Day Treatment of Patients With Personality Disorders: Experiences From a Norwegian Treatment Research Network

Department for Personality Psychiatry, Psychiatric Division, Ullevål University Hospital, Oslo, Norway.
Journal of Personality Disorders (Impact Factor: 2.31). 07/2003; 17(3):243-62. DOI: 10.1521/pedi.
Source: PubMed


This study sought to investigate the following research questions: Are time-limited day treatment programs for patients with personality disorder (PD) effective outside resourceful university settings, and what are the overall treatment results when the program is implemented on a larger scale? Do all categories and subtypes of PDs respond favorably to such treatment? How intensive should such day treatment programs be? All patients (n = 1,244) were consecutively admitted to eight different treatment programs in the Norwegian Network of Psychotherapeutic Day Hospitals from 1993 to 2000. Altogether, 1,010 patients were diagnosed with PD. Avoidant, borderline, not otherwise specified (NOS), and paranoid PD were the most common conditions. SCID-II and MINI were used as diagnostic instruments. Outcome measures included GAF Global Assessment of Functioning, (GAF; American Psychiatric Association, 1994), SCL-90R, CIP, Quality of Life, work functioning and parasuicidal behavior, measured at admittance, discharge and 1-year follow up. The attrition rate was 24%. The number of dropouts did not improve over time. As a group, completers with PD improved significantly on all outcome variables from admittance to discharge and improvement was maintained or increased at follow up. Treatment results were best for borderline PD, cluster C patients, PD NOS and No PD, and poorer for cluster A patients. Units with a high treatment dosage did not experience better outcomes than those with a low treatment dosage (10 hours per week). Results from the University unit were not better than those from units at local hospitals or mental health centers.

