Residential versus community treatment of personality disorders: a comparative study of three treatment programs.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
The Cassel Hospital, Richmond, TW10 7JF, UK. m.chiesa@ucl.ac.uk
Marco
M
Chiesa
Peter
P
Fonagy
Jeremy
J
Holmes
Carla
C
Drahorad
D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D003156:Community Mental Health Services / Q000379:methods*; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D010359:Patient Readmission / Q000706:statistics & numerical data; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy / Q000379:methods*; D012114:Residential Treatment / Q000379:methods*; D016728:Self-Injurious Behavior / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control; D012917:Social Adjustment; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D016896:Treatment Outcome