Back to Journals » Neuropsychiatric Disease and Treatment » Volume 12

Comparison of treatment outcomes in severe personality disorder patients with or without substance use disorders: a 36-month prospective pragmatic follow-up study

Authors Lana F, Sanchez-Gil C, Adroher N, Perez Sola V, Feixas G, Martí-Bonany J, Torrens Melich M

Received 12 February 2016

Accepted for publication 31 March 2016

Published 21 June 2016 Volume 2016:12 Pages 1477—1487

DOI https://doi.org/10.2147/NDT.S106270

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Lucy Goodman

Peer reviewer comments 3

Editor who approved publication: Dr Roger Pinder


Fernando Lana,1–3 Carmen Sánchez-Gil,1–3 Núria D Adroher,4,5 Víctor Pérez,1–4 Guillem Feixas,6 Josep Martí-Bonany,1–3 Marta Torrens1–4

1Institute of Neuropsychiatry and Addictions (INAD), Centre Emili Mira and Hospital del Mar, Parc de Salut Mar, Barcelona, Spain; 2Mental Health Research Networking Center (CIBERSAM), Madrid, Spain; 3Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain; 4IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; 5Public Health and Epidemiology Research Networking Center (CIBERESP), Madrid, Spain; 6Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain

Background: Concurrent personality disorder (PD) and substance use disorder (SUD) are common in clinical practice. However, SUD is the main criterion for study exclusion in most psychotherapeutic studies of PD. As a result, data on treatment outcomes in patients with concurrent PD/SUD are scarce.
Methods: The study sample consisted of 51 patients diagnosed with severe PD and admitted for psychotherapeutic treatment as a part of routine mental health care. All patients were diagnosed with PD according to the Structured Clinical Interview for PD. Patients were further assessed (DSM-IV diagnostic criteria) to check for the presence of concurrent SUD, with 28 patients diagnosed with both disorders (PD-SUD). These 28 cases were then compared to the 23 patients without SUD (PD-nSUD) in terms of psychiatric hospitalizations and psychiatric emergency room (ER) visits before and during the 6-month therapeutic intervention and every 6 months thereafter for a total of 36 months.
Results: The baseline clinical characteristics correspond to a sample of PD patients (78% met DSM-IV criteria for borderline PD) with poor general functioning and a high prevalence of suicide attempts and self-harm behaviors. Altogether, the five outcome variables – the proportion and the number of psychiatric inpatient admissions, the number of days hospitalized, and the proportion and the number of psychiatric ER visits – improved significantly during the treatment period, and this improvement was maintained throughout the follow-up period. Although PD-SUD patients had more psychiatric hospitalizations and ER visits than PD-nSUD patients during follow-up, the differences between these two groups remained stable over the study period indicating that the treatment was equally effective in both groups.
Conclusion: Specialized psychotherapy for severe PD can be effectively applied in patients with concurrent PD-SUD under usual practice conditions. These findings suggest that exclusion of patients with dual disorders from specialized treatments is unjustified.

Keywords: personality disorder, substance use disorder, borderline personality disorder, dual disorders, psychotherapy, pragmatic clinical study

 

Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]