Step-down versus outpatient psychotherapeutic treatment for personality disorders: 6-year follow-up of the Ullevål personality project.
BACKGROUND
Although psychotherapy is considered the treatment of choice for patients with personality disorders (PDs), there is no consensus about the optimal level of care for this group of patients. This study reports the results from the 6-year follow-up of the Ullevål Personality Project (UPP), a randomized clinical trial comparing outpatient individual psychotherapy with a long-term step-down treatment program that included a short-term day hospital treatment followed by combined group and individual psychotherapy.


METHODS
The UPP included 113 patients with PDs. Outcome was evaluated after 8 months, 18 months, 3 years and 6 years and was based on a wide range of clinical measures, such as psychosocial functioning, interpersonal problems, symptom severity, and axis I and II diagnoses.


RESULTS
At the 6-year follow-up, there were no statistically significant differences in outcome between the treatment groups. Effect sizes ranged from medium to large for all outcome variables in both treatment arms. However, patients in the outpatient group had a marked decline in psychosocial functioning during the period between the 3- and 6-year follow-ups; while psychosocial functioning continued to improve in the step-down group during the same period. This difference between groups was statistically significant.


CONCLUSIONS
The findings suggest that both hospital-based long-term step-down treatment and long-term outpatient individual psychotherapy may improve symptoms and psychosocial functioning in poorly functioning PD patients. Social and interpersonal functioning continued to improve in the step-down group during the post-treatment phase, indicating that longer-term changes were stimulated during treatment.


BACKGROUND
NCT00378248.
Institute for Clinical Medicine, University of Oslo, Oslo, Norway. bjornar.antonsen@medisin.uio.no.
Bjørnar T
BT
Antonsen
Ole
O
Klungsøyr
Anne
A
Kamps
Benjamin
B
Hummelen
Merete S
MS
Johansen
Geir
G
Pedersen
Oyvind
O
Urnes
Elfrida H
EH
Kvarstein
Sigmund
S
Karterud
Theresa
T
Wilberg
D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D003631:Day Care, Medical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010045:Outpatients; D010551:Personality; D010554:Personality Disorders / Q000523:psychology / Q000628:therapy*; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult