title: Six-year follow-up of three treatment programs to personality disorder.
abstract: Previous studies of long-term outcome for personality disorder (PD) were either retrospective in design or did not include a control condition. In this paper we report results for three PD cohorts (N = 111) treated in two different specialist psychosocial programs (step-down and long-term inpatient) and in general psychiatric treatment as usual (TAU), which were prospectively followed up for 72-months after intake. The three PD samples were compared on symptom severity, social adjustment, global functioning and other clinical indicators (self-mutilation, parasuicide and readmission rates) at intake, 6, 12, 24, and 72 months. Results indicated that a specialist step-down model showed significantly greater change than a purely inpatient model and TAU in most key dimensions of functioning, a difference maintained at 72-months follow-up. Improvement in the samples was not associated with amount of intercurrent treatment received in the year prior to the follow-up assessment. This study confirms that a step-down program retains significant improvement associated with a specialist psychosocial approach for PD. However, this conclusion should be qualified by design limitations. The samples were not randomly allocated to the three conditions and the naturalistic geographical allocation used in the study created a potential for a number of confounds. Whilst we used extensive statistical controls, the possibility that the differences found between the groups may be due to population differences cannot be discounted.
authors.affiliation: The Cassel Hospital, Richmond, UK. m.chiesa@ucl.ac.uk
authors.forename: Marco
authors.initials: M
authors.lastname: Chiesa
authors.forename: Peter
authors.initials: P
authors.lastname: Fonagy
authors.forename: Jeremy
authors.initials: J
authors.lastname: Holmes
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001521:Behavior Therapy / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D015999:Multivariate Analysis; D010554:Personality Disorders / Q000628:therapy*; D010555:Personality Inventory; D012189:Retrospective Studies; D016728:Self-Injurious Behavior / Q000517:prevention & control; D012720:Severity of Illness Index; D012917:Social Adjustment; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents