Adaptation of interpersonal psychotherapy to borderline personality disorder: a comparison of combined therapy and single pharmacotherapy.
OBJECTIVE
Combined treatment with interpersonal psychotherapy (IPT) and antidepressants (ADs) has been found more effective than single pharmacotherapy in patients with major depression and concomitant borderline personality disorder (BPD). The aim of our study is to investigate whether combined treatment with a modified version of IPT is still superior to ADs when treating patients with a single diagnosis of BPD.


METHODS
Fifty-five consecutive outpatients with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnosis of BPD were enrolled. They were randomly assigned to 2 treatment arms for 32 weeks: fluoxetine 20 to 40 mg per day plus clinical management; and fluoxetine 20 to 40 mg per day plus IPT adapted to BPD (IPT-BPD). Eleven patients (20%) discontinued treatment owing to noncompliance. Forty-four patients completed the treatment period. They were assessed at baseline, and at week 16 and 32 with: a semi-structured interview for demographic and clinical variables; Clinical Global Impression Scale (CGI-S); Hamilton Depression Rating Scale (HDRS); Hamilton Anxiety Rating Scale (HARS); Social and Occupational Functioning Assessment Scale (SOFAS); BPD Severity Index (BPD-SI); and a questionnaire for quality of life (Satisfaction Profile [SAT-P]). A univariate general linear model was performed with 2 factors: duration and type of treatment. P values of less than 0.05 were considered significant.


RESULTS
Remission rates did not differ significantly between subgroups. Duration, but not type of treatment, had a significant effect on CGI-S, HDRS, SOFAS, and total BPD-SI score changes. Combined therapy was more effective on the HARS; the items: interpersonal relationships, affective instability, and impulsivity of BPD-SI; and the factors: psychological functioning and social functioning of SAT-P.


CONCLUSIONS
Combined therapy with adapted IPT was superior to fluoxetine alone in BPD patients, concerning a few core symptoms of the disorder, anxiety, and quality of life.
Bellino
Silvio
S
Service for Personality Disorders, Unit of Psychiatry 1, Department of Neurosciences, University of Turin, Via Cherasco 11, Turin, Italy. silvio.bellino@unito.it
Rinaldi
Camilla
C
Bogetto
Filippo
F
D000293:Adolescent; D000328:Adult; D000342:Affective Symptoms / Q000188:drug therapy; D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use*; D001007:Anxiety / Q000188:drug therapy; D003131:Combined Modality Therapy; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D007175:Impulsive Behavior / Q000188:drug therapy; D007398:Interpersonal Relations; D008297:Male; D010554:Personality Disorders / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D011613:Psychotherapy; D011788:Quality of Life / Q000523:psychology; D012919:Social Behavior; D016896:Treatment Outcome; D055815:Young Adult
D018687:Antidepressive Agents, Second-Generation; D005473:Fluoxetine