8-Year Follow-Up of Patients Treated for Borderline Personality Disorder: Mentalization-Based Treatment Versus Treatment as Usual

Halliwick Unit, St. Ann's Hospital, Barnet, Enfield, and Haringey Mental Health Trust, London, UK N15 3TH.
American Journal of Psychiatry (Impact Factor: 12.3). 06/2008; 165(5):631-8. DOI: 10.1176/appi.ajp.2007.07040636
Source: PubMed

ABSTRACT This study evaluated the effect of mentalization-based treatment by partial hospitalization compared to treatment as usual for borderline personality disorder 8 years after entry into a randomized, controlled trial and 5 years after all mentalization-based treatment was complete.
Interviewing was by research psychologists blind to original group allocation and structured review of medical notes of 41 patients from the original trial. Multivariate analysis of variance, chi-square, univariate analysis of variance, and nonparametric Mann-Whitney statistics were used to contrast the two groups depending on the distribution of the data.
Five years after discharge from mentalization-based treatment, the mentalization-based treatment by partial hospitalization group continued to show clinical and statistical superiority to treatment as usual on suicidality (23% versus 74%), diagnostic status (13% versus 87%), service use (2 years versus 3.5 years of psychiatric outpatient treatment), use of medication (0.02 versus 1.90 years taking three or more medications), global function above 60 (45% versus 10%), and vocational status (employed or in education 3.2 years versus 1.2 years).
Patients with 18 months of mentalization-based treatment by partial hospitalization followed by 18 months of maintenance mentalizing group therapy remain better than those receiving treatment as usual, but their general social function remains impaired.

