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Groot IZ, Venhuizen ASSM, Bachrach N, Walhout S, de Moor B, Nikkels K, Dalmeijer S, Maarschalkerweerd M, van Aalderen JR, de Lange H, Wichers R, Hollander AP, Evers SMAA, Grasman RPPP, Arntz A. Design of an RCT on cost-effectiveness of group schema therapy versus individual schema therapy for patients with Cluster-C personality disorder: the QUEST-CLC study protocol. BMC Psychiatry 2022; 22:637. [PMID: 36209067 PMCID: PMC9548126 DOI: 10.1186/s12888-022-04248-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Given the high prevalence of Cluster-C Personality Disorders (PDs) in clinical populations, disease burden, high societal costs and poor prognosis of comorbid disorders, a major gain in health care can be achieved if Cluster-C PDs are adequately treated. The only controlled cost-effectiveness study published so far found Individual Schema Therapy (IST) to be superior to Treatment as Usual (TAU). Group ST (GST) might improve cost-effectiveness as larger numbers can be treated in (>50%) less time compared to IST. However, to date there is no RCT supporting its (cost-) effectiveness. The overall aim of this study is to assess the evidence for GST for Cluster-C PDs and to improve treatment allocation for individual patients. Three main questions are addressed: 1) Is GST for Cluster-C PDs (cost-)effective compared to TAU? 2) Is GST for Cluster-C PDs (cost-) effective compared to IST? 3) Which patient-characteristics predict better response to GST, IST, or TAU? METHODS In a multicenter RCT, the treatment conditions GST, IST, and TAU are compared in 378 Cluster-C PD patients within 10 sites. GST and IST follow treatment protocols and are completed within 1 year. TAU is the optimal alternative treatment available at the site according to regular procedures. Severity of the Cluster-C PD is the primary outcome, assessed with clinical interviews by independent raters blind for treatment. Functioning and wellbeing are important secondary outcomes. Assessments take place at week 0 (baseline), 17 (mid-GST), 34 (post-GST), 51 (post-booster sessions of GST), and 2 years (FU). Patient characteristics predicting better response to a specific treatment are studied, e.g., childhood trauma, autistic features, and introversion. A tool supporting patients and clinicians in matching treatment to patient will be developed. An economic evaluation investigates the cost-effectiveness and cost-utility from a societal perspective. A process evaluation by qualitative methods explores experiences of participants, loved ones and therapists regarding recovery, quality of life, and improving treatment. DISCUSSION This study will determine the (cost-)effectiveness of treatments for Cluster-C PDs regarding treatment type as well as optimal matching of patient to treatment and deliver insight into which aspects help Cluster-C-PD patients recover and create a fulfilling life. TRIAL REGISTRATION Dutch Trial Register: NL9209 . Registered on 28-01-2021.
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Affiliation(s)
- Iuno Z. Groot
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, PO Box 15933, Amsterdam, 1001 NK the Netherlands
| | - Anne-Sophie S. M. Venhuizen
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, PO Box 15933, Amsterdam, 1001 NK the Netherlands
| | - Nathan Bachrach
- grid.12295.3d0000 0001 0943 3265Department of medical and clinical psychology, Tilburg University, Tilburg, the Netherlands ,grid.476319.e0000 0004 0377 6226GGZ-Oost Brabant, Department of Personality Disorders, Helmond, Boxmeer, Oss, the Netherlands
| | - Simone Walhout
- grid.476319.e0000 0004 0377 6226GGZ-Oost Brabant, Department of Personality Disorders, Helmond, Boxmeer, Oss, the Netherlands
| | - Bregje de Moor
- grid.476319.e0000 0004 0377 6226GGZ-Oost Brabant, Department of Personality Disorders, Helmond, Boxmeer, Oss, the Netherlands
| | | | | | | | | | | | | | | | - Silvia M. A. A. Evers
- grid.5012.60000 0001 0481 6099Department of Health Services Research, Care and Public Health Research Institute (CAPHRI) Maastricht University, Maastricht, the Netherlands ,grid.416017.50000 0001 0835 8259Centre for Economic Evaluation, Trimbos Institute, Utrecht, the Netherlands
| | - Raoul P. P. P. Grasman
- grid.7177.60000000084992262Department of Psychological Methods, University of Amsterdam, Amsterdam, the Netherlands
| | - Arnoud Arntz
- grid.7177.60000000084992262Department of Clinical Psychology, University of Amsterdam, PO Box 15933, Amsterdam, 1001 NK the Netherlands
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Groot IZ, Lever AG, Koolschijn PC, Geurts HM. Brief Report: Using Cognitive Screeners in Autistic Adults. J Autism Dev Disord 2020; 51:3374-3379. [PMID: 33201420 DOI: 10.1007/s10803-020-04782-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2020] [Indexed: 10/23/2022]
Abstract
By comparing 51 autistic adults and 49 age-matched controls (aged 30-73 years) we tested if (1) the Montreal Cognitive Assessment (MoCA) is more sensitive in measuring cognitive impairments than the Mini Mental State Examination (MMSE) and (2) if we can replicate the MoCA-findings of Powell et al. (2017) with the Dutch MoCA(-NL). Results showed that: (1) The MoCA-NL is more sensitive, and (2) like Powell, no group differences were observed on the MoCA-NL. However, in contrast to Powell, we did not observe that older autistic adults show more impairment than controls on the MoCA-NL. Nonetheless, as the MoCA-NL is more sensitive to cognitive impairment, it is the recommended screener for older autistic adults.
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Affiliation(s)
- Iuno Z Groot
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
| | - Anne G Lever
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.,Dimence, Institute for Mental Health, Deventer, The Netherlands
| | - P Cédric Koolschijn
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, The Netherlands
| | - Hilde M Geurts
- Dutch Autism & ADHD Research Center, Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.,Dr. Leo Kannerhuis, Autism Clinic, Amsterdam, The Netherlands.,Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, The Netherlands
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