title: Supervised team management, with or without structured psychotherapy, in heavy users of a mental health service with borderline personality disorder: a two-year follow-up preliminary randomized study.
abstract: BACKGROUND
  Individuals affected by severe Borderline Personality Disorder (BPD) are often heavy users of Mental Health Services (MHS). Short-term treatments currently used in BPD therapy are useful to target disruptive behaviors but they are less effective in reducing heavy MHS use. Therefore, alternative short-term treatments, less complex than long-term psychodynamic psychotherapies but specifically oriented to BPD core problems, need to be developed to reduce MHS overuse. This study aimed to evaluate the efficacy of adding Sequential Brief Adlerian Psychodynamic Psychotherapy (SB-APP) to Supervised Team Management (STM) in BPD treatment compared to STM alone in a naturalistic group of heavy MHS users with BPD. Effectiveness was evaluated 6 times along a two-year follow-up.
  
  
  METHODS
  Thirty-five outpatients who met inclusion criteria were randomly assigned to two treatment groups (STM = 17; SB-APP = 18) and then compared. Clinical Global Impression (CGI) and CGI-modified (CGI-M) for BPD, Global Assessment of Functioning (GAF), State-Trait Anger Expression Inventory (STAXI), and Symptom Checklist-90 Revised (SCL-90-R) were administered at T1, T3, T6, T12, T18 and T24. At T12 the Working Alliance Inventory-Short Form (WAI-S) was also completed. At the one-year follow-up, SB-APP group did not receive any additional individual psychological support. MHS team was specifically trained in BPD treatment and had regular supervisions.
  
  
  RESULTS
  All patients improved on CGI, GAF, and STAXI scores after 6 and 12 months, independently of treatment received. SB-APP group showed better outcome on impulsivity, suicide attempts, chronic feelings of emptiness, and disturbed relationships. We found a good stabilization at the one year follow-up, even after the interruption of brief psychotherapy in the SB-APP group.
  
  
  CONCLUSIONS
  Although STM for BPD applied to heavy MHS users was effective in reducing symptoms and improving their global functioning, adding a time-limited and focused psychotherapy was found to achieve a better outcome. In particular, focusing treatment on patients' personality with a specific psychotherapeutic approach (i.e. SB-APP) seemed to be more effective than STM alone.
  
  
  BACKGROUND
  ClinicalTrials.gov: NCT1356069.
authors: Neurosciences Department, Psychiatry Section, University of Torino, Turin, Italy.
authors: Federico
authors: F
authors: Amianto
authors: Andrea
authors: A
authors: Ferrero
authors: Andrea
authors: A
authors: Pierò
authors: Elisabetta
authors: E
authors: Cairo
authors: Giuseppe
authors: G
authors: Rocca
authors: Barbara
authors: B
authors: Simonelli
authors: Simona
authors: S
authors: Fassina
authors: Giovanni
authors: G
authors: Abbate-Daga
authors: Secondo
authors: S
authors: Fassino
mesh_terms: D000328:Adult; D001883:Borderline Personality Disorder / Q000523:psychology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008603:Mental Health; D008605:Mental Health Services; D008875:Middle Aged; D010348:Patient Care Team; D011614:Psychotherapy, Brief / Q000379:methods*; D016896:Treatment Outcome