Supervised team management, with or without structured psychotherapy, in heavy users of a mental health service with borderline personality disorder: a two-year follow-up preliminary randomized study

BMC Psychiatry

Research Article

Andrea Pierò¹  Giovanni Abbate-Daga²  Secondo Fassino²  Federico Amianto²  Giuseppe Rocca²  Elisabetta Cairo³  Barbara Simonelli³  Andrea Ferrero³  Simona Fassina³ 

[1] Centre Hospitalier Alpes-Isère, 38000, Grenoble, France;Neurosciences Department, Psychiatry Section, University of Torino, Via Cherasco 11, Turin, Italy;Psychotherapy Unit, Mental Health Department, Health District TO-4, Via Don Paviolo 5, Settimo T.se, Turin, Italy;SAIGA Institute of Research, Via Principe Amedeo 16, Turin, Italy;

关键词: Mental Health Service;    Borderline Personality Disorder;    Clinical Global Impression;    Dialectical Behavior Therapy;    Borderline Personality Disorder;   

DOI  :  10.1186/1471-244X-11-181

 received in 2011-05-10, accepted in 2011-11-21,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundIndividuals affected by severe Borderline Personality Disorder (BPD) are often heavy users of Mental Health Services (MHS). Short-term treatments currently used in BPD therapy are useful to target disruptive behaviors but they are less effective in reducing heavy MHS use. Therefore, alternative short-term treatments, less complex than long-term psychodynamic psychotherapies but specifically oriented to BPD core problems, need to be developed to reduce MHS overuse. This study aimed to evaluate the efficacy of adding Sequential Brief Adlerian Psychodynamic Psychotherapy (SB-APP) to Supervised Team Management (STM) in BPD treatment compared to STM alone in a naturalistic group of heavy MHS users with BPD. Effectiveness was evaluated 6 times along a two-year follow-up.MethodsThirty-five outpatients who met inclusion criteria were randomly assigned to two treatment groups (STM = 17; SB-APP = 18) and then compared. Clinical Global Impression (CGI) and CGI-modified (CGI-M) for BPD, Global Assessment of Functioning (GAF), State-Trait Anger Expression Inventory (STAXI), and Symptom Checklist-90 Revised (SCL-90-R) were administered at T1, T3, T6, T12, T18 and T24. At T12 the Working Alliance Inventory-Short Form (WAI-S) was also completed. At the one-year follow-up, SB-APP group did not receive any additional individual psychological support. MHS team was specifically trained in BPD treatment and had regular supervisions.ResultsAll patients improved on CGI, GAF, and STAXI scores after 6 and 12 months, independently of treatment received. SB-APP group showed better outcome on impulsivity, suicide attempts, chronic feelings of emptiness, and disturbed relationships. We found a good stabilization at the one year follow-up, even after the interruption of brief psychotherapy in the SB-APP group.ConclusionsAlthough STM for BPD applied to heavy MHS users was effective in reducing symptoms and improving their global functioning, adding a time-limited and focused psychotherapy was found to achieve a better outcome. In particular, focusing treatment on patients' personality with a specific psychotherapeutic approach (i.e. SB-APP) seemed to be more effective than STM alone.Trial RegistrationClinicalTrials.gov: NCT1356069

【 授权许可】

Unknown   
© Amianto et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.