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Restek-Petrovic B, Grah M, Ivezic E, Handl H, Milovac Z, Bahun I, Mayer N, Vrbek P. Borderline Personality Disorder: Comparison of Two Treatment Modalities. J Nerv Ment Dis 2023; 211:11-16. [PMID: 36596287 DOI: 10.1097/nmd.0000000000001546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
ABSTRACT The aim of this study was to compare the effectiveness of two treatment modalities for patients diagnosed with borderline personality disorder (BPD). A total of 100 psychiatric patients diagnosed with BPD participated in this study. Among them, 50 patients were outpatients who attended the Reason and Emotion (RIO) program, and the remaining 50 were inpatients who were treated on psychotherapeutic ward at the same hospital. All the participants filled out the following battery of tests when entering the program/psychotherapy ward and 3 months later: Rosenberg's Self-Esteem Scale, Tennessee Self-Concept Scale (2nd ed), Barratt Impulsiveness Scale, The COPE Inventory, and the WHOQOL-BREF scale. The results showed significant positive effects of both treatment modalities on patients' self-esteem, different domains of self-concept, impulsivity, and different domains of subjective quality of life. No significant changes were observed in terms of coping strategies. Thus, the results speak in favor of the outpatient RIO program, which is more cost-effective than the inpatient ward treatment.
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Buer Christensen T, Hummelen B, Paap MCS, Eikenaes I, Selvik SG, Kvarstein E, Pedersen G, Bender DS, Skodol AE, Nysæter TE. Evaluation of Diagnostic Thresholds for Criterion A in the Alternative DSM-5 Model for Personality Disorders. J Pers Disord 2020; 34:40-61. [PMID: 31682197 DOI: 10.1521/pedi_2019_33_455] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Level of Personality Functioning Scale (LPFS) of the Alternative DSM-5 Model for Personality Disorders (AMPD) was formulated to assess the presence and severity of personality disorders (PDs). Moderate impairment (Level 2) in personality functioning, as measured by the LPFS, was incorporated into the AMPD as a diagnostic threshold for PD in Criterion A of the general criteria, as well as for the "any two areas present" rule for assigning a specific PD diagnosis. This study represents the first evaluation of the diagnostic decision rules for Criterion A, in a clinical sample (N = 282). The results indicate that an overall diagnostic threshold for PDs should be used with caution because it may not identify all DSM-IV PDs. The "any two areas present" rule proved to be a reasonable alternative, although this finding should be interpreted with caution because the LPFS does not measure the disorder-specific A criteria.
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Affiliation(s)
| | - Benjamin Hummelen
- Department of Personality Psychiatry, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Research and Development, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Muirne C S Paap
- Department of Research and Development, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Department of Special Needs, Education, and Youth Care, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Ingeborg Eikenaes
- Department of Personality Psychiatry, Division of Mental Health and Addiction Treatment, Vestfold Hospital Trust, Tonsberg, Norway
| | - Sara Germans Selvik
- Department of Psychiatry, Hospital Namsos, Namsos, Norway.,Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Elfrida Kvarstein
- Department of Personality Psychiatry, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Department of Personality Psychiatry, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, KG Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Donna S Bender
- Department of Psychiatry and Behavioral Sciences and Counseling and Psychological Services, Tulane University, New Orleans, Louisiana
| | - Andrew E Skodol
- Department of Psychiatry, University of Arizona College of Medicine, Tucson, Arizona
| | - Tor Erik Nysæter
- Department of Mental Health, Sorlandet Hospital, Arendal, Norway
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Buer Christensen T, Paap MCS, Arnesen M, Koritzinsky K, Nysaeter TE, Eikenaes I, Germans Selvik S, Walther K, Torgersen S, Bender DS, Skodol AE, Kvarstein E, Pedersen G, Hummelen B. Interrater Reliability of the Structured Clinical Interview for the DSM–5 Alternative Model of Personality Disorders Module i: Level of Personality Functioning Scale. J Pers Assess 2018; 100:630-641. [DOI: 10.1080/00223891.2018.1483377] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
| | - Muirne C. S. Paap
- Department of Special Needs, Education, and Youth Care, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | | | | | | | - Ingeborg Eikenaes
- Department of Personality Psychiatry, Division of Mental Health and Addiction Treatment, Vestfold Hospital Trust, Vestfold, Norway
| | - Sara Germans Selvik
- Department of Psychiatry, Hospital Namsos, Namsos, Norway
- Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kristoffer Walther
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Donna S. Bender
- Department of Psychiatry and Behavioral Sciences and Counseling and Psychological Services, Tulane University
| | - Andrew E. Skodol
- 9Department of Psychiatry, University of Arizona College of Medicine, Oslo University Hospital, Oslo, Norway
| | - Elfrida Kvarstein
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- NORMENT, KG Jebsen Center for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Benjamin Hummelen
- Department of Personality Psychiatry, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Research and Development, Clinic Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Abstract
SUMMARYThis article reviews historical contributions to the conceptualisation of narcissism and narcissistic personality disorder (NPD), including its evolution as a clinical diagnosis within the DSM classification of mental disorders. It discusses the epidemiology and aetiology of NPD, noting that empirical studies of both are limited. The challenges of managing patients with prominent narcissistic traits are presented, and the psychological therapies specifically designed for the treatment of patients with NPD are summarised.LEARNING OBJECTIVES•Understand different models of narcissism•Understand the epidemiology, comorbidity and theories of aetiology of NPD•Know how to manage and treat patients with pathological narcissism and NPDDECLARATION OF INTERESTNone.