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Available from: Svein Friis, Aug 18, 2015
    • "The local clinical units receive feedback and comparison with other units, and results are discussed in network meetings . The target groups are individuals with personality disorders, but most patients also have other mental disorders such as recurrent depression or anxiety disorders (Karterud et al., 2003). Another example of collaboration across health authorities is a joint quality register recently established by Viken old Age Psychiatry Research Network (Kristiansen & Engedal, 2013). "
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    ABSTRACT: Norway has not had any strategy exclusively for the implementation of routine outcome measurement in the mental health services, but some efforts have been made as part of strategies for a national patient register and quality indicators. Fifteen years after the decision to make the rating of the Global Assessment of Functioning scale (GAF) mandatory at admission and discharge of each treatment episode in adult mental health services, this is still not fully implemented. An unknown and probably very low proportion of mental health services use GAF as a routine outcome measure in everyday clinical practice. Well-established electronic patient records in the mental health services and established procedures for reporting routine data to the National Patient Register should make it possible to collect and use routine outcome data. Implementation of routine outcome measurement in mental health services must be done with due emphasis on the critical steps in the various phases of the implementation process. The regional health authorities have a key role in establishing electronic systems that make relevant outcome measurements available in a seamless way for clinicians as well as for patients, and by contributing to a culture where quality and outcome are valued and given priority.
    International Review of Psychiatry 08/2015; 27(4). DOI:10.3109/09540261.2015.1054268 · 1.80 Impact Factor
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    • "Participants included 483 women diagnosed with BPD, aged 18 – 65 years, with an initial admission between 1996 and 2009 to the Norwegian Network of Personality-Focused Treatment Programs. Established in 1992, this is a clinical research network providing mostly long-term, group-based (or concurrent individual– group) treatment (see also Karterud et al., 2003; Reas et al., 2013). All treatment units used uniform and standardized assessment procedures (Pedersen, Karterud, Hummelen, & Wilberg, 2013) following the longitudinal, expert, all-data (LEAD) standard, which is a comprehensive , integrative diagnostic approach using multiple sources of information (e.g., interview data, informants, behavioral observations , and medical records). "
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    ABSTRACT: Objective: Few studies have investigated whether a diagnosis of Bulimia nervosa (BN) confers additional risk of life-threatening behaviors such as self-harm and suicidal behavior in borderline personality disorder (BPD). Method: Participants were 483 treatment-seeking women diagnosed with BPD according to the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997; Diagnostic and Statistical Manual of Mental Disorders, 4th ed.; APA, 1994) and admitted to the Norwegian Network of Psychotherapeutic Day Hospitals between 1996 and 2009. Of these, 57 (11.8%) women met DSM-IV diagnostic criteria for BN according to the Mini-International Neuropsychiatric Interview (M.I.N.I.; Sheehan et al., 1998) and they were compared with women with BPD and other Axis I disorders. Results: We found that comorbid BN is uniquely and significantly associated with increased risk of suicidal behavior among women being treated for BPD. Findings underscore the importance of routinely screening for BN among women seeking treatment for BPD, as co-occurring bulimia appears to be a significant marker for immediate life-threatening behaviors in this already high-risk population, which is a significant public health issue. A significantly greater proportion of women with BPD-BN reported suicidal ideation at intake (past 7 days), engaged in self-harm behavior during treatment, and attempted suicide during treatment. All bivariate associations remained significant in the logistic regression models after controlling for mood, anxiety, and substance-related disorders. Conclusion: The presence of a concurrent diagnosis of BN among women with BPD is significantly and uniquely associated with recent suicidal ideation, and self-harm behavior and suicide attempts during treatment after controlling for major classes of mental disorders. Co-occurring BN appears to represent a significant marker for immediate life-threatening behaviors in women seeking treatment for BPD. Extra vigilance and careful monitoring of suicidal behavior during treatment is important for these individuals, and routine screening for BN is warranted.
    Journal of Consulting and Clinical Psychology 12/2014; 83(3). DOI:10.1037/ccp0000014 · 4.85 Impact Factor
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    • "The format was originally designed for the treatment of poorly functioning patients with personality disorder, based on the idea that the intensive day hospital programme would provide initial containment, support, and initiate a treatment alliance, while the protracted outpatient group psychotherapy would facilitate further personality development. However, despite observed benefits of the day-hospital phase (Karterud et al., 2003; Wilberg et al., 1999), additional effects of the outpatient treatment were less than expected (Wilberg et al., 2003). Moreover, a qualitative study of drop-out patients with BPD identified the transition to outpatient group psychotherapy as a major disturbance of the treatment process (Hummelen, Wilberg, & Karterud, 2007). "
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    ABSTRACT: Few studies outside United Kingdom have documented effects of mentalization-based treatment (MBT) for patients with borderline personality disorder (BPD). This study aimed to investigate outcomes for BPD patients treated in an MBT programme in a Norwegian specialist treatment unit and compare benefits of the implemented MBT with the unit's former psychodynamic treatment programme. A naturalistic, longitudinal, comparison of treatment effects for BPD patients before and after transition to MBT. The sample consisted of 345 BPD patients treated in the period 1993–2013. Before 2008, patients were admitted to a psychodynamic treatment programme (n = 281), after 2008 patients received MBT (n = 64). Symptom distress, interpersonal problems, and global functioning were assessed repeatedly throughout the treatment. Suicidal/self-harming acts, hospital admissions, medication, and occupational status were assessed at the start and end of treatment. Therapists' competence and adherence to MBT was rated and found satisfactory. The statistical method for longitudinal analyses was mixed models. BPD patients in MBT and in the former psychodynamic treatment programme had comparable baseline severity and impairments of functioning. BPD patients in MBT had a remarkably low drop-out rate (2%), significantly lower than the former treatment. Improvements of symptom distress, interpersonal, global and occupational functioning were significantly greater for MBT patients. Large reductions in suicidal/self-harming acts, hospital admissions, and use of medication were evident in the course of both treatments. The study confirms the effectiveness of MBT for BPD patients and indicates greater clinical benefits than in traditional psychodynamic treatment programmes.
    07/2014; 88(1). DOI:10.1111/papt.12036
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