Psychosocial treatment for severe personality disorder. 36-month follow-up.
BACKGROUND
In a previous report a step-down psychosocial programme for severe personality disorders was found to be more effective at expected termination of treatment than a longer in-patient treatment with no planned after-care.


OBJECTIVE
To evaluate the clinical effectiveness of these two psychosocial specialist programmes over a 3-year follow-up period.


METHODS
Two samples allocated to the in-patient treatment and to the step-down programme were compared prospectively on symptom severity, social adjustment, global assessment of mental health and other clinical indicators at 6, 12, 24 and 36 months after intake.


RESULTS
Improvements were significantly greater in the step-down programme for social adjustment and global assessment of mental health. Patients in the programme were found to self-mutilate, attempt suicide and be readmitted significantly less at 24- and 36-month follow-up than patients in the in-patient group.


CONCLUSIONS
Improvements associated with specialist residential treatment continued 2 years after discharge. A step-down model has significant advantages over a purely in-patient model.
D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000523:psychology / Q000628:therapy*; D015397:Program Evaluation; D011446:Prospective Studies; D011613:Psychotherapy / Q000379:methods*; D012917:Social Adjustment; D016896:Treatment Outcome