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Antonsen BT, Kvarstein EH, Urnes Ø, Hummelen B, Karterud S, Wilberg T. Favourable outcome of long-term combined psychotherapy for patients with borderline personality disorder: Six-year follow-up of a randomized study. Psychother Res 2015; 27:51-63. [DOI: 10.1080/10503307.2015.1072283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Karterud S. On Structure and Leadership in Mentalization-based Group Therapy and Group Analysis. ACTA ACUST UNITED AC 2015. [DOI: 10.1177/0533316415577339] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mentalization-based group therapy (MBT-G) has its roots in group analytic psychotherapy. Modifications were made in order to suit the needs of more disturbed personality disordered patients, and to avoid the chaotic and destructive processes often encountered in groups dominated by these patients. In this article I outline the kind of leadership, structure and authority that MBT proscribes and discuss these principles in comparison with group analysis. I also comment upon a study of a MBT group that failed to establish a good mentalizing culture, with reference to Bion’s concept of ‘attack on linking’. This study reminds us that strong professional support and competent supervision is necessary in order to achieve sound communicational ideals, when the group is composed of members who easily resort to prementalistic modes of thinking.
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Antonsen BT, Klungsøyr O, Kamps A, Hummelen B, Johansen MS, Pedersen G, Urnes Ø, Kvarstein EH, Karterud S, Wilberg T. Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project. BMC Psychiatry 2014; 14:119. [PMID: 24758722 PMCID: PMC4000615 DOI: 10.1186/1471-244x-14-119] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 04/10/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although psychotherapy is considered the treatment of choice for patients with personality disorders (PDs), there is no consensus about the optimal level of care for this group of patients. This study reports the results from the 6-year follow-up of the Ullevål Personality Project (UPP), a randomized clinical trial comparing outpatient individual psychotherapy with a long-term step-down treatment program that included a short-term day hospital treatment followed by combined group and individual psychotherapy. METHODS The UPP included 113 patients with PDs. Outcome was evaluated after 8 months, 18 months, 3 years and 6 years and was based on a wide range of clinical measures, such as psychosocial functioning, interpersonal problems, symptom severity, and axis I and II diagnoses. RESULTS At the 6-year follow-up, there were no statistically significant differences in outcome between the treatment groups. Effect sizes ranged from medium to large for all outcome variables in both treatment arms. However, patients in the outpatient group had a marked decline in psychosocial functioning during the period between the 3- and 6-year follow-ups; while psychosocial functioning continued to improve in the step-down group during the same period. This difference between groups was statistically significant. CONCLUSIONS The findings suggest that both hospital-based long-term step-down treatment and long-term outpatient individual psychotherapy may improve symptoms and psychosocial functioning in poorly functioning PD patients. Social and interpersonal functioning continued to improve in the step-down group during the post-treatment phase, indicating that longer-term changes were stimulated during treatment. TRIAL REGISTRATION NCT00378248.
