Defining severity of personality disorder using electronic health records: short report.

Severity of personality disorder is an important determinant of future health. However, this key prognostic variable is not captured in routine clinical practice. Using a large clinical data-set, we explored the predictive validity of items from the Health of Nation Outcome Scales (HoNOS) as potential indicators of personality disorder severity.

Reflective function as a mediator between childhood adversity, personality disorder and symptom distress.

A growing body of literature has indicated the central role of childhood adversity for the development in later life of personality disorder (PD) and psychiatric distress. In this investigation, we examine the role of reflective function (RF) as a mediator between childhood adversity, subsequent development of PD and psychiatric morbidity. We tested the hypothesis that adversity leads to decreased RF, which in turn is associated with PD, and both increase the likelihood of psychiatric distress.

Psychiatric morbidity and treatment pathway outcomes of patients presenting to specialist NHS psychodynamic psychotherapy services: results from a multi-centre study.

Objective: Little is known about socio-demographic, diagnostic, and clinical characteristics of patients referred for assessment to psychodynamic psychotherapy services. The aim of this study was to remedy this by prospectively collecting comprehensive and systematic demographic and clinical information on a large number of patients referred to NHS psychodynamic psychotherapy services.

Design: Fourteen psychotherapy services operating within a National Health Service joined the study and contributed data for 1,136 patients referred from primary and secondary care clinics.

Prediction of medium-term outcome in cluster B personality disorder following residential and outpatient psychosocial treatment.

Background: There is a paucity of research concerning the identification of individual characteristics predictive of outcome in the treatment of personality disorders (PDs).

Methods: In this study, we carried out a predictor analysis of a sample of 73 hospitalized patients with a primary diagnosis of cluster B PD admitted to two different psychosocial programs for PD: (a) long-term inpatient treatment, and (b) a step-down program.

Results: Younger age, higher Global Assessment Scale intake scores, longer length of treatment, absence of self-mutilation and avoidant PDs were a significant predictor of outcome at 24-month follow-up.

Psychosocial treatment for severe personality disorder. 36-month follow-up.

Background: In a previous report a step-down psychosocial programme for severe personality disorders was found to be more effective at expected termination of treatment than a longer in-patient treatment with no planned after-care.

Aims: To evaluate the clinical effectiveness of these two psychosocial specialist programmes over a 3-year follow-up period.

Method: Two samples allocated to the in-patient treatment and to the step-down programme were compared prospectively on symptom severity, social adjustment, global assessment of mental health and other clinical indicators at 6, 12, 24 and 36 months after intake.

When less is more: An exploration of psychoanalytically oriented hospital-based treatment for severe personality disorder.

This paper discusses the main findings of a prospective study based at the Cassel Hospital, a centre dedicated to the psychoanalytically informed residential treatment of severe personality disorders. The results--showing that significantly greater improvements on a number of outcome indicators were found in patients exposed to the psychoanalytically informed treatment programmes compared to a general psychiatric approach based on management and pharmacotherapy alone--underscores the importance and the centrality of the psychoanalytic input in the treatment of severe personality disorders. However, the results of the study also suggested that some features of long-term hospital treatment might carry the risk of iatrogenic and anti-therapeutic effects for a sub-group of patients with severe borderline core pathology.

Patients' characteristics, outcome and cost-benefit of hospital-based treatment for patients with personality disorder: a comparison of three different programmes.

In this study we aimed (a) to ascertain whether a relationship exists between different treatment programmes and settings for personality disorder and patient characteristics; (b) to give an indication of treatment effects in three personality disordered populations admitted to different treatment contexts; and (c) to compare costs in relation to outcomes. We collected and compared three samples from one in-patient site (Cassel in England) and two day hospitals (Halliwick in England and Ulleval in Norway) on a number of demographic, diagnostic and other key clinical variables. Outcome in the areas of symptom severity (Symptom Checklist-90-R) and social adaptation (Social Adjustment Scale) was evaluated by comparing admission with discharge scores.