Impact of Psychotherapy on Psychosocial Functioning in Borderline Personality Disorder Patients.
26 Jun 2020-International Journal of Environmental Research and Public Health (MDPI AG)-Vol. 17, Iss: 12, pp 4610
TL;DR: Results indicate the BPD patients in the intervention group had a significantly higher level of psychosocial functioning after receiving the specifically-designed psychotherapies in comparison with B PD patients in control groups after receiving non-specific psychotherAPies.
Abstract: Borderline Personality Disorder (BPD) significantly impairs functioning Fortunately, effective treatments are available for borderline symptoms but their effect on functioning should be assessed The objective of this meta-analysis is to assess the effect of specifically-designed versus non-specifically designed psychotherapies on function in adult patients with BPD The reference list of Cristea et al 2017 was used to identify the randomized controlled trials (RCTs) assessing the BPD-specifically-designed psychotherapy versus non-specific psychotherapies in adult BPD patients Among those, RCTs assessing post-treatment functioning using the Global Assessment of Functioning, Social Adjustment Scale-Self-Report and Inventory of Interpersonal Problems were included Ten trials (880 participants) were included Summary effect size was calculated using the measured Hedge's g The results indicate the BPD patients in the intervention group had a significantly higher (g = 041; 95% CI, 009-073) level of psychosocial functioning after receiving the specifically-designed psychotherapies in comparison with BPD patients in control groups after receiving non-specific psychotherapies Specifically-designed psychotherapies can improve psychosocial functioning although improvement in measurement of function (ie, more objective and universal tools) and improvement in psychotherapies (ie, more focused on general functioning) will be helpful
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TL;DR: In this article, a systematic review on the application of repetitive transcranial magnetic stimulation (rTMS) in Borderline Personality Disorder (BPD) is conducted, and the results suggest that rTMS is a well-tolerated treatment in patients with BPD.
Abstract: The literature on the application of repetitive transcranial magnetic stimulation (rTMS) in Borderline Personality Disorder (BPD) is unclear, even though its neuromodulatory effects on underlying neural circuitry involved in BPD symptoms suggest that it could be a potential treatment option. We sought to review the evidence on rTMS as a treatment option in BPD. PubMed (for Medline database), Google Scholar, and Scopus were systematically searched following the PRISMA guidelines for studies of any design examining the application of the rTMS treatment in adult patients with precise and primary diagnosis of BPD written in the English language. The systematic review has been registered on PROSPERO (CRD42020215927). Forty one records were screened, and eight fulfilled inclusion criteria (total of 63 patients). The existing studies suggest that rTMS is a well-tolerated treatment in patients with BPD. Double-blind randomized controlled studies are necessary to help elucidate the effects of rTMS in the different symptoms in BPD and establish efficacy and the best cortical targets and stimulation protocols. Longitudinal studies that combine evidenced based psychotherapy with rTMS may be a future line of investigation that could potentially improve outcomes for this population.
7 citations
TL;DR: Patients with Borderline Personality Disorder (BPD) can form a functioning alliance with an eHealth program and that eHealth programs may be especially useful for psychoeducation and cognitive exercises.
Abstract: eHealth programs have been found to be effective in treating many psychological conditions. Regarding Borderline Personality Disorder (BPD), few programs have been tested; nevertheless, results are promising. The therapeutic alliance is an important factor predicting treatment outcome in BPD. However, we do not know yet to what extent BPD patients form a therapeutic alliance with an eHealth tool and how this relationship differs from the relationship with their human therapist. This study aims to address this question using priovi, an interactive schema therapy-based eHealth tool for BPD. Semi-structured interviews were conducted to explore how patients perceived the therapeutic alliance with priovi and its differences compared to the alliance with their human therapist (N = 9). Interview data were analyzed following the procedures of qualitative content analysis. Additionally, the Working Alliance Inventory (WAI-SR) was administered in two versions (regarding the human therapist and priovi, N = 16) every three months during the treatment phase of one year. Results indicate that patients were able to form a good therapeutic relationship with priovi, but it differed from the relationship to their human therapist. Important categories were "priovi is helpful, supportive and always there" and "priovi is less flexible". WAI ratings for the task subscale were high in both relationships but significantly higher in WAItherapist compared to WAIpriovi in two measurements (nine-months measurement: t = 2.76, df = 15, p = 0.015; twelve-months measurement: t = 3.44, df = 15, p = 0.004). These results indicate that BPD patients can form a functioning alliance with an eHealth program and that eHealth programs may be especially useful for psychoeducation and cognitive exercises.