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Affiliation(s)
| | - Ole Klungsøyr
- Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anne Kamps
- Department of Psychiatry, Lovisenberg Diaconal hospital, Oslo, Norway
| | - Benjamin Hummelen
- Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Merete S Johansen
- Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Geir Pedersen
- Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Urnes
- Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elfrida H Kvarstein
- Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Sigmund Karterud
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway,Department of Personality Psychiatry, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Theresa Wilberg
- Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Curral R, Lopes R, Silveira C, Norton A, Domingues I, Lopes F, Ramos E, Roma-Torres A. Forty years of a psychiatric day hospital. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2014; 36:52-8. [PMID: 27000548 DOI: 10.1590/2237-6089-2013-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 12/02/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Day hospitals in psychiatry are a major alternative to inpatient care today, acting as key components of community and social psychiatry. OBJECTIVE To study trends in the use of psychiatric day hospitals over the last decades of the 20th century and the first decade of the 21st century, focusing on patient age, sex, and diagnostic group, using data from Centro Hospitalar São João, Porto, Portugal. METHODS Data corresponding to years 1970 to 2009 were collected from patient files. Patients were classified into seven diagnostic groups considering their primary diagnoses only. RESULTS Mean age upon admission rose from 32.7±12.1 years in the second half of the 1970s to 43.5±12.2 years in 2005-2009 (p for trend < 0.001). Most patients were female (63.2%), however their proportion decreased from nearly 70% in the 1970s to 60% in the first decade of the 21st century. In males, until the late 1980s, neurotic disorders (E) were the most common diagnosis, accounting for more than one third of admissions. In the subsequent years, this proportion decreased, and the number of admissions for schizophrenia (C) exceeded 50% in 2004- 2009. In females, until the late 1980s, affective disorders (D) and neurotic disorders (E), similarly distributed, accounted for most admissions. From the 1990s on, the proportion of neurotic disorders (E) substantially decreased, and affective disorders (D) came to represent more than 50% of all admissions. CONCLUSIONS Mean age upon admission rose with time, as did the percentage of female admissions, even though the latter tendency weakened in the last 10 years assessed. There was also an increase in the proportion of patients with schizophrenia.
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Affiliation(s)
- Rosário Curral
- Department of Clinical Neurosciences and Mental Health, Porto Medical School, Porto, Portugal
| | - Rui Lopes
- Centro Hospitalar São João, Porto, Portugal
| | - Celeste Silveira
- Department of Clinical Neurosciences and Mental Health, Porto Medical School, Porto, Portugal
| | | | | | - Fernando Lopes
- Department of Health Information and Decision Sciences, Porto Medical School, Porto, Portugal
| | - Elisabete Ramos
- Department of Epidemiology, Porto Medical School, Porto, Portugal
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Reas DL, Rø Ø, Karterud S, Hummelen B, Pedersen G. Eating disorders in a large clinical sample of men and women with personality disorders. Int J Eat Disord 2013; 46:801-9. [PMID: 23983043 DOI: 10.1002/eat.22176] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We assessed and compared the prevalence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS) across six Axis II groups (borderline, obsessive-compulsive, avoidant, dependent, paranoid, and personality disorder NOS) and patients with major depressive disorder (MDD) without personality disorders (PD). METHOD The sample included 3,266 consecutive and first admissions to 16 different treatment units in the Norwegian Network of Psychotherapeutic Day Hospitals between 1993 and 2009. All patients were interviewed with the SCID-II for DSM-III-R (prior to 1996) or DSM-IV (from 1996) and the MINI for Axis I disorders in accordance with the LEAD (longitudinal, expert, all-data) standard. RESULTS The prevalence of any ED in the PD sample was approximately 17% for women and 3% for men. A lower rate of ED (5%) was found for patients with MDD without PD. A significantly higher proportion of patients with borderline personality disorder were diagnosed with BN or EDNOS. The rate of AN was significantly elevated in female patients with obsessive-compulsive personality disorder. Men demonstrated significantly less diagnostic co-occurrence and no significant differential variation across PD groups or MDD. DISCUSSION Data which included a psychiatric comparison group showed less co-occurrence and non-significant variation across PD groups for men, but demonstrated a meaningful and specific pattern of comorbidity between ED and PD for women. There was an elevated risk of ED among female patients with PD, most pronounced for borderline. An almost five-fold higher rate of AN was found among women with obsessive-compulsive PD.
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Affiliation(s)
- Deborah L Reas
- Regional Eating Disorders Service, Division of Mental Health and Addiction, Oslo University Hospital, Norway
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Butareva MM. Hospitalization replacement technologies in the Russian Federation. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents data on different forms of hospitalization replacement technologies in foreign countries and in the Russian Federation. The author describes an experience of administering medical aid according to individual profiles under the conditions of hospitalization replacement technologies.
