Outcome of a psychotherapeutic programme for patients with severe personality disorders.

A specialized psychotherapeutic day treatment programme was established in a Danish clinical setting on the basis of recent research and advances in treatment for severe personality disorders. This study analyses treatment effectiveness by comparing the day treatment programme with a treatment as usual (TAU) situation as given to personality-disordered patients on a waiting list. The sample consisted of 66 personality-disordered patients consecutively referred and diagnosed according to standardized criteria. The intervention group comprised 38 patients. There was no selection made for the intervention group: when the programme capacity was reached, a waiting list of 28 consecutive patients formed the comparison group; none of these patients figured in the intervention group. Intervention included psychodynamic and cognitive-based therapy in a group/individual setting and lasted 5 months. Outcome measures were self-rated and observer-rated multidimensional evaluation of functioning relevant to personality-disordered patients. The day treatment programme did significantly better in reducing acute and prolonged hospitalizations and suicide attempts, in stabilizing the psychosocial functioning and in reducing complaints that lead to treatment. The intensive day treatment programme stabilized patient functioning but did not lead to changes on personality traits for which more extended treatment might be necessary.

[Psychotherapeutic day treatment of patients with severe personality disorders. Results from the first two years]. / Psykoterapeutisk dagbehandling af svaert personlighedsforstyrrede patienter. En toårsopgørelse.

INTRODUCTION: A psychotherapeutic day treatment (DT) for patients with severe personality disorders (PD) was established in January 2003, consisting of five months of intensive psychodynamic based integrated therapy for 14 patients. This paper presents results from the first two years. MATERIAL AND METHODS: 53 patients were included in a five month combined group psychotherapeutic DT, including psychoeducation, cognitive, body, music/drawing and individual therapy. Semi-structured interviews were used to assess diagnosis (PSE, SCID-II). SCL-90-R, self-rating scales and GAF rating (s/f) were used before and after therapy. The design was naturalistic. RESULTS: 40 patients (34 women) completed the DT. Eight dropped out and five received another treatment. Before treatment: Average age 27(SD 6,5), mean GAF= 43 corresponding with unemployment, singles and social dysfunctions, high degree of self mutilation, suicide attempts, earlier hospitalisations and substance abuse. The most frequent diagnosis was borderline disorder 63%. There were co-morbidity with anxiety disorder 48% and depression 22%. Most importantly, we found a significant reduction in symptoms, significant increase in the level of function, reduction in self destructive behaviour, a pronounced reduction in hospitalisations and a relatively high degree of satisfaction with the treatment programme. CONCLUSION: According to literature, effective treatment of patients with severe PD has to be long term, integrated, theoretical coherent and focused on compliance. Our study indicates that the intensive DT is effective and a good introduction to long term psychotherapy.

Topical application of representative multifunctional acrylates produced proliferative and inflammatory lesions in F344/N rats and B6C3F1 mice, and squamous cell neoplasms in Tg.AC mice.

Widespread human exposure to multifunctional acrylates is of concern, due to their inherent reactivity and irritating properties. Trimethylolpropane triacrylate (TMPTA) and pentaerythritol triacrylate (PETA) are industrially important representatives of multifunctional acrylates. The current studies characterized the toxicity of 3-month topical administration of technical grade TMPTA and PETA in F344/N rats and B6C3F1 mice, and evaluated the carcinogenic potential of TMPTA and PETA in hemizygous Tg.AC (v-Ha-ras) transgenic mice. Administration of 0.75, 1.5, 3, 6, and 12 mg/kg TMPTA and PETA for 3 months resulted in hyperplastic, degenerative, and necrotic lesions, accompanied by chronic inflammation of the skin, with severities generally increasing with dose. Lesions were slightly more severe in rats, when compared with mice, and illustrate the irritant potential of TMPTA and PETA. A similar dosage regimen was used for the 6-month study with Tg.AC mice. Topical application of TMPTA and PETA to Tg.AC mice showed dose-dependent increases in squamous cell papillomas at the site of application, with decreases in the latency of their appearance in mice receiving 3 mg/kg or greater. Papillomas, the reporter phenotype in Tg.AC mice, were accompanied by a few squamous cell carcinomas, along with hyperplastic and inflammatory lesions. Although chronic inflammation might have contributed to the development of the skin lesions, the dose-related nature of the induction of the skin papillomas in Tg.AC mice by TMPTA and PETA may reflect a potential for carcinogenicity.

Oral and dermal exposure to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) induces cutaneous papillomas and squamous cell carcinomas in female hemizygous Tg.AC transgenic mice.

Tg.AC mice develop epidermal papillomas in response to treatment with dermally applied nongenotoxic and complete carcinogens. The persistent environmental contaminant 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) is a multi-site rodent carcinogen and tumor promoter that induces the formation of papillomas in Tg.AC mice. To examine the dose-response relationship and compare dermal and oral routes of exposure for TCDD-induced skin papillomas, female Tg.AC mice were exposed dermally to average daily doses of 0, 2.1, 7.3, 15, 33, 52, 71, 152, and 326 ng TCDD/kg/day or 0, 75, 321, and 893 ng TCDD/kg body weight by gavage for 26 weeks. The incidence of cutaneous papillomas was increased in a dose-dependent manner, and tumors developed earlier with higher exposure to TCDD regardless of route of administration. Increased incidences of cutaneous squamous cell carcinomas were observed in mice exposed to dermal (> or =52 ng/kg) and oral (893 ng/kg) TCDD. Higher gavage doses than dermal exposure doses were required to induce papillomas and squamous cell carcinomas. Despite a linear correlation between administered dose and terminal skin concentrations, the incidence of tumor formation was lower in the gavage study than in the dermal study with respect to mean terminal skin TCDD concentrations. These studies demonstrate that, although Tg.AC mice are less responsive to TCDD by gavage than by dermal exposure, the induction of skin neoplasms is a response to systemic exposure and not solely a local response at the site of dermal application. Differences in response between the routes of exposure may reflect pharmacokinetic differences in the delivery of TCDD to the skin over the duration of the study.