Effectiveness of Different Modalities of Psychotherapeutic Treatment for Patients with Cluster C Personality Disorders: Results of a Large Prospective Multicentre Study

Abstract

Background: No previous studies have compared the effectiveness of different modalities of psychotherapeutic treatment, as defined by different settings and durations, for patients with cluster C personality disorders. The aim of this multicentre study was to compare the effectiveness of 5 treatment modalities for patients with cluster C personality disorders in terms of psychiatric symptoms, psychosocial functioning, and quality of life. The following treatment modalities were compared: long-term outpatient (more than 6 months), short-term day hospital (up to 6 months), long-term day hospital, short-term inpatient, and long-term inpatient psychotherapy. Methods: The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 371 patients with a DSM-IV-TR axis-II cluster C diagnosis. Patients were assigned to 5 different modalities of psychotherapeutic treatment, and effectiveness was assessed at 12 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45), and quality of life (EQ-5D), using multilevel statistical modelling. As the study was non-randomised, the propensity score method was used to control for initial differences. Results: Patients in all treatment groups had improved on all outcomes 12 months after baseline. Patients receiving short-term inpatient treatment showed more improvement than patients receiving other treatment modalities. Conclusions: Psychotherapeutic treatment, especially in the short-term inpatient modality, is an effective treatment for patients with cluster C personality disorders.

Effectiveness of Outpatient, Day Hospital, and Inpatient Psychotherapeutic Treatment for Patients with Cluster B Personality Disorders

“…In the light of the present results, however, specialised inpatient treatment deserves to be considered as a valuable treatment option for patients with cluster B PD and future research should not a priori exclude this treatment setting from effectiveness studies. In a recent study on cluster C PD, short inpatient treatment also emerged as the treatment with the best results, compared to other treatment modalities [80]. On the other hand, Chiesa et al [38] showed in a naturalistic study that specialised low-intensive treatment can equal (or even surpass) the results of traditional inpatient treatment.…”

A systematic review, psychometric analysis and qualitative assessment of generic preference-based measures of health in mental health populations and the estimation of mapping functions from widely used specific measures

“…96,[119][120][121][122][123][124][125][126][127][128] Six studies looked at the EQ-5D, 120,[124][125][126][127][128] two at the SF-36 119,121 and two at the SF-12 (corresponding to three articles). 96,122,123 No studies were found investigating the validity or responsiveness of the SF-6D in this patient group.…”

“…Studies were undertaken in four countries. Nine 96,[119][120][121][122][123][124][125][126][127][128] of the 10 studies presented data for different personality disorders together. One study looked exclusively at individuals with borderline personality disorder.…”

“…The mean age of participants with personality disorders, reported in 9 of the 10 studies, ranged between 29.4 and 45 years. 96,[119][120][121][124][125][126][127][128] Two studies 120,127 investigated the known-group validity of the EQ-5D, one study 127 investigated the convergent validity of the EQ-5D and four studies [124][125][126]128 investigated the responsiveness of the EQ-5D. Two studies 119,121 investigated the known-group validity of the SF-36 and two studies 96,122,123 investigated this property in the SF-12.…”

Predicting Response to Day Treatment for Personality Disorder

“…Day treatment for patients with PD is a viable treatment option. 50,51 Future work to identify factors that contribute to remaining and benefiting from this type of treatment will help to make it more efficient and effective.…”