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Olmsted MP, McFarlane T, Trottier K, Rockert W. Efficacy and intensity of day hospital treatment for eating disorders. Psychother Res 2013; 23:277-86. [DOI: 10.1080/10503307.2012.721937] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Gullestad FS, Wilberg T, Klungsøyr O, Johansen MS, Urnes Ø, Karterud S. Is treatment in a day hospital step-down program superior to outpatient individual psychotherapy for patients with personality disorders? 36 months follow-up of a randomized clinical trial comparing different treatment modalities. Psychother Res 2012; 22:426-41. [DOI: 10.1080/10503307.2012.662608] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Ogrodniczuk JS, Lynd LD, Joyce AS, Grubisic M, Piper WE, Steinberg PI. Predicting response to day treatment for personality disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:110-7. [PMID: 21333038 DOI: 10.1177/070674371105600206] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Efforts to improve the effectiveness of day treatment should attend to factors that influence treatment response. Our prospective study identified predictors of response to day treatment for personality disorder (PD). METHOD Patients with a PD, consecutively admitted to a day treatment program, were assessed with self-report and interview measures. Predictors included personality characteristic, demographic, initial disturbance, and PD variables. Patients' overall response to treatment was classified as better, same, or worse, based on change in multiple outcome measures. A comprehensive approach to multivariate modelling was used. RESULTS The likelihood of being classified as better significantly increased if the patient was more psychologically minded, used avoidance-oriented coping strategies, and had a high level of baseline symptom severity. Probability of being classified as better decreased if the patient had a substance use disorder and a history of high service use. CONCLUSIONS Identifying factors that affect response to day treatment can help clinicians make better selection decisions or take measures to modify treatment.
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Affiliation(s)
- John S Ogrodniczuk
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia.
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Karterud S, Arefjord N, Andresen NE, Pedersen G. Substance use disorders among personality disordered patients admitted for day hospital treatment. Implications for service developments. Nord J Psychiatry 2009; 63:57-63. [PMID: 19172500 DOI: 10.1080/08039480802298705] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Personality disorders (PD) and substance use disorders (SUD) are highly comorbid conditions. However, their treatment services are often separated. The aims of this study was to investigate how extensive this separation was prior to a Norwegian health reform (2004) that promoted integration, and to discuss clinical challenges for an integrated treatment of PD and SUD. All patients with a diagnosis of PD (n=1783) admitted to 10 day hospital treatment programs (1993-2003) were examined. Diagnoses were assessed by Mini International Neuropsychiatric Interview and Structured Clinical Interview for DSM-IV interviews. Socio-demographic data, psychosocial functioning (Global Assessment of Functioning Scale), symptom distress (Symptom Check List-90-Revised), interpersonal problems (Circumplex of Interpersonal Problems) and treatment course were recorded. The majority of patients were females (72%) and the prevalence of SUD was low (14%). SUD occurred among all PD categories. Patients with borderline PD were over-represented and patients with cluster C disorders were under-represented in the SUD sample. The SUD sample contained more men and it was associated with more previous violence against self and others. The reported violence was partly explained by gender (males) and diagnoses (borderline and SUD). PD patients with SUD also displayed more aggression during treatment and dropped out more frequently. The findings demonstrate that the female dominated specialized psychiatric treatment services for PD to a large extent had excluded PD patients who also had SUD. The reasons are probably related to the surplus problems that characterized the SUD sample and gender issues. Implications for the development of the PD and SUD services with respect to an integrated treatment for these comorbid conditions are discussed.
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Affiliation(s)
- Sigmund Karterud
- Institute of Psychiatry, University of Oslo, Department of Personality Psychiatry, Ullevål University Hospital, Oslo, Norway
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Halsteinli V, Karterud S, Pedersen G. When costs count: The impact of staff size, skill mix and treatment intensity on patient outcome for psychotherapeutic day treatment programmes. Health Policy 2008; 86:255-65. [DOI: 10.1016/j.healthpol.2007.10.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 10/22/2007] [Accepted: 10/29/2007] [Indexed: 11/28/2022]
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Abstract
PURPOSE OF REVIEW Borderline personality disorder is the most widely researched single personality disorder, and much research activity continues. This review covers empirical literature on diagnosis, classification and treatment of borderline personality disorder published during 2006 and 2007. Several of the issues that concern borderline personality disorder also concern personality disorders in general, and so the review is broadened in the diagnostic section to include the latter. RECENT FINDINGS Integration of categorical and dimensional approaches to personality disorders is actively being sought for inclusion in the next revision of the psychiatric classifications. Although there are few new studies on pharmacotherapy for borderline personality disorder, many new findings on psychotherapy have been reported. They indicate that a variety of treatment modalities can influence borderline personality disorder, but the role of spontaneous improvement over time and established prognostic factors have not received sufficient attention. New modalities of psychotherapy have been tested by less stringent designs. SUMMARY Research into classification, diagnosis and psychotherapy of borderline personality disorder is flourishing, but research activity in pharmacotherapy is limited.
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