A group of researchers of the University of Amsterdam published a new study on the impact of psychotherapy for personality disorders in the current issue of Psychotherapy and Psychosomatics. While psychopharmacological studies are common in patients with cluster A personality disorders (schizoid, paranoid, schizotypal), the effects of psychotherapy have received little attention.
The aim of this study is to explore whether psychotherapeutic treatment yields health gains for patients cluster A personality disorders. The study was conducted between March 2003 and June 2008 in 6 mental health care centers in the Netherlands with a sample of 57 patients with a DSM-IV-TR axis II cluster A diagnosis. Patients were assigned to 3 settings of psychotherapeutic treatment (outpatient, day hospital, inpatient), and effectiveness was assessed at 18 months after baseline. An intention-to-treat analysis was conducted for psychiatric symptoms (Brief Symptom Inventory), psychosocial functioning (Outcome Questionnaire-45) and quality of life (EQ-5D) using multilevel statistical modelling. As the study was non-randomized.
Patients in the day hospital and inpatient group improved substantially in terms of psychiatric symptoms, social and interpersonal functioning, and quality of life. Patients in the outpatient group showed less improvement. Direct comparison of the improvement of psychiatric symptoms showed significant results in favor of day hospital (p=0.046) and inpatient (p=0.01) treatment as compared to outpatient treatment. However, due to substantial baseline differences, this direct comparison should be judged carefully.
In summary, cluster A psychopathology is not contraindicated for psychotherapy, and patients appeared to benefit from treatment. This is especially true for more intensive forms like inpatient and day hospital treatment. Future research should focus more on psychotherapeutic treatment to gain further insight into effective treatment options for this patient group.
Material adapted from Journal of Psychotherapy and Psychosomatics.
Bartak, A.; Andrea, H.; Spreeuwenberg, M.D.; Thunnissen, M.; Ziegler, U.M.; Dekker, J.; Bouvy, F.; Hamers, E.F.M.; Meerman, A.M.M.A. ; Busschbach, J.J.V.; Verheul, R.; Stijnen, T.; Emmelkamp, P.M.G. Patients with Cluster A Personality Disorders in Psychotherapy: An Effectiveness Study. Psychother Psychosom 2011;80:88-99.