Democratic therapeutic community treatment for personality disorder: randomised controlled trial.

BACKGROUND: Democratic therapeutic community (DTC) treatment has been used for many years in an effort to help people with personality disorder. High-quality evidence from randomised controlled trials (RCTs) is absent. AIMS: To test whether DTC treatment reduces use of in-patient services and improves the mental health of people with personality disorder. METHOD: An RCT of 70 people meeting DSM-IV criteria for personality disorder (trial registration: ISRCTN57363317). The intervention was DTC and the control condition was crisis planning plus treatment as usual (TAU). The primary outcome was days of in-patient psychiatric treatment. Secondary outcomes were social function, mental health status, self-harm and aggression, attendance at emergency departments and primary care, and satisfaction with care. All outcomes were measured at 12 and 24 months after randomisation. RESULTS: Number of in-patient days at follow-up was low among all participants and there was no difference between groups. At 24 months, self- and other directed aggression and satisfaction with care were significantly improved in the DTC compared with the TAU group. CONCLUSIONS: DTC is more effective than TAU in improving outcomes in personality disorder. Further studies are required to confirm this conclusion.

Coprological prevalence and intensity of helminth infection in working horses in Lesotho.

This study aimed to (1) estimate infection prevalence of strongyle, Oxyuris equi and Parascaris equorum species and the intensity of infection with strongyles in working horses in lowland Lesotho and (2) investigate associations between infection and horse age, sex and owner-reported use of anthelmintics. In a cross-sectional survey, fresh faecal samples were obtained from 305 randomly selected horses and worm egg counts performed using a validated field laboratory kit. Details of anthelmintic use were collected using a standardised face-to-face owner questionnaire. Infection prevalence estimates for each species were calculated, as were infection intensity estimates for strongyle species. Logistic regression was used to investigate associations between exposure variables and infection status/intensity. Prevalence of strongyle infection was 88.2%; 11.8% of horses were not infected and infection intensity was low (1-500 eggs per gram (epg)) in 19.7%, medium (501-1,000 epg) in 19.7%) and high (>1,001 epg) in 48.8%. Decreasing strongyle infection intensity was associated with the use of proprietary equine anthelmintic products (OR 0.18, 95%CI 0.11-0.30, p<0.0001). Prevalence of O. equi infection was 6.2%; the odds of infection with this parasite decreased with increasing horse age (OR 0.84, 95%CI 0.72-0.97, p = 0.02). P. equorum infection prevalence was 21.6%; no statistically significant associations with the investigated exposure variables were found. In conclusion, strongyle infection is endemic in working horses in lowland Lesotho, but proprietary equine anthelmintics assist in managing infection. The apparent lack of age-acquired immunity to P. equorum infection may deserve further investigation. Although O. equi infection is less widespread, measures to protect younger animals may be appropriate.