Treatment benefits of psychoanalytically oriented partial hospitalisation were maintained over 18 months in borderline personality disorder: Commentary

Abstract

QUESTION: In patients with borderline personality disorder, are the short term benefits of psychoanalytically oriented partial hospitalisation maintained over an 18 month follow up period?DesignRandomised {allocation concealed*}**, unblinded*, controlled trial with 36 months total follow up.SettingHalliwick Psychotherapy Unit, London, UK.Patients44 patients with borderline personality disorder diagnosed using DSM-III-R and the Diagnostic Interview for Borderline Patients. Exclusion criteria were schizophrenia, bipolar disorder, substance misuse, mental impairment, or evidence of organic brain disorder. 3 patients in the control group refused continued participation.Intervention22 patients were allocated to psychoanalytically oriented partial hospitalisation and 22 to standard psychiatric care. Treatment was for a maximum of 18 months. A follow up programme was offered to those assigned to partial hospitalisation which consisted of analytic therapy twice a week over 18 months. The control group continued to receive general psychiatric treatment.Main outcome measuresFrequency of suicide attempts and acts of self harm, number and duration of inpatient admissions, service utilisation, and self reported measures of depression, anxiety, general symptom distress, interpersonal functioning, and social adjustment.Main resultsAnalysis was by intention to treat. At 36 months follow up, fewer patients assigned partial hospitalisation reported engaging in self mutilation and fewer had made serious suicidal gestures (table). Over the 18 month extended follow up period, patients in the partial hospitalisation group had fewer inpatient treatment days (1.7 v 15.8 mean d in the control group), outpatient psychiatric visits (0.7 v 4.3 mean visits), partial hospitalisation days (0 v 13.9 mean d), and days in community centre attendance (0.9 v 17.3 mean d) (p < 0.002 for all comparisons). Patients in the partial hospitalisation group improved more than the control patients on all self report measures (p < 0.001).ConclusionIn patients with borderline personality disorder, benefits of psychoanalytically oriented partial hospitalisation were maintained 18 months after treatment completion.*See glossary.**Information provided by the author.