A new time limited psychotherapy for BPD: preliminary results of a randomized and controlled trial.

INTRODUCTION: Psychic Representation focused Psychotherapy (PRFP) is a new time limited dynamic psychotherapy for the treatment of Borderline Personality Disorder. It is a psychodynamic technique based on brief psychoanalytic psychotherapy principles. It is manualized and designed to be applied in the framework of public health care services. A randomized and controlled study with a sample of 53 patients was conducted to assess PRFP efficacy. This work presents the results for the first 44 trial completers at termination of treatment. METHODS: Both groups, the experimental (n= 18) and control group (n= 26), received treatment as usual. The experimental group received an additional 20 (PRFP) sessions, conducted by four therapists with homogenous characteristics specifically trained in this technique. The main outcome variables measures were: Severity global index of SCL-90-R, Barrat Impulsivity Scale scores and Social Adaptation (SASS score). Baseline and final condition at termination was compared. CONCLUSIONS: Preliminary results showed significantly better outcomes for the experimental group in all the main variables measured and in most of the secondary ones. PRFP may represent an important contribution for the treatment of BPD patients. Follow-up assessment at 6 and 12 months is planned.

Una nueva Psicoterapia Breve para Trastornos límite de la personalidad. Resultados preliminares de un Ensayo controlado y aleatorizado / A new Time Limited Psychotherapy for BPD: Preliminary Results of a Randomized and Controlled Trial

Introducción: La Psicoterapia centrada en la Representación Psíquica (PCRP) es una nueva psicoterapia breve manualizada para los Trastornos Límite de la personalidad (TLP). Es una técnica psicodinámica basada en los principios de las psicoterapias psicoanalíticas breves, está manualizada y diseñada para su utilización en los servicios públicos. Con el objetivo de evaluar su eficacia en pacientes ambulatorios se realizó un estudio randomizado y controlado con una muestra total de 53 pacientes. En este trabajo se presenta la metodología del estudio y los resultados preliminares de los primeros 44 pacientes al final del periodo de intervención. Metodología: Ambos grupos, experimental (n= 18) y control (n= 26), recibieron tratamiento convencional, el grupo experimental recibió además 20 sesiones de PCRP realizada por cuatro terapeutas con características homogéneas y especialmente entrenados. Las variables principales de resultados fueron: Índice global de gravedad del SCL-90-R y puntuaciones de la escala de Impulsividad de Barrat y Adaptación Social SASS, comparándose entre la situación basal y al final de la intervención en cada grupo y en ambos. Los resultados preliminares resultaron significativamente superiores en el grupo experimental en las variables principales yen la mayoría de las secundarias. Conclusiones: La PCRP puede suponer un avance importante para el tratamiento de los TLP si se confirman los resultados preliminares con los datos finales del estudio. Éstos se presentarán una vez finalizado el mismo incluyendo la evaluación en el seguimiento a los seis y doce meses (AU)

Introduction: Psychic Representation focused Psychotherapy (PRFP) is a new time limited dynamic psychotherapy for the treatment of Borderline Personality Disorder. It is a psychodynamic technique based on brief psychoanalytic psychotherapy principles. It is manualized and designed to be applied in the framework of public health care services. A randomized and controlled study with a sample of 53 patients was conducted to assess PRFP efficacy. This work presents the results for the first 44 trial completers at termination of treatment. Methods: Both groups, the experimental (n= 18) and control group (n= 26), received treatment as usual. The experimental group received an additional 20 (PRFP) sessions, conducted by four therapists with homogenous characteristics specifically trained in this technique. The main outcome variables measures were: Severity global index of SCL-90-R, Barrat Impulsivity Scale scores and Social Adaptation (SASS score). Baseline and final condition at termination was compared. Conclusions: Preliminary results showed significantly better outcomes for the experimental group in all the main variables measured and in most of the secondary ones. PRFP may represent an important contribution for the treatment of BPD patients. Follow-up assessment at 6 and 12 months is planned (AU)

Patterns of mental health service utilization in a general hospital and outpatient mental health facilities: analysis of 365,262 psychiatric consultations.

PURPOSE: Mental health is one of the priorities of the European Commission. Studies of the use and cost of mental health facilities are needed in order to improve the planning and efficiey of mental health resources. We analyze the patterns of mental health service use in multiple clinical settings to identify factors associated with high cost. SUBJECTS AND METHODS: 22,859 patients received psychiatric care in the catchment area of a Spanish hospital (2000-2004). They had 365,262 psychiatric consultations in multiple settings. Two groups were selected that generated 80% of total costs: the medium cost group (N = 4,212; 50% of costs), and the high cost group (N = 236; 30% of costs). Statistical analyses were performed using univariate and multivariate techniques. Significant variables in univariate analyses were introduced as independent variables in a logistic regression analysis using "high cost" (>7,263$) as dependent variable. RESULTS: Costs were not evenly distributed throughout the sample. 19.4% of patients generated 80% of costs. The variables associated with high cost were: age group 1 (0-14 years) at the first evaluation, permanent disability, and ICD-10 diagnoses: Organic, including symptomatic, mental disorders; Mental and behavioural disorders due to psychoactive substance use; Schizophrenia, schizotypal and delusional disorders; Behavioural syndromes associated with physiological disturbances and physical factors; External causes of morbidity and mortality; and Factors influencing health status and contact with health services. DISCUSSION: Mental healthcare costs were not evenly distributed throughout the patient population. The highest costs are associated with early onset of the mental disorder, permanent disability, organic mental disorders, substance-related disorders, psychotic disorders, and external factors that influence the health status and contact with health services or cause morbidity and mortality. CONCLUSION: Variables related to psychiatric diagnoses and sociodemographic factors have influence on the cost of mental healthcare.

Diagnostic stability of psychiatric disorders in clinical practice.

BACKGROUND: Psychiatric disorders are among the top causes worldwide of disease burden and disability. A major criterion for validating diagnoses is stability over time. AIMS: To evaluate the long-term stability of the most prevalent psychiatric diagnoses in a variety of clinical settings. METHOD: A total of 34 368 patients received psychiatric care in the catchment area of one Spanish hospital (1992-2004). This study is based on 10 025 adult patients who were assessed on at least ten occasions (360 899 psychiatric consultations) in three settings: in-patient unit, 2000-2004 (n=546); psychiatric emergency room, 2000-2004 (n=1408); and out-patient psychiatric facilities, 1992-2004 (n=10 016). Prospective consistency, retrospective consistency and the proportion of patients who received each diagnosis in at least 75% of the evaluations were calculated for each diagnosis in each setting and across settings. RESULTS: The temporal consistency of mental disorders was poor, ranging from 29% for specific personality disorders to 70% for schizophrenia, with stability greatest for in-patient diagnoses and least for out-patient diagnoses. CONCLUSIONS: The findings are an indictment of our current psychiatric diagnostic practice.