title: Patients with cluster a personality disorders in psychotherapy: an effectiveness study.
abstract: BACKGROUND
  While psychopharmacological studies are common in patients with cluster A personality disorders, the effects of psychotherapy have received little attention. The aim of this study is to explore whether psychotherapeutic treatment yields health gains for these patients.
  
  
  METHODS
  The study was conducted between March 2003 and June 2008 in 6 mental health care centres in the Netherlands, with a sample of 57 patients with a DSM-IV-TR axis II cluster A diagnosis. Patients were assigned to 3 settings of psychotherapeutic treatment (outpatient, day hospital, inpatient), and effectiveness was assessed at 18 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 the day hospital and inpatient group improved substantially in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life. Patients in the outpatient group showed less improvement. Direct comparison of the improvement of psychiatric symptoms showed significant results in favour of day hospital (p = 0.046) and inpatient (p = 0.01) treatment, as compared to outpatient treatment. However, due to substantial baseline differences, this direct comparison should be judged carefully.
  
  
  CONCLUSIONS
  Cluster A psychopathology is not a contraindication to benefit from psychotherapy. This is especially true for more intensive forms like inpatient and day hospital treatment. Future research should focus more on psychotherapeutic treatment to gain further insight into effective treatment options for this patient group.
authors.affiliation: Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands. a.bartak@uva.nl
authors.forename: Anna
authors.initials: A
authors.lastname: Bartak
authors.forename: Helene
authors.initials: H
authors.lastname: Andrea
authors.forename: Marieke D
authors.initials: MD
authors.lastname: Spreeuwenberg
authors.forename: Moniek
authors.initials: M
authors.lastname: Thunnissen
authors.forename: Uli M
authors.initials: UM
authors.lastname: Ziegler
authors.forename: Jack
authors.initials: J
authors.lastname: Dekker
authors.forename: Fleur
authors.initials: F
authors.lastname: Bouvy
authors.forename: Elisabeth F M
authors.initials: EF
authors.lastname: Hamers
authors.forename: Anke M M A
authors.initials: AM
authors.lastname: Meerman
authors.forename: Jan J V
authors.initials: JJ
authors.lastname: Busschbach
authors.forename: Roel
authors.initials: R
authors.lastname: Verheul
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.forename: Paul M G
authors.initials: PM
authors.lastname: Emmelkamp
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D003631:Day Care, Medical; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D010260:Paranoid Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010343:Patient Admission; D010555:Personality Inventory / Q000706:statistics & numerical data; D011446:Prospective Studies; D011594:Psychometrics; D011613:Psychotherapy; D011615:Psychotherapy, Group; D011788:Quality of Life; D012557:Schizoid Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D012569:Schizotypal Personality Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D055815:Young Adult