Efectividad de un programa terapéutico integrado para trastornos graves de la personalidad. Seguimiento pragmático de 36 meses

Lana, Fernando; Sánchez-Gil, Carmen; Ferrer, Laia; López-Patón, Nuria; Litvan, Lia; Marcos, Susana; Sierra, Ana Cristina; Soldevilla, Joan Miquel; Feixas, Guillem; Pérez, Ví­ctor

doi:10.1016/j.rpsm.2014.09.002

Cited by 6 publications

(7 citation statements)

References 38 publications

(34 reference statements)

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“…This study consists of a secondary analysis of data obtained in a previous pragmatic study. 27 We carried out a pre–post, prospective, pragmatic study of patients admitted to an integrated therapeutic program for PD with serious psychiatric symptomatology and low psychosocial functioning (severe PD). The study was conducted at a day hospital within the Barcelonès-Nord mental health network, a public health care catchment area that provides services to a population of approximately 299,000 inhabitants in the metropolitan area of Barcelona.…”

Section: Methodsmentioning

confidence: 99%

“…The treatment program, which has been described previously in detail, 27 is a multicomponent, integrated treatment that adopts the four general therapeutic strategies suggested by Livesley 38 as a general organizational framework and combines effective techniques from various evidence-based therapeutic models, such as DBT 39 and MBT. 40 The program offers 6 months of treatment, open to both male and female subjects aged 18–55 years.…”

Section: Methodsmentioning

confidence: 99%

“…Studies that have evaluated the efficacy of psychotherapy in patients with SUD and comorbid PD 9 – 11 are sparse and often controversial. 12 , 13 In contrast, a variety of different psychotherapeutic interventions have been proven effective for PD in several prospective studies, 14 – 16 and similar outcomes are achieved regardless of whether the interventions are applied in outpatient settings, 17 – 21 day hospital programs, 22 – 27 or inpatient programs. 28 However, many of the studies that have investigated the efficacy of PD psychotherapy have excluded PD patients with concurrent SUD (PD-SUD).…”

Section: Introductionmentioning

confidence: 99%

“…More restrictive studies exclude 70%–94% of PD-SUD patients, 17 , 21 , 22 , 24 while less restrictive studies exclude less than 50% of the PD-SUD patients. 19 , 26 , 27 , 30 …”

Section: Introductionmentioning

confidence: 99%

“…In a previous pragmatic study, 27 we assessed a 6-month psychotherapeutic treatment for severe PD (mainly [78%] BPD patients) in a sample of patients with poor general functioning and a high prevalence of suicide attempts, self-harm behaviors, and comorbid SUD. In that study, we used a multicomponent integrated psychotherapeutic approach that combines effective techniques from various therapeutic models, primarily DBT and mentalization-based treatment (MBT).…”

Section: Introductionmentioning

confidence: 99%

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Comparison of treatment outcomes in severe personality disorder patients with or without substance use disorders: a 36-month prospective pragmatic follow-up study

Lana¹,

Sánchez-Gil²,

Pérez‐Solà³

et al. 2016

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BackgroundConcurrent personality disorder (PD) and substance use disorder (SUD) are common in clinical practice. However, SUD is the main criterion for study exclusion in most psychotherapeutic studies of PD. As a result, data on treatment outcomes in patients with concurrent PD/SUD are scarce.MethodsThe study sample consisted of 51 patients diagnosed with severe PD and admitted for psychotherapeutic treatment as a part of routine mental health care. All patients were diagnosed with PD according to the Structured Clinical Interview for PD. Patients were further assessed (DSM-IV diagnostic criteria) to check for the presence of concurrent SUD, with 28 patients diagnosed with both disorders (PD-SUD). These 28 cases were then compared to the 23 patients without SUD (PD-nSUD) in terms of psychiatric hospitalizations and psychiatric emergency room (ER) visits before and during the 6-month therapeutic intervention and every 6 months thereafter for a total of 36 months.ResultsThe baseline clinical characteristics correspond to a sample of PD patients (78% met DSM-IV criteria for borderline PD) with poor general functioning and a high prevalence of suicide attempts and self-harm behaviors. Altogether, the five outcome variables – the proportion and the number of psychiatric inpatient admissions, the number of days hospitalized, and the proportion and the number of psychiatric ER visits – improved significantly during the treatment period, and this improvement was maintained throughout the follow-up period. Although PD-SUD patients had more psychiatric hospitalizations and ER visits than PD-nSUD patients during follow-up, the differences between these two groups remained stable over the study period indicating that the treatment was equally effective in both groups.ConclusionSpecialized psychotherapy for severe PD can be effectively applied in patients with concurrent PD-SUD under usual practice conditions. These findings suggest that exclusion of patients with dual disorders from specialized treatments is unjustified.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…More restrictive studies exclude 70%–94% of PD-SUD patients, 17 , 21 , 22 , 24 while less restrictive studies exclude less than 50% of the PD-SUD patients. 19 , 26 , 27 , 30 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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