old fomrat

September 2013 Glasgow Conference

Impact of clinical severity on outcomes of mentalisation-based treatment for borderline personality disorder - Anthony Bateman and Peter Fonagy - BJPsych Sep 2013 Background Evidence of remission from borderline personality disorder (BPD) without specialised treatment is accumulating. Aims To establish whether specialised treatments are indicated for patients with clinically severe disorder.

Method The impact of clinical severity on outcomes of a randomised controlled trial of mentalisation-based treatment (MBT) was contrasted with structured clinical management (SCM). Severity indicators were defined as severity of comorbid psychiatric syndromes, severity of BPD, severity of personality disturbance and severity of symptom distress.

Results testing the significance of distribution of cases of recovery v. non-recovery suggested that multiple Axis II diagnoses and symptom distress influenced outcomes.

Results testing the significance of distribution of cases of recovery v. non-recovery suggested that multiple Axis II diagnoses and symptom distress influenced outcomes.

Conclusions -Borderline personality disorder with significant Axis II comorbidity is a possible but uncertain indicator for specialist treatment - Patients whose only personality disorder diagnosis is BPD do equally well with SCM. Prospective studies are needed.

Introducing…

“common features rationale” ‘active therapeutic stance’ ‘therapeutic relationship - validating and hopeful’ ‘therapeutic model is well structured’ ‘quality assurance of therapist and user experience’ organizational willingness’ ‘team supervision’ ‘self monitoring of affects – clinician and service user’ ‘skilled and balanced approach to crisis’ involves families

‘Mentalisation Skills’ training cascaded throughout - more than SCM recommends PD liaison service using SCM approach to fit the Scottish Health Service

“KISS” taking MBT skills training skills and providing a structure to apply it to but which is easily acquired ( highly manualised ) does not require specialist psychotherapy training

But….. SCM is labour intensive – group and individual sessions we may need to do our own ‘pic and mix’ of effective interventions and adapt what we have