Four Years Comparative Follow-up Evaluation of Community-based, Step-down and Residential Specialist Psycho-dynamic Programs for Personality Disorders

Chiesa, M Dr (Marco)¹, Fonagy, P Prof (Peter), Cirasola, A Ms (Antonella)^1
1Verenigd Koninkrijk

 

Submission type

Oral only

Scheduled

Parallel Session V: Administratiezaal, 09-06-2018, 09:00 - 10:30

Onderzoeksgebied

Personality disorders

Introductie

Few studies have attempted to compare specialist out-patient programs with specialist high intensity residential models for personality disorder, or to explore whether a period of in-patient treatment may be necessary to improve outcome and prognosis

Materiaal en methodes

Changes over a 4-year period in psychiatric distress, deliberate self-injury and suicide attempt are evaluated in three groups of patients with personality disorders (N=162) treated in a specialist community-based (CBP, N=30), a step-down (RT-CBP, N=87) and a specialist residential program (RT, N=45) using multi-level modelling and multivariate logistic regression analyses

Resultaten

Percentages of early-dropout were significantly different (p=0.0001) for the three programs (CBP= 13.4%, RT-CBP=10.2% & RT=41.4%). A significant interaction between treatment model and time was found for psychiatric distress (p=0.001), with CBP and RT-CBP achieving more marked changes (g=1.20 & g=0.68, respectively) compared to RT (g=0.30) at 48-month follow-up. CBP and RT-CBP were found to significantly reduce impulsive behavior (deliberate self-injury and suicide attempt) compared to RT. Severity of presentation was not found to be a significant predictor of outcome.

Conclusie

A specialist CBP has been confirmed as effective treatment for PD, while residential treatment is not indicated unless followed by long-term out-patient treatment. No added benefit of residential treatment was found

Auteurs