Day Hospital Mentalization-Based Treatment MBT-DH versus treatment as usual in the treatment of severe borderline personality disorder: protocol of a randomized controlled trialReportar como inadecuado

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BMC Psychiatry

, 14:149

Personality disorders and disorders of adult behavior


BackgroundSevere borderline personality disorder is associated with a very high psychosocial and economic burden. Current treatment guidelines suggest that several manualized treatments, including day hospital Mentalization-Based Treatment MBT-DH, are effective in these patients. However, only two randomized controlled trials have compared manualized MBT-DH with treatment as usual. Given the relative paucity of data supporting the efficacy and cost-effectiveness of MBT-DH, the possible influence of researcher allegiance in one of the trials, and potential problems with the generalization of findings to mental health systems in other countries, this multi-site randomized trial aims to investigate the efficacy and cost-effectiveness of manualized MBT-DH compared to manualized specialist treatment as usual in The Netherlands.

Methods-designThe trial is being conducted at two sites in The Netherlands. Patients with a DSM-IV-TR diagnosis of borderline personality disorder and a score of ≥ 20 on the Borderline Personality Disorder Severity Index were randomly allocated to MBT-DH or treatment as usual. The MBT-DH program consists of a maximum of 18 months’ intensive treatment, followed by a maximum of 18 months of maintenance therapy. Specialist treatment as usual is provided by the City Crisis Service in Amsterdam, a service that specializes in treating patients with personality disorders, offering manualized, non-MBT interventions including family interventions, Linehan training, social skills training, and pharmacotherapy, without a maximum time limit. Patients are assessed at baseline and subsequently every 6 months up to 36 months after the start of treatment. The primary outcome measure is the frequency and severity of manifestations of borderline personality disorder as assessed by the Borderline Personality Disorder Severity Index. Secondary outcome measures include parasuicidal behaviour, symptomatic distress, social and interpersonal functioning, personality functioning, attachment, capacity for mentalizing and quality of life. Cost-effectiveness is assessed in terms of the cost per quality-adjusted life year. Outcomes will be analyzed using multilevel analyses based on intention-to-treat principles.

DiscussionSevere borderline personality disorder is a serious psychological disorder that is associated with high burden. This multi-site randomized trial will provide further data concerning the efficacy and cost-effectiveness of MBT-DH for these patients.

Trial registrationNTR2175

KeywordsMentalization-based treatment Treatment as usual Randomized controlled trial Multi-site Cost-effectiveness AbbreviationsBDIBeck depression inventory

BPDBorderline personality disorder

BPDSIBorderline personality disorder severity index

BSIBrief symptom inventory

CGIClinical global impression scale

DAPP-SFDimensional assessment of personality pathology – short form

ECRExperiences in close relationships

GAFGlobal assessment of functioning

GSIGlobal severity index

HAQHelping alliance questionnaire

ICERIncremental cost-effectiveness ratio

IIP-64Inventory of interpersonal problems

MATEMeasurements in the addictions for triage and evaluation

MBT-DHDay hospital mentalization-based treatment

MBTMentalization-based treatment

MBT-IOPIntensive outpatient mentalization-based treatment

OQ-45Outcome questionnaire

PAI-BORPersonality assessment inventory-borderline

QALYQuality-adjusted life year

RCTRandomized controlled trial

RFQReflective functioning questionnaire

SCID-IStructured clinical interview for DSM-IV Axis I personality disorders

SCID-IIStructured clinical interview for DSM-IV Axis II personality disorders

SDSSheehan disability scale

SIPP-SFSeverity indices of personality problems – short form

SSHISuicide and self-harm inventory

STEPPSSystems training for emotional predictability and problem-solving

TAUTreatment as usual

TiC-PTrimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-244X-14-149 contains supplementary material, which is available to authorized users.

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Autor: Elisabeth MP Laurenssen - Dieuwertje Westra - Martijn J Kikkert - Marc J Noom - Hester V Eeren - Anna J van Broekhuyzen


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