Psychiatrists have been criticised for failing to develop adequate treatment for personality disorder. Psychotherapeutic treatments are promising, but their effectiveness is uncertain.
To investigate ...the evidence for effectiveness of psychotherapeutic treatment for personality disorder.
Systematic literature review.
There is evidence for the effectiveness of psychotherapy for personality disorder. Problems of case identification, comorbidity, randomisation, specificity of treatment and outcome measurement are inadequately addressed. Authors mainly relied on cohort studies. Evidence neither suggests superiority of one type of therapy over another nor indicates which subgroups of patients should be offered psychotherapy as in-patient, day patient, or out-patient.
New research strategies are needed to show that personality change is both measurable and clinically meaningful. Effectiveness studies using randomised controlled designs are required. The literature suggests that effective treatment should be long-term, integrated, theoretically coherent and focused on compliance.
This article describes a series of studies involving 2,730 participants on the development and validity testing of the Severity Indices of Personality Problems (SIPP), a self-report questionnaire ...covering important core components of (mal)adaptive personality functioning. Results show that the 16 facets constituted homogeneous item clusters (i.e., unidimensional and internally consistent parcels) that fit well into 5 clinically interpretable, higher order domains: self-control, identity integration, relational capacities, social concordance, and responsibility. These domains appeared to have good concurrent validity across various populations, good convergent validity in terms of associations with interview ratings of the severity of personality pathology, and good discriminant validity in terms of associations with trait-based personality disorder dimensions. Furthermore, results suggest that the domain scores are stable over a time interval of 14-21 days in a student sample but are sensitive to change over a 2-year follow-up interval in a treated patient population. Taken together, the final instrument, the SIPP-118, provides a set of 5 reliable, valid, and efficient indices of the core components of (mal)adaptive personality functioning.
•Modular CBT for children with epilepsy is acceptable/valued by health professionals.•Telephone delivery of CBT within pediatric epilepsy services increases accessibility.•Future research may ...optimise training of health professionals in this context.
The primary aim of this qualitative study was to explore the views of health professionals, with little previous clinical mental health training, of an adapted modular cognitive-behavioral intervention (MATCH-ADTC) for common mental health problems in children and young people with epilepsy.
Healthcare Professionals (HCPs) and their supervisors were interviewed at the start (n = 23) and end (n = 15) of the six-month training period. The interviews were transcribed verbatim and analyzed using thematic analysis.
Three higher order themes with sub-themes were identified: (1) strengths of the MATCH-ADTC content and manual; (2) expectations of the treatment; and (3) improving practice with MATCH-ADTC. Overall impressions of the training and treatment were largely positive, with HCPs viewing MATCH-ADTC as an acceptable treatment for the families that they worked with. HCPs highlighted some challenges in delivering an integrated service, particularly relating to the time commitment involved and their own confidence in delivering the intervention, as many participants did not have a mental health background.
The findings suggested that the intervention and training was acceptable to HCPs working in pediatric epilepsy services, and confidence grew over the six-month training period. Further research is needed to understand how to best train, supervise, and support HCPs in pediatric epilepsy services to deliver mental health treatments.
Abstract We used a probabilistic reversal learning task to examine prediction error-driven belief updating in three clinical groups with psychosis or psychosis-like symptoms. Study 1 compared people ...with at-risk mental state and first episode psychosis (FEP) to matched controls. Study 2 compared people diagnosed with treatment-resistant schizophrenia (TRS) to matched controls. The design replicated our previous work showing ketamine-related perturbations in how meta-level confidence maintained behavioural policy. We applied the same computational modelling analysis here, in order to compare the pharmacological model to three groups at different stages of psychosis. Accuracy was reduced in FEP, reflecting increased tendencies to shift strategy following probabilistic errors. The TRS group also showed a greater tendency to shift choice strategies though accuracy levels were not significantly reduced. Applying the previously-used computational modelling approach, we observed that only the TRS group showed altered confidence-based modulation of responding, previously observed under ketamine administration. Overall, our behavioural findings demonstrated resemblance between clinical groups (FEP and TRS) and ketamine in terms of a reduction in stabilisation of responding in a noisy environment. The computational analysis suggested that TRS, but not FEP, replicates ketamine effects but we consider the computational findings preliminary given limitations in performance of the model.
