Article

Select comorbid personality disorders and the treatment of chronic depression with nefazodone, targeted psychotherapy, or their combination

Department of Psychology, Lund University, Lund, Sweden.
Journal of Affective Disorders (Impact Factor: 3.71). 03/2009; 117(3):174-9. DOI: 10.1016/j.jad.2009.01.010
Source: PubMed

ABSTRACT Individuals with chronic depression respond poorly to both medication and psychotherapy. The reasons for the poorer response, however, remain unclear. One potential factor is the presence of comorbid Axis II personality disorders (PDs), which occur at high rates among these patients.
This study examines the moderating influence of co-occurring PDs, primarily in cluster C, among 681 chronically depressed adult outpatients who were randomly assigned to 12 weeks of treatment with nefazodone, a specialized psychotherapy for chronic depression, or their combination.
At baseline, 50.4% (n=343) of patients met criteria for one or more Axis II disorders. Following 12 weeks of treatment, patients with comorbid PDs had statistically lower depression scores (M=12.2, SD=+9.2) than patients without comorbid PDs (M=13.5, SD=+8.7). There was no differential impact of a comorbid PD on responsiveness to medication versus psychotherapy. The results did not change when the data were analyzed using an intent-to-treat sample or when individual personality disorders were examined separately.
Patients with severe borderline, antisocial, and schizotypal PDs were excluded from study entry; therefore, these data primarily apply to patients with cluster C PDs and may not generalize to other Axis II conditions.
Comorbid Axis II disorders did not negatively affect treatment outcome and did not differentially affect response to psychotherapy versus medication. Treatment formulations for chronically depressed patients with certain PDs may not need to differ from treatment formulations of chronically depressed patients without co-occurring PDs.

0 Followers
 · 
335 Views
  • Source
    • "With respect to treatment, only a handful of studies have examined the influence of DPD on outcomes, and these studies have focused solely on depression [24] [44] [45]. In a secondary analysis of a large, multi-site clinical trial, Maddux and colleagues [46] examined the moderating effect of DPD, as diagnosed by the clinician-rated Structured Clinical Interview for Axis-II Disorders (SCID-II; [47]), on levels of depression following 12 weeks of treatment with an antidepressant medication (ADM), a modified version of cognitivebehavioral psychotherapy, or their combination among 680 patients with chronic forms of depression. Results indicated no significant differences between those with and without DPD in terms of their response to any modality of treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The present study assessed the rate of depressive personality (DP), as measured by the self-report instrument depressive personality disorder inventory (DPDI), among 159 clients entering psychotherapy at an outpatient university clinic. The presenting clinical profile was evaluated for those with and without DP, including levels of depressed mood, other psychological symptoms, and global severity of psychopathology. Clients were followed naturalistically over the course of therapy, up to 40 weeks, and reassessed on these variables again after treatment. Results indicated that 44 percent of the sample qualified for DP prior to treatment, and these individuals had a comparatively more severe and complex presenting disposition than those without DP. Mixed-model repeated-measures analysis of variance was used to examine between-groups changes on mood and global severity over time, with those with DP demonstrating larger reductions on both outcome variables, although still showing more symptoms after treatment, than those without DP. Only eleven percent of the sample continued to endorse DP following treatment. These findings suggest that in routine clinical situations, psychotherapy may benefit individuals with DP.
    Depression research and treatment 12/2012; 2012:208435. DOI:10.1155/2012/208435
  • Source
    • "With respect to treatment, only a handful of studies have examined the influence of DPD on outcomes, and these studies have focused solely on depression [24] [44] [45]. In a secondary analysis of a large, multi-site clinical trial, Maddux and colleagues [46] examined the moderating effect of DPD, as diagnosed by the clinician-rated Structured Clinical Interview for Axis-II Disorders (SCID-II; [47]), on levels of depression following 12 weeks of treatment with an antidepressant medication (ADM), a modified version of cognitivebehavioral psychotherapy, or their combination among 680 patients with chronic forms of depression. Results indicated no significant differences between those with and without DPD in terms of their response to any modality of treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The present study assessed the rate of depressive personality (DP), as measured by the self-report instrument depressive personality disorder inventory (DPDI), among 159 clients entering psychotherapy at an outpatient university clinic. The presenting clinical profile was evaluated for those with and without DP, including levels of depressed mood, other psychological symptoms, and global severity of psychopathology. Clients were followed naturalistically over the course of therapy, up to 40 weeks, and reassessed on these variables again after treatment. Results indicated that 44 percent of the sample qualified for DP prior to treatment, and these individuals had a comparatively more severe and complex presenting disposition than those without DP. Mixed-model repeated-measures analysis of variance was used to examine between-groups changes on mood and global severity over time, with those with DP demonstrating larger reductions on both outcome variables, although still showing more symptoms after treatment, than those without DP. Only eleven percent of the sample continued to endorse DP following treatment. These findings suggest that in routine clinical situations, psychotherapy may benefit individuals with DP.
    Depression research and treatment 12/2012;
  • Harvard Review of Psychiatry 01/2010; 18(4):238-46. DOI:10.3109/10673229.2010.496628 · 2.49 Impact Factor
Show more