Group Psychotherapy in Norway.

This paper gives an overview of group psychotherapy in Norway: the history, approaches in use, programs for systematic training, how group services are financed, and finally how practice and research are integrated in the public mental health system.

Health service costs and clinical gains of psychotherapy for personality disorders: a randomized controlled trial of day-hospital-based step-down treatment versus outpatient treatment at a specialist practice.

BACKGROUND: Day-hospital-based treatment programmes have been recommended for poorly functioning patients with personality disorders (PD). However, more research is needed to confirm the cost-effectiveness of such extensive programmes over other, presumably simpler, treatment formats. METHODS: This study compared health service costs and psychosocial functioning for PD patients randomly allocated to either a day-hospital-based treatment programme combining individual and group psychotherapy in a step-down format, or outpatient individual psychotherapy at a specialist practice. It included 107 PD patients, 46% of whom had borderline PD, and 40% of whom had avoidant PD. Costs included the two treatment conditions and additional primary and secondary in- and outpatient services. Psychosocial functioning was assessed using measures of global (observer-rated GAF) and occupational (self-report) functioning. Repeated assessments over three years were analysed using mixed models. RESULTS: The costs of step-down treatment were higher than those of outpatient treatment, but these high costs were compensated by considerably lower costs of other health services. However, costs and clinical gains depended on the type of PD. For borderline PD patients, cost-effectiveness did not differ by treatment condition. Health service costs declined during the trial, and functioning improved to mild impairment levels (GAF > 60). For avoidant PD patients, considerable adjuvant health services expanded the outpatient format. Clinical improvements were nevertheless superior to the step-down condition. CONCLUSION: Our results indicate that decisions on treatment format should differentiate between PD types. For borderline PD patients, the costs and gains of step-down and outpatient treatment conditions did not differ. For avoidant PD patients, the outpatient format was a better alternative, leaning, however, on costly additional health services in the early phase of treatment. TRIAL REGISTRATION: Clinical Trials NCT00378248.

Patients' characteristics, outcome and cost-benefit of hospital-based treatment for patients with personality disorder: a comparison of three different programmes.

In this study we aimed (a) to ascertain whether a relationship exists between different treatment programmes and settings for personality disorder and patient characteristics; (b) to give an indication of treatment effects in three personality disordered populations admitted to different treatment contexts; and (c) to compare costs in relation to outcomes. We collected and compared three samples from one in-patient site (Cassel in England) and two day hospitals (Halliwick in England and Ulleval in Norway) on a number of demographic, diagnostic and other key clinical variables. Outcome in the areas of symptom severity (Symptom Checklist-90-R) and social adaptation (Social Adjustment Scale) was evaluated by comparing admission with discharge scores. Treatment costs for each sample were also estimated and compared. Significant differences were found on most baseline variables across the three sites. In general with regard to severity of psychopathology, the Halliwick sample was the most disturbed, Ulleval the least, with Cassel somewhat in between. No significant differences in improvement were found among the three sites, but treatment costs were considerably higher at Cassel than in the two day centres. The differences found in the three samples bear no clear relationship to context of treatment. These results suggest that referral of personality disorder for in-patient or day hospital treatment is less influenced by severity of problem than had previously been supposed and may depend more on availability of treatment facility.