Transcript Dia 1 - de Viersprong

Treatment selection in patients with
personality disorders:
The 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
Introduction
Treatment 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:
Agreement among n=28 intake clinicians
Patient variables
Severity
Psychological strengths
Social role involvement
Setting
Duration
-
+
+
-
Aim
Which patient characteristics are related to
treatment allocation?

Predictors: Patient variables (severity, strength, social role)

Outcome: treatment allocation in terms of
- Setting
- Duration
Method
SCEPTRE:
 Prospective multi-centre study (six treatment centres)
De Viersprong, Gelderse Roos, Altrecht, Zaans Medisch Centrum, Mentrum, GGZ WNB
N=928 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%
Prospective design
Intake
Selected for treatment
(n=928)
Patient characteristics
- Severity
- Psychological strength
- Social role involvement
Setting
Outpatient
Day hospital
Inpatient
Duration
Short
Long
Patient characteristics
Severity:
 SCL-90 (GSI)
 Axis-II clusters (A/B/C/NOS)
 Treatment history
Psychological strengths:
 Ego strength/identity
integration (SIPP)
 Psychological mindedness
(PMAP)
 Capacity to relate (SIPP)
Social role involvement:
 Readiness for change
 Work
(Motivation for Treatment
 Care responsibility for children
Questionnaire)
 Defensive functioning
(ODF-score DSQ)
Strongest severity variable:
Outpatient history (%)
100
90
80
70
60
50
40
30
20
10
0
Short
Long
Outpatient
Day hospital
Inpatient
Strongest severity variable:
Outpatient history (%)
100
90
80
70
60
50
40
30
20
10
0
Setting
effect
Short
Long
Outpatient
Day hospital
Inpatient
Strongest severity variable:
Outpatient history (%)
100
90
80
70
60
50
40
30
20
10
0
Setting
effect
No duration effect
Short
Long
Outpatient
Day hospital
Inpatient
Strongest psychological strength variable:
Motivation (Readiness for change)
34
30
Setting
26
effect
22
18
14
10
Short
Long
Outpatient
Day hospital
Inpatient
Strongest psychological strength variable:
Motivation (Readiness for change)
34
30
Setting
26
effect
22
18
No duration effect
14
10
Short
Long
Outpatient
Day hospital
Inpatient
Strongest social role variable:
Care responsibility for children (%)
100
90
80
70
60
50
40
30
20
10
0
Setting
effect
Short
Long
Outpatient
Day hospital
Inpatient
Strongest social role variable:
Care responsibility for children (%)
100
90
80
70
60
50
40
30
20
10
0
Setting
effect
No duration effect
Short
Long
Outpatient
Day hospital
Inpatient
Overview results
Setting
Duration
Severity
++
+/-
Psychological strengths
+
+/-
Social role involvement
++
-
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
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