1. Four years comparative follow-up evaluation of community-based, step-down, and residential specialist psychodynamic programmes for personality disorders.
- Author
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Chiesa, Marco, Cirasola, Antonella, and Fonagy, Peter
- Subjects
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PERSONALITY disorder treatment , *RESIDENTIAL care , *COMPARATIVE studies , *LONGITUDINAL method , *PROBABILITY theory , *PSYCHODYNAMIC psychotherapy , *SELF-mutilation , *PSYCHOLOGICAL stress , *SUICIDAL behavior , *LOGISTIC regression analysis , *HOSPITAL observation units , *SAMPLE size (Statistics) , *STATISTICAL significance , *TREATMENT effectiveness , *PATIENT dropouts , *DATA analysis software , *DESCRIPTIVE statistics - Abstract
Although the fulcrum of service provision for personality disorder (PD) has shifted from hospital-based to psychodynamically- and cognitively-oriented outpatient programmes, very few studies have attempted to compare specialist moderate intensity outpatient programmes with specialist high-intensity residential models, or to explore whether a period of inpatient treatment may be necessary to improve outcome and prognosis. In this article, we prospectively compare changes over a 4-year period in 3 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 programme (RT, N = 45) in psychiatric distress, deliberate self-injury, and suicide attempt using multilevel modelling and multivariate logistic regression analyses. The results showed that percentages of early-dropout were significantly different ( p = .0001) for the 3 programmes (CBP = 13.4%, RT-CBP = 10.2%, and RT = 41.4%). A significant interaction between treatment model and time was found for psychiatric distress ( p = .001), with CBP and RT-CBP achieving more marked changes ( g = 1.20 and 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 behaviour (deliberate self-injury and suicide attempt) compared to RT. Severity of presentation was not found to be a significant predictor of outcome. Long-term RT showed no advantage over long-term CBP, either as stand-alone or as step-down treatment. Replication may be needed to confirm generalizability of results, and a number of limitations in the study design may moderate the inferences that can be drawn from the results. [ABSTRACT FROM AUTHOR]
- Published
- 2017
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