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Summary Taak 7 Treatment
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Taak 7 Treatment MHS4503 personality disorders Master mental health
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Taak 7 TreatmentZanarini Description and prediction of time-to-attainment of excellent recovery for
borderline patients followed prospectively for 20 years
- One purpose of this study was to determine the cumulative rates of excellent recovery
for borderline patients and axis II comparison subjects followed prospectively for 20
years. Another purpose was to find the best set of baseline predictors of excellent
recovery for borderline patients. A total of 290 inpatients meeting rigorous criteria for
borderline personality disorder and 72 axis II comparison subjects completed
semistructured interviews and self-report measures during their index admission.
Subjects were reassessed prospectively over 10 contiguous two-year waves of follow-
up. 39% of borderline patients and 73% of personalitydisordered comparison subjects
met our operationalized definition of excellent recovery (concurrent remission of
borderline or another primary personality disorder, good social and full-time
vocational functioning, and absence of an axis I disorder associated decreased social
and/or vocational functioning). Five variables formed our multivariate predictive
model of excellent recovery for borderline patients: higher IQ, good childhood work
history, good adult vocational record (beroepsgeschiedenis), lower trait neuroticism,
and higher trait agreeableness. The results of this study suggest that complete recovery
is difficult for borderline patients to achieve even over long periods of time. They also
suggest that competence displayed in both childhood and adulthood is the best
predictor of this important outcome.
- Nine factors were found to be associated with a poor long-term outcome: affective
instability, chronic dysphoria, younger age at first treatment, length of prior
hospitalization, antisocial behavior, substance abuse, parental brutality, a family
history of psychiatric illness, and a problematic relationship with one's mother (but not
one's father)
- The current study examined rates of good and excellent recovery achieved by both
borderline patients and axis II comparison subjects over 20 years of prospective
follow-up—two different definitions of recovery that may have different clinical
implications. It also examined the relationship between a wide array of clinically
relevant predictor variables assessed at baseline and time-to-excellent recovery in
borderline patients, which was assessed at 10 contiguous two-year time periods. In
addition, the sample of borderline patients being studied is large, carefully diagnosed,
and socioeconomically diverse.
Methods
- At each of 10 follow-up waves, separated by 24 months, psychosocial functioning and
treatment utilization as well as axis I and II psychopathology were reassessed via
interview methods similar to the baseline procedures by staff members blind to
previously collected information.
- we selected a GAF score of 61 or higher as our measure of good recovery because it
was used in the four follow-back studies conducted in the 1980s.
results
- 59% of borderline patients and 92% of axis II comparison subjects attained this
outcome by 20-year follow-up. Borderline patients were significantly less likely to
attain good recovery and to attain it at a significantly slower rate than personality-
disordered comparison subjects
- 39% of borderline patients and 73% of axis II comparison subjects attained excellent
recovery (GAF>71) by 20-year follow-up. As with good recovery, borderline patients
were significantly less likely to attain this outcome and to attain it at a significantly
slower rate than personality-disordered comparison subjects
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, - The significant variables were: younger age, severity of other forms of abuse, higher
IQ, work competence under the age of 18, popularity in childhood, lower neuroticism,
higher extraversion, higher agreeableness, good vocational record as an adult, and
number of friends as an adult.
- These significant predictors were: higher IQ, childhood work competence, good
vocational functioning in adulthood, lower trait neuroticism, and higher trait
agreeableness
- these results are consistent with the view that BPD is a more severe disorder
symptomatically and psychosocially than the heterogeneous personality disorder
diagnoses that comprise our comparison group.
- the results of this study suggest that a complete recovery is difficult for borderline
patients to achieve even over long periods of time. They also suggest that competence
displayed in both childhood and adulthood is the best predictor of this important
outcome.
Giessen Outpatient Psychotherapy for Borderline Personality Disorder Randomized Trial
of Schema-Focused Therapy vs Transference-Focused Psychotherapy
- Objective: To compare the effectiveness of schemafocused therapy (SFT) (meer
gefocust Beck) and psychodynamically based transference-focused psychotherapy
(meer focus op Freud) (TFP) in patients with borderline personality disorder.
- Design: A multicenter, randomized, 2-group design.
- Setting: Four general community mental health centers.
- Participants: Eighty-eight patients with a Borderline Personality Disorder Severity
Index, fourth version, score greater than a predetermined cutoff score.
- Intervention: Three years of either SFT or TFP with sessions twice a week.
- Main Outcome Measures: Borderline Personality Disorder Severity Index, fourth
version, score; quality of life; general psychopathologic dysfunction; and measures of
SFT/TFP personality concepts. Patient assessments were made before randomization
and then every 3 months for 3 years.
- Results: Data on 44 SFT patients and 42 TFP patients were available. The
sociodemographic and clinical characteristics of the groups were similar at baseline.
Survival analyses revealed a higher dropout risk for TFP patients than for SFT
patients. Using an intention to- treat approach, statistically and clinically significant
improvements were found for both treatments on all measures after 1-, 2-, and 3-year
treatment periods. After 3 years of treatment, survival analyses demonstrated that
significantly more SFT patients recovered (relative risk=2.18) or showed reliable
clinical improvement (relative risk=2.33) on the Borderline Personality Disorder
Severity Index, fourth version. Robust analysis of covariance showed that they also
improved more in general psychopathologic dysfunction and measures of SFT/TFP
personality concepts. Finally, SFT patients showed greater increases in quality of life
than TFP patients.
- Conclusions: Three years of SFT or TFP proved to be effective in reducing borderline
personality disorder– specific and general psychopathologic dysfunction and measures
of SFT/TFP concepts and in improving quality of life; SFT is more effective than TFP
for all measures.
- Baanbrekend: borderline blijkt toch redelijk goed behandelbaar zeker op lange
termijn terwijl iedereen dacht onbehandelbaar
- Schema-focused therapy is an integrative cognitive therapy, and TFP is a
psychodynamically based psychotherapy
- we decided to compare SFT and TFP because (1) these treatments seemed promising
after an uncontrolled pilot study and therapists’ individual clinical experiences (now
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