Day treatment of patients with personality disorders: experiences from a Norwegian treatment research network.
ABSTRACT 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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ABSTRACT: The Global Assessment of Functioning (GAF) Scale is used in routine clinical practice and research to estimate symptom and functional severity and longitudinal change. Concerns about poor interrater reliability have been raised, and the present study evaluated the effect of a Web-based GAF training program designed to improve interrater reliability in routine clinical practice. Clinicians rated up to 20 vignettes online, and received deviation scores as immediate feedback (i.e., own scores compared with expert raters) after each rating. Growth curves of absolute SD scores across the vignettes were modeled. A linear mixed effects model, using the clinician’s deviation scores from expert raters as the dependent variable, indicated an improvement in reliability during training. Moderation by content of scale (symptoms; functioning), scale range (average; extreme), previous experience with GAF rating, profession, and postgraduate training were assessed. Training reduced deviation scores for inexperienced GAF raters, for individuals in clinical professions other than nursing and medicine, and for individuals with no postgraduate specialization. In addition, training was most beneficial for cases with average severity of symptoms compared with cases with extreme severity. The results support the use of Web-based training with feedback routines as a means to improve the reliability of GAF ratings performed by clinicians in mental health practice. These results especially pertain to clinicians in mental health practice who do not have a masters or doctoral degree.Psychological Assessment 02/2015; · 2.99 Impact Factor
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ABSTRACT: Introducción: En los últimos 25 años varios estudios han mostrado la eficacia de diversas intervenciones psicológicas para los trastornos graves de la personalidad. Sin embargo, la generalización de estos resultados positivos desde entornos con larga tradición investigadora a condiciones de practica habitual ha sido cuestionada, reclamándose la replicación en estudios pragmáticos. Métodos: Este estudio pragmático compara las hospitalizaciones y las visitas a urgencias antes y durante un programa terapéutico de 6 meses para trastornos graves de la personalidad y 36 meses después del inicio. El programa terapéutico, que integra varias intervenciones específicas en un encuadre coherente, se realizó en un entorno de práctica habitual. Se incluyeron 51 pacientes evaluados de acuerdo a criterios DSM-IV por medio de la versión española de la Entrevista Clínica Estructurada para trastornos de la personalidad (SCID II). Resultados: Las características clínicas evidenciaron un grupo de pacientes muy graves, de los que el 78,4% cumplía criterios de trastorno límite de la personalidad. El porcentaje de pacientes hospitalizados y que visitaron urgencias así como el número de días de hospitalización y de visitas a urgencias se redujo significativamente durante el tratamiento y esta mejoría se mantuvo en el tiempo. Conclusiones: Un tratamiento integrado para trastornos graves de la personalidad puede ser efectivo para reducir las re-admisiones o las estancias hospitalarias prolongadas cuando es implementado por clínicos en condiciones de práctica habitual.Revista de Psiquiatría y Salud Mental (1,04 IF). 01/2015;
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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. (PsycINFO Database Record (c) 2014 APA, all rights reserved).Journal of Consulting and Clinical Psychology 12/2014; · 4.85 Impact Factor