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Borderline Personality Disorder

Borderline Personality Disorder. Recent Psychodynamic therapy Trials. BATEMAN AND FONAGY PARTIAL HOSPITILISATION STUDIES 1999, 2001, 2003, 2008. (1) 38 BPD patients Random Allocation 18/12 partial Hospitalisation General Psychiatric Care

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Borderline Personality Disorder

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  1. Borderline Personality Disorder Recent Psychodynamic therapy Trials

  2. BATEMAN AND FONAGYPARTIAL HOSPITILISATION STUDIES 1999, 2001, 2003, 2008 (1) 38 BPD patients Random Allocation 18/12 partial Hospitalisation General Psychiatric Care Individual and group Psychotherapy (Rx as Usual) PH Stat sign - suicide attempts - self harming - number and duration I/P stays - self reports – depression, anxiety general symptom distress, interpersonal functioning and social adjustment Began after 6/12 Continued to end. TAU group limited change or deterioration

  3. BATEMAN AND FONAGY – PH STUDIES (2) • Follow up of original group. 3/12ly for 18/12 of 44 patients • Maintained gains and continued to improve (stat. sign.) on most measures for PH group. • Limited change in TAU group • Rehabilitative change

  4. BATEMAN AND FONAGY – PH STUDIES COSTS – Psychiatric, Pharmacological, A&E • Pre Rx and during Rx – No differences in service utilisation • cost of day care in PH group balanced by less I/P care and less A&E • Trend for costs in PH group during F/U no trend for costs in TAU group

  5. 8 yr follow up-5yrs after Rx 2008 • Rxed group-13% vs 87% TAU group still meet criteria for BPD • Stat sig decrease in suicidality, service and medication use in Rx Gp • Stat sig increase in global and vocational functioning in Rx Gp • But still appreciable social and functional impairment- quality of life. • Bateman and Fonagy Am J Psych 165 631-638

  6. Transference Focused Therapy(TFP) • Clarkin et al 2007-Am J Psych 164:6 922-928- RCT • Levy et al 2006-J Cons and Clin Psychol 74(6) 1027-1040.RCT • Structured Outpatient treatment-twice weekly, modified psychodynamic Rx based on Kernberg’s theoretical model

  7. TFP /DBT/SPT Clarkin et al-1yr figs • All broadly equivalent overall but individual domains differ-?different routes to symptom change • TFP and DBT reduce suicidality • TFT and SPT reduce anger and impulsivity • All reduce depression, anxiety • All improve global functioning • All improve social adjustment • Only TFT sign predictive of changes in irritability, verbal and physical assault

  8. TFP /DBT/SPT Clarkin et al-1yr figs • All broadly equivalent overall but individual domains differ-?different routes to symptom change • TFP and DBT reduce suicidality • TFT and SPT reduce anger and impulsivity • All reduce depression, anxiety • All improve global functioning • All improve social adjustment • Only TFT sign predictive of changes in irritability, verbal and physical assault

  9. Attachment changes in Levy 2006 • Same trial as Clarkin • Sign inc in attachment security on AAI in TFP not others • Sign inc in reflective functioning, and attachment coherence in TFT not others

  10. Borderline Personality Disorders • Are Common • Frequently exist as co-morbid disorders • Arouse powerful feelings in staff and teams • Can test professional boundaries • Can be understood • Can be treated-often need combined psychotherapy and pharmacotherapy • MBT,DBT TFP all effective • Treatment teams need to communicate

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