The aim of this study was to compare the effectiveness of three treatment models for personality disorder: 1) a long-term psychoanalytically oriented residential specialist program, 2) a phased ..."step-down" specialist psychosocial program that included a briefer residential stay and an outpatient component, and 3) a general community psychiatric model.
One hundred forty-three patients with a personality disorder diagnosis were allocated according to geographical criteria to the three treatment conditions. Outcome was prospectively evaluated at 6, 12, and 24 months through the use of a standardized battery of instruments that included measures of general symptom severity, social adaptation, assessment of mental health functioning, frequency of self-harm and suicide attempts, and rates and duration of hospital readmissions.
By 24 months, patients in the step-down condition showed significant improvements on all measures. Patients in the long-term residential model showed significant improvements in symptom severity, social adaptation, and global functioning, while no changes were achieved in self-harm, attempted suicide, and readmission rates. Patients in the general psychiatric group showed no improvement on any variables except self-harm and hospital readmissions.
The results of this study suggest that for personality disorders, a specialist step-down program is more effective than both long-term residential treatment and general psychiatric treatment in the community. Replication is needed that includes a random allocation of patients to conditions to ensure that geographical factors did not account for the observed differences.
Objective:
Identify the core ‘interaction structures’ between therapists and depressed adolescents within and across two common forms of psychotherapy.
Method:
A total of 70 audio-recorded ...psychotherapy sessions representing short-term psychoanalytic psychotherapy (STPP) and cognitive behavioural therapy (CBT) with youth aged 12–18 years old were coded with the Adolescent Psychotherapy Q-set (APQ), a newly developed instrument. Data included different therapist-patient dyads and stages in treatment and were analysed with cluster analysis.
Results:
Three distinct interaction structures between therapists and depressed adolescents: two influenced by the therapists’ techniques and one more influenced by the young people’s attitude to therapy.
Conclusion:
When there is a collaborative working relationship between therapists and depressed young people, the therapy process is influenced by the therapists’ techniques; while when there is a poor working relationship, the techniques used by therapists of different theoretical orientation become more similar with the aim of engaging the young person in the process.
The authors of this paper discuss changes in the child's perception of psychic reality during normal development, highlighting a major shift in the child's understanding of minds ('theory of mind') ...at the oedipal stage. They illustrate this transition with material from the analysis of a 4-year-old girl. They maintain that the very young child uses two forms of psychic reality, which they have called 'psychic equivalent' and 'pretend' modes, which differ primarily in the assumed relationship between internal and external realities. The integration of the dual modes into a singular reflective mode is normally completed by about the age of 4, with affect leading cognition: the child first understands that people have different feelings, then that they may have different thoughts about the same external reality. The authors describe normal psychological growth and neurotic pathology, in which the integration of these two modes of functioning has been only partly achieved.
Background: Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). There are gaps in our knowledge of DSI as an indicator of severity of psychopathology, as ...moderator of outcome and with regard to its response to different treatment programs and settings. Methods: We compare 2 samples of PD with (n = 59) and without (n = 64) DSI in terms of clinical presentation, response to psychosocial treatment and relative outcome when treated with specialist long-term residential and community-based programs. We test the assumption that DSI is an appropriate indicator for long-term inpatient care by contrasting the outcomes (symptom severity and DSI recidivism) of the 2 DSI sub-groups treated in the 2 different approaches. Results: PD with DSI had greater severity of presentation on a number of variables (early maternal separation, sexual abuse, axis-I comorbidities, suicidality and inpatient episodes) than PD without DSI. With regard to treatment response, we found a significant 3-way interaction between DSI, treatment model and outcome at 24-month follow-up. PD with DSI treated in a community-based program have significantly greater chances of improving on symptom severity and recidivism of self-injurious behaviour compared to PD with DSI treated in a long-term residential program. Conclusions: Although limitations in the study design invite caution in interpreting the results, the poor outcome of the inpatient DSI group suggests that explicit protocols for the management of DSI in inpatient settings may be beneficial and that the clinical indications for long-term inpatient treatment for severe and non-severe PD may require updating.
Professor Sami Timimi recently expressed concerns about the Improving Access to Psychological Therapies (IAPT) programme. We argue that the concerns are largely unfounded and provide readers with an ...update on the programme.
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