholarly journals Favourable outcome of long-term combined psychotherapy for patients with borderline personality disorder: Six-year follow-up of a randomized study

2015 ◽  
Vol 27 (1) ◽  
pp. 51-63 ◽  
Author(s):  
Bjørnar T. Antonsen ◽  
Elfrida H. Kvarstein ◽  
Øyvind Urnes ◽  
Benjamin Hummelen ◽  
Sigmund Karterud ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Randomized Study ◽  
Favourable Outcome ◽  
Borderline Personality

10-Year Outcome of Suicidal Behavior in Borderline Personality Disorder

2019 ◽  
Vol 33 (1) ◽  
pp. 82-100 ◽  
Author(s):  
Paul H. Soloff ◽  
Laurel Chiappetta
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Lower Socioeconomic ◽  
Increased Risk ◽  
Core Symptoms ◽  
Predominately Female

Prospective predictors of suicide attempts were assessed in 118 subjects with borderline personality disorder (BPD) after 10 or more years of follow-up. Mean (SD) time to follow-up was 14.4 (4.7) years. Subjects were predominately female (78.8%), Caucasian (81.4%), and of lower socioeconomic status. Initial recruitment was evenly balanced between inpatient, outpatient, and non-patient (community) sources. In the 10-year interval, 55 subjects (46.6%) attempted suicide. Compared to baseline, suicidal ideation, number of attempts, and non-suicidal self-injury diminished markedly. Core symptoms of BPD, substance abuse, and alcohol use disorders decreased significantly; however, major depressive disorder (MDD) remained constant at 50%. Forty-four percent of subjects had poor psychosocial, vocational, and economic outcomes. Psychosocial outcome was independent of suicide history and any treatment. Increased risk was associated with interval hospitalization prior to any attempt (illness severity), as well as poor social, vocational, and psychosocial functioning at baseline.

Bridging the Gap Between Remission and Recovery in BPD: Qualitative Versus Quantitative Perspectives

2019 ◽  
pp. 1-20
Author(s):  
Paul H. Soloff
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Psychosocial Functioning ◽  
Impulse Control ◽  
Borderline Personality ◽  
Objective Measures ◽  
Changes Over Time ◽  
Symptom Changes ◽  
Over Time

The 10-year outcome for patients with borderline personality disorder (BPD) is diagnostic remission in 85% to 93% however, less than half achieve good social and vocational functioning, and few attain full psychosocial recovery. To assess the gap between diagnostic remission and psychosocial recovery, quantitative measures of outcome were compared with narrative reports of psychosocial functioning in 150 BPD subjects followed prospectively from 2 to 31 years (mean 9.94 years). Subjects with the best and the worst outcomes were compared on symptom changes over time, and on efforts to improve psychosocial functioning. At intake, poor outcome subjects were more impaired than those with good outcomes, with more borderline psychopathology, hospitalizations, and poverty. At follow-up, 53.8% of good outcome subjects complained of continuing problems with depression, 33.3% with anger and impulse control, and 25.6% with unstable relationships. Despite objective measures of improvement, narrative reports documented residual BPD symptoms, comorbidity, and unemployment interfering with psychosocial recovery.

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