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Available from: Peter Fonagy, Jul 10, 2014
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    • "Few specific psychotherapeutic treatments have been designed specifically for NSSI. (For a review of exceptions see, e.g., Dialectical Behavior Therapy [Linehan et al., 2006], mentalization-based treatment [Bateman & Fonagy, 2008, 2009], and Muehlenkamp, 2006.) Social support, however, seems to be a key factor both in the prevention and treatment response to NSSI (Wichstrøm, 2009). "
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    ABSTRACT: Teenagers and young adults who had experienced child maltreatment, being bullied in school and other serious life events have an increased risk of Non-Suicidal Self-Injury (NSSI), but some individuals manage to escape serious stressful life events. The research question is: does social support make a difference? A national representative sample of 4,718 persons born in 1984 were selected for an interview about their childhood, maltreatment, serious life events and social support in order to test if social support during childhood is a statistical mediator between childhood disadvantages and NSSI. The survey obtained a 67% response rate (N=2,980). The incidence rate of NSSI among this sample was estimated at 2.7% among young adult respondents. Participants with a history of child maltreatment, being bullied in school or other traumatic life events reported a rate of NSSI 6 times greater than participants without this history (odds ratio: 6.0). The correlation between traumatic life events during adolescence and NSSI is reduced when low social support is accounted for in the statistical model (p<0.01). The results indicate that social support is a partial mediator for NSSI. The reported low self-esteem indicates the importance of treating adolescents who are engaged in NSSI with respect and dignity when they are treated in the health care system. Results further imply that increasing social support may reduce the likelihood of NSSI. Copyright © 2014 Elsevier Ltd. All rights reserved.
    Child Abuse & Neglect 11/2014; 44. DOI:10.1016/j.chiabu.2014.10.023 · 2.47 Impact Factor
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    • "These results were maintained during the 18-month follow-up period [32]. Five years after discharge from MBT, the MBT-DH group still showed superiority over TAU on suicidality, diagnostic status, service use, use of medication, global functioning scores above 60 (on the Global Assessment of Functioning [GAF] Scale), and vocational status [33]. For example, 74% of the patients in the TAU condition had made at least one suicide attempt, in comparison with only 23% in the MBT-DH group. "
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    ABSTRACT: Background: Severe borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment (MBT-DH), are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible influence of researcher allegiance in one of the trials, and potential problems with the generalization of findings to mental health systems in other countries, this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands. Methods/design: The trial is being conducted at two sites in The Netherlands. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of ≥ 20 on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual. The MBT-DH program consists of a maximum of 18 months' intensive treatment, followed by a maximum of 18 months of maintenance therapy. Specialist treatment as usual is provided by the City Crisis Service in Amsterdam, a service that specializes in treating patients with personality disorders, offering manualized, non-MBT interventions including family interventions, Linehan training, social skills training, and pharmacotherapy, without a maximum time limit. Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment. The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index. Secondary outcome measures include parasuicidal behaviour, symptomatic distress, social and interpersonal functioning, personality functioning, attachment, capacity for mentalizing and quality of life. Cost-effectiveness is assessed in terms of the cost per quality-adjusted life year. Outcomes will be analyzed using multilevel analyses based on intention-to-treat principles. Discussion: Severe borderline personality disorder is a serious psychological disorder that is associated with high burden. This multi-site randomized trial will provide further data concerning the efficacy and cost-effectiveness of MBT-DH for these patients. Trial registration: NTR2175.
    BMC Psychiatry 05/2014; 14(1):149. DOI:10.1186/1471-244X-14-149 · 2.21 Impact Factor
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    • "This is reflected in treatment guidelines (e.g., Landelijke Stuurgroep Richtlijnontwikkeling in de GGZ, 2008; National Institute for Health and Clinical Excellence, 2009a, 2009b). Specialized psychotherapeutic treatments have proven to be effective for PD in general (Gabbard, 2000; Leichsenring & Leibing, 2003), to be more effective than being on a waiting list or general psychiatric outpatient care and to be associated with faster recovery rates compared with natural recovery (Bateman & Fonagy, 2008; Perry, Banon, & Ianni, 1999; Petersen et al., 2008). Approximately 75 years ago, Rosenzweig suggested that common factors were responsible for the effectiveness of psychotherapies making them equally effective in outcome. "
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    ABSTRACT: Objective Although personality disorder not otherwise specified (PDNOS) is highly prevalent and associated with a high burden of disease, only a few treatment studies in this patient group exist. This study is the first to investigate the effectiveness of different modalities of psychotherapy in patients with PDNOS, i.e., short-term (up to 6 months) and long-term (more than 6 months) outpatient, day hospital, and inpatient psychotherapy. Method A total of 205 patients with PDNOS were assigned to one of six treatment modalities. Effectiveness was assessed over 60 months after baseline. The primary outcome measure was symptom severity, and the secondary outcome measures included psychosocial functioning and quality of life. The study design was quasi-experimental, and the multiple propensity score was used to control for initial differences between treatment groups. Results All treatment modalities showed positive outcomes, especially in terms of improvements of symptom severity and social role functioning. At 12-month follow-up, after adjustment for initial differences between the treatment groups, short-term outpatient psychotherapy and short-term inpatient psychotherapy showed most improvement and generally outperformed the other modalities concerning symptom severity. At 60 months after baseline, effectiveness remained but observed differences between modalities mostly diminished. Conclusion Patients with PDNOS benefit from psychotherapy both at short-term and long-term follow-up. Short-term outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness. Copyright © 2014 John Wiley & Sons, Ltd. Key Practitioner Messages The effectiveness of different modalities of psychotherapy in patients with PDNOS (i.e., short-term vs long-term; outpatient versus day hospital versus inpatient psychotherapy) has not yet been compared. Different modalities of psychotherapy are effective for patients with PDNOS, and positive effects remain after 5 years. In patients with PDNOS short-term (less than 6 months) outpatient psychotherapy and short-term inpatient psychotherapy seem to be superior to the four other treatment modalities at 12-month follow-up. At 60-month follow-up, treatments showed mostly comparable effectiveness.
    Clinical Psychology & Psychotherapy 05/2014; DOI:10.1002/cpp.1904 · 1.66 Impact Factor
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