Citation

Chiesa M, Fonagy P. Br. J. Psychiatry 2003; 183: 356-362.

Copyright

(Copyright © 2003, Royal College of Psychiatry)

DOI

10.1192/bjp.183.4.356

PMID

14519615

Abstract

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.
RESULTS: Improvements were significantly greater in the step-down programme for social adjustment and global assessment of mental health. Patients in the programme were found to self-mutilate, attempt suicide and be readmitted significantly less at 24- and 36-month follow-up than patients in the in-patient group.
CONCLUSIONS: Improvements associated with specialist residential treatment continued 2 years after discharge. A step-down model has significant advantages over a purely in-patient model.

Language: en

Keywords

Adult; Female; Follow-Up Studies; Humans; Male; Middle Aged; Personality Disorders; Program Evaluation; Prospective Studies; Psychotherapy; Social Adjustment; Treatment Outcome