Relationships between treatments received in the Nottingham Study of Neurotic Disorder over 30 years and personality status

The effect of environmental change, planned and unplanned life events on the long-term outcome of common mental disorders

PURPOSE

To examine the nature of positive and negative environmental change on clinical outcome in 210 patients presenting with anxiety and depression and followed up over 30 years.

METHODS

In addition to clinical assessments, major environmental changes, particularly after 12 and 30 years, were recorded in all patients by a combination of self-report and taped interviews. Environmental changes were separated into two major groups, positive or negative, determined by patient opinion.

RESULTS

In all analyses positive changes were found to be associated with better outcome at 12 years with respect to accommodation (P = 0.009), relationships (P = 007), and substance misuse (P = 0.003), with fewer psychiatric admissions (P = 0.011) and fewer social work contacts at 30 years (P = 0.043). Using a consolidated outcome measure positive changes were more likely than negative ones to be associated with a good outcome at 12 and 30 years (39% v 3.6% and 30.2% v 9.1%, respectively). Those with personality disorder at baseline had fewer positive changes (P = 0.018) than others at 12 years and fewer positive occupational changes at 30 years (P = 0.041). Service use was greatly reduced in those with positive events with 50-80% more time free of all psychotropic drug treatment (P < 0.001). Instrumental positive change had greater effects than imposed changes.

CONCLUSIONS

Positive environmental change has a favourable impact on clinical outcome in common mental disorders. Although studied naturalistically in this study the findings suggest that if harnessed as a therapeutic intervention, as in nidotherapy and social prescribing, it would yield therapeutic dividends.

New data toward fulfilling the promise of the ICD-11 severity criterion

Great progress has been made in furthering our understanding of the long-term course of personality pathology. However, our knowledge about the long-term outcomes of personality disorder, thus far, is based on a polythetic and categorical definition of personality disorder. This special issue brings together a set of papers reporting on the results of the 30-year prospective study, the Nottingham Study of Neurotic Disorder, in addition to presenting a study protocol for a future study, the Boston (UK) Personality Project, and results from a study of lived experience of individuals who have been in treatment for personality challenges. Together, these papers highlight the value in viewing personality pathology not as a categorically defined disorder, but as a severity criterion related to functioning. This special issue paves the way for considering how to further refine and conceptualize the general severity criterion common to all manifestations (types) of personality disorder.