5 citations
TL;DR: Several socio-demographic and illness-related variables predicted improvement of real-world functioning, besides psychopathology and severity of the disease, in outpatients with different diagnoses.
Abstract: Introduction: Investigations on predictors of real-world functioning were mainly performed in patients with schizophrenia, while fewer studies have been conducted in other psychiatric disorders. Objective: Our objective was to identify clinical, socio-demographic, and illness-related predictors of real-world functioning during 12 months of standard treatments in outpatients with different diagnoses. Methods: Outpatients (n = 1019) with schizophrenia (SZ), major depressive disorder (MDD), bipolar disorder (BD), and borderline personality disorder (BPD) were evaluated with the following tools: SCID-5-CV and SCID-5-PD, CGI-S, SAT-P, DAI-10, and PSP. Change of PSP (ΔPSP) between baseline and 12 months was used as the dependent variable in multiple regression analysis. Results: Higher PSP score at baseline and the achievement of main milestones predicted better functioning after follow-up in all subgroups of patients, with the exception of BD. In the total sample, ΔPSP was related to age of onset, treatments, and quality of life, and inversely related to psychiatric anamnesis, antidepressants, and global symptoms. In SZ, ΔPSP was related to adherence and quality of life. In MDD, ΔPSP was related to psychotherapy and quality of life, and inversely related to antidepressants and global symptoms. In BD, ΔPSP was related to age of onset, antipsychotics, and quality of life, while it was inversely related to psychiatric anamnesis. In BPD, antipsychotics, mood stabilizers, psychotherapy, and quality of life were directly related to ΔPSP, while suicidal attempts and global symptoms had an inverse relation. Conclusions: Several socio-demographic and illness-related variables predicted improvement of real-world functioning, besides psychopathology and severity of the disease.
4 citations
References
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Journal Article•
17,222 citations
"Impact of Psychotherapy on Psychoso..." refers background in this paper
...Generally, the width of confidence interval in a meta-analysis with random-effects model depends on the number of studies combined, the heterogeneity in the meta-analysis and variability in the outcome measurements [22]....
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TL;DR: On a shelf in the sunny, open-plan office of Cochrane Australia in Melbourne, there's a large, white ring-binder that, it's fair to say, hasn't been opened in a while.
Abstract: On a shelf in the sunny, open-plan office of Cochrane Australia in Melbourne, there's a large, white ring-binder that, it's fair to say, hasn't been opened in a while. It's a printed copy of the original, 1994 edition of the Cochrane Collaboration Handbook, edited by Dave Sackett,[1] and within it the original guidance on the methods to be used. The section on preparing and maintaining systematic reviews, edited by Andy Oxman, weighs in at a total of 76 pages.[2]
4,228 citations
TL;DR: BPD is much more prevalent in the general population than previously recognized, is equally prevalent among men and women, and is associated with considerable mental and physical disability, especially among women.
Abstract: Borderline personality disorder (BPD) is a complex, serious psychiatric disorder characterized by pervasive instability in regulation of emotion, self-image, interpersonal relationships, and impulse control.1 BPD is the most prevalent personality disorder in clinical settings and is associated with severe functional impairment, substantial treatment utilization, and high rates of mortality by suicide.2–5 Clinical studies have also shown BPD to be highly comorbid with most substance use, mood, anxiety, and other personality disorders (PDs).6–12
Although BPD is among the most frequently studied PDs in clinical settings, little is known about its prevalence, correlates, disability, and comorbidity in general population samples. Several earlier community studies13–27 of BPD were limited by selection of small samples (n=133–799) not entirely representative of the general population. Others preselected individuals from larger general population samples based on responses to PD screening instruments or psychopathology,15,19,20,24 further limiting the size of the survey samples on which to base prevalence estimates. Of the 2 larger-scale epidemiologic surveys, the one conducted in Norway28 (n = 2,053) was compromised by a low response rate (57%), and the Australian survey29 (n=10,641) used a PD screening measure rather than a diagnostic assessment instrument to assess PDs. Because of these limitations, very little is known about the sociodemographic characteristics, disability, and comorbidity of BPD with other psychiatric disorders. The 1 study that presented data on disorder-specific comorbidity19 did not control for other comorbid disorders, thereby precluding analysis of common and unique factors underlying disorder-specific associations with BPD.
