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The British Journal of Psychiatry (2003) 183: 356-362
© 2003 The Royal College of Psychiatrists

Psychosocial treatment for severe personality disorder

36-month follow-up

MARCO CHIESA, MRCPsych

The Cassel Hospital, Richmond, UK

PETER FONAGY, FBA

Sub-department of Clinical Health Psychology, University College London, UK

Correspondence: Marco Chiesa, Consultant Psychiatrist and Head of Research Unit, The Cassel Hospital, Richmond TW10 7JF, UK. Tel: 020 8237 2902; fax: 020 8332 6424; e-mail: m.chiesa{at}ucl.ac.uk

Declaration of interest Grants from the Henry Smith and Welton Foundations.

1 Reliable change takes into account measurement error according to the formula x2–x1/Sdiff, where x1is the pre-test score, x2 is the post-test score and Sdiff is the standard error of difference between the two test scores. A reliable change index value below 1.96 represents a change ascribable to the imprecision of the measurement.

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.


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