[Residential and day-hospital treatment for borderline personality disorder: a systematic review and meta-analysis]. / (Dag)klinische psychotherapie bij borderlinepersoonlijkheidsstoornis; systematische review en meta-analyse.

BACKGROUND: Residential and day-hospital psychotherapy are treatment modalities for patients with borderline personality disorder (BPD). A systematic overview of their effectiveness is lacking. AIM: To systematically examine the effects of residential and day-hospital psychotherapy for BPD (PROSPERO, CRD42020158557). METHOD: PsycINFO and PubMed, as well as previously published meta-analytic reviews, were searched for pre-post and controlled studies examining the effect of residential and day-hospital psychotherapy in adults with BPD. RESULTS: After screening, 37 studies were included representing 5936 individuals with BPD. Pre-post studies showed an average effect size of residential or day-hospital psychotherapy from beginning to end of treatment on primary outcomes (Hedges' g = 0.77; 95% CI: 0.67-0.87) and quality of life (g = 0.84; 95% CI: 0.54-1.13). The controlled studies showed a significant, but small effect of residential or day-hospital psychotherapy on primary outcome compared to outpatient controls (g = 0.27; 95% CI: 0.15-0.39), and on quality of life (g = 0.42; 95% CI: 0.13-0.72) compared to control conditions, at the end of treatment. CONCLUSION: Residential and day-hospital psychotherapy have a significant positive effect on pathology and quality of life of patients with BPD. More studies on long-term outcome are needed to determine effectiveness of residential and day-hospital psychotherapy.

[Risk of recidivism for forensic psychiatric patients with an autism spectrum disorder]. / Risico op recidive bij patiënten met een autismespectrumstoornis in de forensische psychiatrie.

BACKGROUND: There is limited knowledge of the predictive validity of risk factors and protective factors for recidivism in forensic psychiatric patients with an autism spectrum disorder (ASD). AIM: To examine risk factors, protective factors and the predictive value of these factors in relation to recidivism for forensic psychiatric patients with ASD compared to patients without ASD. METHOD: For 69 patients, including 32 patients with ASD, the risk factors and protective factors were measured at the start and end of treatment. Of these 69 patients recidivism was examined for 23 patients, including 10 patients with ASD. Furthermore, the predictive validity of these measurements in relation to recidivism was explored. RESULTS: The positive changes on risk and protective factors at the end of treatment did not differ significantly between both groups, except for the external protective factor, on which patients with ASD scored less favourable. We used a follow-up period of 2.5 to 4 years. Only 1 out of 10 ASS-patient showed recidivism compared to 7 out of 13 in the non-ASD-group. The scores on the risk assessment instruments at the start of treatment showed a significant predictive validity for recidivism, the scores at the of the end treatment did not. Structured clinical judgment of recidivism showed no significant predictive validity at the start as well as the end of treatment. CONCLUSION: Despite the small sample, the results give rise to further research about risk factors and protective factors for recidivism, and the usability of risk-assessment for forensic patients with ASD.

[Inpatient dialectical behaviour therapy for borderline personality disorder: effect on symptoms, coping, attachment and quality of life]. / Klinische dialectische gedragstherapie bij borderlinepersoonlijkheidsstoornis: effect op klachten, coping, hechting en kwaliteit van leven.

BACKGROUND: Dialectical behaviour therapy (dbt) is an effective treatment for patients suffering from borderline personality disorder (bpd). When outpatient treatment is ineffective, patients are often referred to inpatient (group) treatment. As of yet, little is known about the effectiveness of inpatient (group) dbt. An altered style of attachment is one of the presumed components of inpatient (group) treatment. At present, this supposition has not yet been examined in inpatient dbt programs. AIM: To examine the treatment outcome of an inpatient group dbt program for patients suffering from bpd, evaluating symptoms, coping, attachment style and quality of life. Whether an improvement in attachment style during treatment is a predictor of psychological wellbeing at the end of treatment will also be examined. METHOD: An inpatient group dbt population, comprising of 64 patients diagnosed with bpd, was evaluated. Self-report questionnaires assessed symptoms, coping, attachment style and quality of life at the start of treatment, after 19 weeks and at the end of treatment. RESULTS: The mentioned variables significantly improved in the inpatients of the group dbt program (treatment lasting on average 7.2 months). Furthermore, positive changes in secure and preoccupied attachment style were a significant predictor of psychological wellbeing at the end of the treatment. CONCLUSION: We conclude that patients diagnosed with bpd may benefit from an inpatient dbt (group) program. Improvements in attachment style during inpatient treatment may contribute to this benefit.

Effects of induced anger in patients with antisocial personality disorder.

BACKGROUND: Anger is the main deregulated emotion in patients with antisocial personality disorder (ASPD). The aim of this study was to examine emotional, cognitive and physiological correlates of anger and compare these between ASPD patients with varying degree of psychopathy (PP) and control groups. METHOD: Assessment of the effect of anger induction on self-reported emotions and schema modes, psychophysiology and implicit reaction-time tasks measuring self-anger and aggressor-swearword associations. Participants (n=147) were patients with DSM-IV antisocial (n=21), borderline (n=45) and cluster C personality disorder (n=46) and non-patient controls (n=35). RESULTS: Groups did not differ in self-reported anger. ASPD patients displayed a decrease in heart rate and systolic blood pressure (SBP) and stronger implicit self-anger associations. ASPD patients scoring low on affective PP reported less negative emotions and displayed a greater decrease in diastolic blood pressure (DBP). CONCLUSIONS: ASPD patients did not display a deviant self-reported anger but physiological hyporesponsivity and cognitive hyper-responsivity. This ASPD anger response might reflect a controlled predatory-like fight preparation.