Personality Disorders are the most controversial diagnostic entities in modern psychiatry. However, there is a common ground in the field of treatment: the psychotherapy of patients with Personality Disorders is the treatment of choice. Research data confirm this assumption, especially for individual psychodynamic and cognitive - behavior psychotherapy.1

From the 80s onwards, new psychotherapeutic interventions were developed to achieve profound changes to the character pathology of the most serious cases with Personality Disorders, utilizing the existing psychiatric settings (inpatient wards or day hospitals). The latter were taken as the necessary framework (or containing, in psychoanalytic terminology) parameter for dealing with the enactments and suicidal behaviors of these patients.2 Psychotherapy always is multimodal, with the concomitant administration of individual and group sessions and expressive psychotherapies as well. The prevailing model is psychodynamic.

Nowadays we have many studies showing that these forms, combining psychiatric and intensive psychotherapeutic approach, provides statistically significant positive results compared to treatment as usual on an outpatient basis or hospitalization without psychotherapeutic orientation.

The research groups headed by Chiesa3,4 and Vermote5 for inpatient treatment and Karterud6,7 and Bateman & Fonagy8,9 for partial hospitalization have given clear evidence of efficacy concerning the treatment of Personality Disorders.

Finally, in our research work, using a naturalistic methodology, the psychotherapy- based inpatient treatment of seriously ill patients with Personality Disorders (mean average 4.5 DSM-IV diagnoses) was evaluated.10 57% of the subjects received medication adjunct to psychotherapy. Our study showed that for the group of patients who received only psychotherapy within the inpatient framework there was effectiveness to a significant degree, in relation to their impulsivity, but not to suicidality. In the latter, a combination of medication and psychotherapy was superior. These results need confirmation as they are the first regarding the combined pharmacotherapy and psychotherapy treatment in cases of severe Personality Disorders. In any case, it shows the way for the convergence of psychodynamic practice along with psychiatric and psychopharmacological practice to treat seriously ill patients with Personality Disorders.

Grigoris Vaslamatzis
Professor of Psychiatry, University of Athens
Eginition Hospital, Athens, Greece

 

References

  1. Verheul R, Herbrink M. The efficacy of various modalities of psychotherapy for personality disorders. A systematic review of the evidence and clinical recommendations. Int Rev Psychiat 2007, 19:25–38
  2. Vaslamatzis G, Zervis C, Ioannovits E, Kokkosi M, Lamnidis N, Tsani C et al. Borderline patient: Psychoanalytic psychotherapy in clinical framework. Kastaniotis Editions, 2005 Athens, Greece (In Greek)
  3. Chieza Μ, Fonagy P, Holmes J, Drahorad C. Residential vs community treatment of personality disorders: a comparative study of three treatment programs. Am J Psychiatry 2004, 161:1463–1470
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  5. Vermote R, Lowyck B, Luyten P, Vertommen H, Corveleyn J, Verhaest Y et al. Process and outcome in psychodynamic hospitalization based treatment for patients with a personality disorder. J Nerv Ment Dis 2010, 198:110–115
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  7. Karterud S, Pedersen G, Bjordal E. Day treatment of patients with personality disorders. Experiences from a Norwegian treatment research network. J Pers Disord 2003, 17:243–262
  8. Bateman A, Fonagy P. Effectiveness of partial hospitalization based treatment of borderline personality disorder. Am J Psychiatry 1999, 156:1563–1569
  9. Bateman A, Fonagy P. 8 years follow up of partial treatment for borderline personality disorder. Am J Psychiatry 2008, 165:631–638
  10. Vaslamatzis Gr, Theodoropoulos P, Vondikaki S, Karamanolaki H, Milia Tsanira M, Gourounti K. Is the residential combined (psychotherapy plus medication) treatment of patients with severe personality disorder effective in terms of suicidality and impulsivity? J Nerv Ment Dis 2014, 202:138–143

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