Treatment selection in patients with personality disorders: The role of patient characteristics

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Treatment selection in patients with personality
disordersThe role of patient characteristics
Helene Andrea Janine van Manen, Anna Bartak,
Jan van Busschbach, Roel Verheul Viersprong
Institute for Studies on Personality
Disorders ISSPD, the Hague, 20 september 2007
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IntroductionTreatment selection

• Influences from - Patients (psychopathology,
  motivation, sociodemographics)- Clinicians
  (reasons for referral, background experience)-
  Treatment availability treatment dosages
• Almost no studies among PD patients
• Recent study

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Aim

• Which patient characteristics are related to
• treatment allocation?
• Predictors Patient variables (severity,
  strength, social role)
• Outcome treatment allocation in terms of -
  Setting - Duration

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Method

• SCEPTRE
• Prospective multi-centre study (six treatment
  centres)De Viersprong, Gelderse Roos, Altrecht,
  Zaans Medisch Centrum, Mentrum, GGZ WNB
• N928 patients allocated to treatment
• 68 female, mean age 34.1 (9.8)
• 87 at least 1 PD
• - Cluster A 7
• - Cluster B 22
• - Cluster C 34
• - PD NOS 24
• - No PD 13

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Prospective design

• Intake
• Patient characteristics
• - Severity
• Psychological strength
• Social role involvement

Selected for treatment (n928) Setting Duration
Outpatient Short Day hospital Long Inpatient
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Patient characteristics

• Severity
• SCL-90 (GSI)
• Axis-II clusters (A/B/C/NOS)
• Treatment history
• Social role involvement
• Work
• Care responsibility for children

• Psychological strengths
• Ego strength/identity integration (SIPP)
• Psychological mindedness (PMAP)
• Capacity to relate (SIPP)
• Readiness for change (Motivation for Treatment
  Questionnaire)
• Defensive functioning
• (ODF-score DSQ)

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Strongest severity variable Outpatient history
()
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Strongest severity variable Outpatient history
()
Setting effect
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Strongest severity variable Outpatient history
()
Setting effect
No duration effect
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Strongest psychological strength variable
Motivation (Readiness for change)
Setting effect
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Strongest psychological strength variable
Motivation (Readiness for change)
Setting effect
No duration effect
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Strongest social role variable Care
responsibility for children ()
Setting effect
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Strongest social role variable Care
responsibility for children ()
Setting effect
No duration effect
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Overview results
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Discussion

• Range of patient characteristics predicts
  treatment selection
• - Severity, psychological strengths, social role
• Effectiveness studies comparing different
  treatment dosages take baseline differences
  into account
• Care for children stronger predictor of treatment
  allocation than level of severity or
  psychological strengths

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Further research

• Operationalisation dosage (e.g. intensity)
• Interactions between patient characteristics
  eg. high severity low psychological strength ?
  inpatient longer duration?eg. patient with
  same profile with children ? outpatient longer
  duration?
• Patient characteristics allocation outcome