Effectiveness of outpatient, day hospital, and inpatient psychotherapeutic treatment for patients with cluster B personality disorders.

BACKGROUND: For patients with cluster B personality disorders there is no consensus regarding the optimal treatment setting. The aim of this study was to compare the effectiveness of different psychotherapeutic settings for patients with cluster B personality disorders, i.e. outpatient, day hospital, and inpatient treatment. METHODS: The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 207 patients with a DSM-IV-TR axis II cluster B diagnosis. Patients were assigned to 3 different settings of psychotherapeutic treatment and effectiveness was assessed at 18 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45), and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. RESULTS: Patients in all 3 settings improved significantly in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life 18 months after baseline. The inpatient group showed the largest improvements. The comparison of outpatient and inpatient treatment regarding psychiatric symptoms showed a marginally significant result (p = 0.057) in favour of inpatient treatment. CONCLUSIONS: Patients with cluster B personality disorders improved in all investigated treatment settings, with a trend towards larger improvements of psychiatric symptoms in the inpatient setting compared to the outpatient setting. Specialised inpatient treatment should be considered as a valuable treatment option for cluster B personality disorders, both in research and in clinical practice.

Association between level of personality organization as assessed with theory-driven profiles of the Dutch Short Form of the MMPI and outcome of inpatient treatment for personality disorder.

The association between level of personality organization as assessed by theory-driven profile interpretation of the MMPI (Hathaway & McKinley, 1943) Dutch Short Form and treatment outcome was investigated in a naturalistic follow-up study among 121 psychotherapy inpatients who had been treated for their severe personality pathology. Treatment outcome was measured with the Brief Symptom Inventory (De Beurs & Zitman, 2006). Personality organization was associated with severity of psychopathology at baseline, the end of treatment, and 36 months after baseline. At 36 months after baseline, all patients except those with the high-level borderline organization profile and the psychotic borderline profile maintained their improvement. Contrary to expectations, (a) personality organization did not differentiate between patients with successful and unsuccessful out-comes, and (b) patients with a neurotic personality organization did not respond better than those with a borderline personality organization. Because of the small N, conclusions are tentative.

Predictive validity of the MMPI-2 clinical, PSY-5, and RC scales for therapy disruptive behavior.

BACKGROUND: Impulsive acts, parasuicidal behavior, and other therapy disruptive incidents occur frequently in the treatment of patients with personality disorders and increase the risk that patients will drop out of treatment. OBJECTIVE: This study examined the predictive validity of the Minnesota Multiphasic Personality Inventory (MMPI)-2 Restructured Clinical (RC) and Psychopathology Five (PSY-5) Scales for therapy disruptive behavior and compared them with the original clinical scales. METHODS: Using an inventory, the treatment staff recorded the therapy disruptive behavior of 104 patients with personality disorders who were receiving inpatient psychotherapy. RESULTS: Both the RC and the PSY-5 scales predicted several categories of therapy disruptive behavior, and both scales predicted more categories of therapy disruptive behavior than the original clinical scales. Anger outbursts were predicted especially well by a combination of two of the RC scales. CONCLUSIONS: The information about the MMPI-2 obtained in this study may be helpful in case formulation when initiating inpatient treatment for patients with personality disorders.

The reliability of the Developmental Profile based on video ratings.

Although psychodynamic interviews often provide a broad spectrum of interesting and useful information for the therapist, most of these interviews lack sufficient psychometric quality. So far, the Developmental Profile interview seemed an exception. However, only first-level reliability ratings based on a written account of an interview had been conducted. This study presents the results of a second-level reliability study of the Developmental Profile, based on ratings of videotapes of the Profile interview. A total of 32 videotaped interviews with psychotherapeutic inpatients were rated by three independent raters in compliance with the new version of the Developmental Profile rating manual. Contrary to earlier findings, the authors found insufficient reliability. Results are discussed.