1. 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

2. Introduction 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:

3. Aim Which patient characteristics are related to treatment allocation?  Predictors: Patient variables (severity, strength, social role)  Outcome: treatment allocation in terms of - Setting - Duration

4. 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%

5. Prospective design Intake Patient characteristics - Severity - Psychological strength - Social role involvement Selected for treatment (n=928) SettingDuration OutpatientShort Day hospitalLong Inpatient

6. Patient characteristics Severity:  SCL-90 (GSI)  Axis-II clusters (A/B/C/NOS)  Treatment history Social role involvement:  Work  Care responsibility for children Psychological strengths:  Ego strength/identity integration (SIPP)  Psychological mindedness (PMAP)  Capacity to relate (SIPP)  Readiness for change (Motivation for Treatment Questionnaire)  Defensive functioning (ODF-score DSQ)

7. : Strongest severity variable : Outpatient history (%)

8. Setting effect

9. : Strongest severity variable : Outpatient history (%) Setting effect No duration effect

10. : Strongest psychological strength variable : Motivation (Readiness for change) Setting effect

11. : Strongest psychological strength variable : Motivation (Readiness for change) Setting effect No duration effect

12. : Strongest social role variable : Care responsibility for children (%) Setting effect

13. : Strongest social role variable : Care responsibility for children (%) Setting effect No duration effect

14. Overview results SettingDuration Severity+++/- Psychological strengths++/- Social role involvement++-

15. 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

16. 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 characteristicsallocation outcome