The lack of comprehensive and detailed information on DSM-IV BPD in the United States represents a gap in our knowledge relevant to prevention, treatment, and economic costs. The present study was designed to address this gap using data from the 2004–2005 Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).30 The Wave 2 NESARC covered DSM-IV alcohol and specific drug use disorders, and mood and anxiety disorders assessed in the 2001–2002 Wave 1 NESARC,31, 32 in addition to BPD, schizotypal and narcissistic PDs, and posttraumatic stress disorder (PTSD). The remaining DSM-IV PDs (avoidant, dependent, obsessive-compulsive, paranoid, schizoid, histrionic, and antisocial), were assessed in the Wave 1 NESARC. The sample size and high response rate of the Wave 2 NESARC allow for reliable and precise estimation of lifetime prevalence of BPD, especially among important sociodemographic subgroups of the population. Furthermore, comorbidity of BPD with each Axis I and II disorder was examined while controlling for both sociodemographic characteristics and additional psychiatric disorders to determine the unique relationship of each specific disorder to BPD. The importance of controlling for other disorders that are highly comorbid with one another represents an advance in our understanding of comorbidity recently highlighted in the epidemiologic literature.33, 34 This study also provides information on mental and physical disability associated with BPD. Because so little is known about sex differences in BPD, information on correlates, disability and comorbidity of BPD is presented for the total sample and by sex.
1,478 citations
"Impact of Psychotherapy on Psychoso..." refers background in this paper
...BPD is common and almost 6 people out of 100 will have BPD in the course of their lives [6]....
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TL;DR: Results suggest that partial hospitalization may offer an alternative to inpatient treatment for patients with borderline personality disorder and that replication is needed with larger groups.
Abstract: OBJECTIVE: This study compared the effectiveness of psychoanalytically oriented partial hospitalization with standard psychiatric care for patients with borderline personality disorder. METHOD: Thirty-eight patients with borderline personality disorder, diagnosed according to standardized criteria, were allocated either to a partially hospitalized group or to a standard psychiatric care (control) group in a randomized controlled design. Treatment, which included individual and group psychoanalytic psychotherapy, was for a maximum of 18 months. Outcome measures included the frequency of suicide attempts and acts of self-harm, the number and duration of inpatient admissions, the use of psychotropic medication, and self-report measures of depression, anxiety, general symptom distress, interpersonal function, and social adjustment. Data analysis used repeated measures analysis of covariance and nonparametric tests of trend. RESULTS: Patients who were partially hospitalized showed a statistically significant d...
1,187 citations
"Impact of Psychotherapy on Psychoso..." refers background in this paper
...Considering RCTs included in our study, the Rating of Bias ranges from 0 in Bateman and Fonagy (1999) [11] to 4 in Bateman and Fonagy (2009) [12] and McMain et al....
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...2011 [16] GAF SB-APP+STM STM Bateman and Fonagy 1999 [11] IIP MBT-PH SPT Bateman and Fonagy 2009 [12] GAF, IIP, SAS-SR MBT SCM Blum et al....
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...Considering RCTs included in our study, the Rating of Bias ranges from 0 in Bateman and Fonagy (1999) [11] to 4 in Bateman and Fonagy (2009) [12] and McMain et al. (2009) [8,13]....
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TL;DR: If you want to communicate the predicted range of effects, then you should simply report this range, which gives readers the information they think is being captured by I2 and does so in a way that is concise and unambiguous.
Abstract: When we speak about heterogeneity in a meta-analysis, our intent is usually to understand the substantive implications of the heterogeneity. If an intervention yields a mean effect size of 50 points, we want to know if the effect size in different populations varies from 40 to 60, or from 10 to 90, because this speaks to the potential utility of the intervention. While there is a common belief that the I2 statistic provides this information, it actually does not. In this example, if we are told that I2 is 50%, we have no way of knowing if the effects range from 40 to 60, or from 10 to 90, or across some other range. Rather, if we want to communicate the predicted range of effects, then we should simply report this range. This gives readers the information they think is being captured by I2 and does so in a way that is concise and unambiguous. Copyright © 2017 John Wiley & Sons, Ltd.
938 citations
"Impact of Psychotherapy on Psychoso..." refers background in this paper
...Although there is no specific number of studies as the cutoff point in this regard, it seems that I-squared is less affected by the small number of studies included although it should be considered that I-squared is rather a more descriptive statistic than point estimate [21]....
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