Brief hospital treatment plans for persons with borderline personality disorder: Perspectives of inpatient psychiatric nurses and community mental health center clinicians

1994 ◽  
Vol 8 (5) ◽  
pp. 303-311 ◽  
Author(s):  
Nadine Nehls
Author(s):  
Stefano Carrera ◽  
Guia Pandolfi ◽  
Jee Yun Cappelletti ◽  
Walter Padoani ◽  
Silvia Salcuni

This contribution presents two brief reports about preliminary results of 18 months of oriented Mentalization-Based Treatment (MBT), with Borderline Personality Disorder patients, recruited at the Camposampiero Mental Health Center. Following in large part Bateman and Fonagy guidelines for MBT in institutional settings, this paper presents preliminary results in two brief reports related to two cohorts of patient underwent to the oriented MBT in Camposampiero Mental Health Center (MHC). In the first study, we analyzed a group of 9 patients: an anamnestic schedule was administered; then, symptoms (SCL-90-R), psychodiagnostic scale and global health functioning (Health of the Nation Outcome Scale, Structured Clinical Interview for DSM-IV Axis II Disorder [SCID-II], Global Assessment of Functioning, [GAF]), data on service impact and service costs (Cassel Community Adjustment Questionnaire, Patient Evaluation Schedule and folder data) were provided at the beginning (T0), at the end of the treatment (T2) and 1 year after the end of the MBT project. The second study showed a micro-analytical change on a second patient cohort (n=6) at T0, 3, 6 and 9 months (T1) were presented considering specifically mentalization (Comparative Psychotherapy Process Scale, Modes of Mentalization Scale, Mentalization Imbalances Scale) and patienttherapist session evaluation trends (Session Evaluation Questionnaire) and patient reflective functioning at T0 and T2 (Reflective Functioning Questionnaire). Aims and hypotheses of the two studies pointed out how the oriented MBT bring to an improvement of the overall functioning of the patients, a reduction of the symptoms, a decrease of the diagnostic criteria for the Borderline Personality Disorder (BPD) and the other Axis II disorders, a reduction of the workload hours for the MHC staff and of the costs of the assistance. The analyses of both the studies were carried out using non-parametric statistics (Friedman test, Spearman correlation, Chi-square). Preliminary results confirmed the improvement in the overall functioning of patients (GAF), the reduction in BPD-related symptoms and in diagnostic criteria for BPD (SCID-II), the improvement of patients’ mentalization skills, and a significant reduction in workload for health staff. Standing the limits and the preliminary results, the two brief reports demonstrate the feasibility of an oriented MBT within an Italian Public Service and the effectiveness of this treatment pathway for patients with BPD, leaving some open questions to stimulate a fruitful clinical discussion.


2009 ◽  
Vol 26 (2) ◽  
pp. 59-63 ◽  
Author(s):  
Richard Blennerhassett ◽  
Lindsay Bamford ◽  
Anthony Whelan ◽  
Sarah Jamieson ◽  
Jennifer Wilson O'Raghaillaigh

AbstractObjectives:Dialectical behaviour therapy (DBT) is a recommended treatment of patients with borderline personality disorder, yet there are few descriptions of the approach in public community mental health settings where the majority of such patients present. This study describes the development and evaluation of a DBT programme in an Irish setting.Methods:The DBT programme was run over a six month period. Participants were assessed at baseline and post intervention with the following instruments: The Structured Clinical Interview for DSM III R personality disorders (SCID II), the clinical Outcomes in Routine Evaluation (CORE) and the symptom checklist 90 Revised (SCL-90-Revised). Inpatient bed usage was determined from case note review.Results:Outcome data was available for eight subjects. Significant improvement (p < 0.005) was seen on all CORE subscales. SCL-90-R showed significant improvement (p < 0.05) on the global severity index and on the positive symptom distress index. A decrease in self harming behaviour was found. Subjects' inpatient bed days dropped from a mean of 58 in the year pre intervention to a mean of four days in the year post intervention. A novel finding was that 43% of subjects who originally fulfilled criteria for avoidant personality disorder no longer did so post intervention.Conclusions:The study found that DBT can be applied in a community mental health setting with benefits similar to more specialist settings. Significant difficulties were encountered in implementing the programme. The clinical implications are that specialist psychotherapy services need to be an integral part of psychiatric services to achieve better outcomes for patients with borderline personality disorder.


Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Judy A. Pickard ◽  
Adam Finch ◽  
Elizabeth Huxley ◽  
Michelle L. Townsend ◽  
Stephanie Deuchar ◽  
...  

Abstract Background Borderline personality disorder (BPD) is a high prevalence and serious mental health disorder that has historically challenged the finite resources of health services. Despite empirical evidence supporting structured psychological therapy as the first line of treatment, there remains significant barriers in providing timely access to evidence-based treatment for this population. The primary aim of this study is to evaluate the effectiveness of providing a stepped-care structured psychological group treatment to individuals with BPD within local mental health services. The secondary aims of the study are to identify the variables that predict the need to step up or down in care and the effectiveness of treatment on psychosocial functioning. Methods Participants seeking treatment at two community mental health services will be invited to participate. Randomised controlled trial assignment will be to either (i) group skills treatment or (ii) treatment as usual. Group treatment will be offered via a stepped-care pathway with participants initially attending a 12-week group with the option of a subsequent 16-week group. The criteria for inclusion in continuing treatment includes meeting > 4 BPD diagnostic criteria or severity on GAF (< 65) at the completion of the 12-week group. Data will be collected at baseline and at five follow-up time points over a 12-month period. Discussion This pragmatic trial will provide valuable information regarding the effectiveness of a progressive stepped-care group treatment for individuals with BPD in the real-world setting of a community mental health service. It will further the current understanding of variables that predict treatment dose and duration. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12618000477224. Registered on 3 April 2018


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