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Short-term day treatment programmes for patients with personality disorders. What is the optimal composition?

https://arctichealth.org/en/permalink/ahliterature179587
Source
Nord J Psychiatry. 2004;58(3):243-9
Publication Type
Article
Date
2004
Author
Sigmund Karterud
Øyvind Urnes
Author Affiliation
Department for Personality Psychiatry, Ullevål University Hospital, Oslo, Norway. sigmund.karterud@psykiatri.uio.no
Source
Nord J Psychiatry. 2004;58(3):243-9
Date
2004
Language
English
Publication Type
Article
Keywords
Cognitive Therapy - methods
Combined Modality Therapy
Day Care - methods
Evidence-Based Medicine
Health Services Research
Humans
Norway
Personality Disorders - diagnosis - psychology - therapy
Psychoanalytic Therapy - methods
Psychotherapy, Brief - methods
Psychotherapy, Group - methods
Treatment Outcome
Abstract
Research evidence indicates that approximately 10 h a week is a sufficient intensity for short-term day treatment programmes for patients with personality disorders. In this article, we discuss which therapeutic components should be included in such a programme. Relevant research and clinical literature are reviewed. The fit between the therapeutic components and the programme as a whole is discussed according to: 1) scientific evidence of the effectiveness of the therapeutic components, 2) a sound theoretical rationale, 3) evidence of user satisfaction among patients, 4) clinical experiences of staff, 5) comprehensiveness and consistency, and 6) available therapeutic skills and resources. We advocate an 11-h treatment programme comprising small group psychotherapy, art group therapy, large group psychotherapy, cognitive group therapy, problem-solving group therapy and optional adjuncts (cognitive behavioural group therapy) for patients with additional anxiety and eating disorders.
PubMed ID
15204213 View in PubMed
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Outpatient group psychotherapy following day treatment for patients with personality disorders.

https://arctichealth.org/en/permalink/ahliterature181836
Source
J Pers Disord. 2003 Dec;17(6):510-21
Publication Type
Article
Date
Dec-2003
Author
Theresa Wilberg
Sigmund Karterud
Geir Pedersen
Oyvind Urnes
Torill Irion
Jørgen Brabrand
Grete Haavaldsen
Harald Leirvåg
Kjell Johnsen
Hanne Andreasen
Helene Hedmark
Bjarte Stubbhaug
Author Affiliation
Department for Personality Disorders, Drug Addiction, and Liaison Psychiatry, Psychiatric Division, Ullevål University Hospital, 0407 Oslo, Norway. theresa.wilberg@psykiatri.uio.no
Source
J Pers Disord. 2003 Dec;17(6):510-21
Date
Dec-2003
Language
English
Publication Type
Article
Keywords
Adult
Aftercare - methods
Female
Humans
Male
Norway
Personality Disorders - therapy
Program Evaluation
Prospective Studies
Psychotherapy, Group - methods
Treatment Outcome
Abstract
This prospective, naturalistic study evaluated the practice and effectiveness of an outpatient group therapy program following day treatment for patients with personality disorders (PDs). One hundred and eighty-seven patients (86% patients with PDs and 14% with no PDs), were treated in outpatient psychodynamic group therapy. Outcome was assessed by Global Assessment of Functioning, Symptom Check List 90-R, and Inventory of Interpersonal Problems-Circumplex, short version, at admission and discharge from day treatment, and at the end of outpatient group therapy. Average length of outpatient therapy was 24 months. Forty-three percent terminated in an irregular manner. Outcome of the continuation therapy was satisfactory for patients without PDs. For PD patients, the improvement from the day treatment was maintained during outpatient therapy, but further improvements were modest for symptoms and interpersonal distress, somewhat better for global functioning. Implications for further treatment development are discussed.
PubMed ID
14744077 View in PubMed
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Long-term continuation treatment after short-term day treatment of female patients with severe personality disorders: Body awareness group therapy versus psychodynamic group therapy.

https://arctichealth.org/en/permalink/ahliterature97350
Source
Nord J Psychiatry. 2010 Apr;64(2):115-22
Publication Type
Article
Date
Apr-2010
Author
Harald Leirvåg
Geir Pedersen
Sigmund Karterud
Author Affiliation
Dagpost Kolonien, Sørlandet Hospital HF, 4604 Kristiansand, Norway. harald@leirvag.com
Source
Nord J Psychiatry. 2010 Apr;64(2):115-22
Date
Apr-2010
Language
English
Geographic Location
Norway
Publication Type
Article
Keywords
Adult
Awareness
Body Image
Borderline Personality Disorder - diagnosis - psychology - therapy
Child
Child Abuse, Sexual - psychology - therapy
Combined Modality Therapy
Day Care - methods
Female
Follow-Up Studies
Humans
Long-Term Care
Middle Aged
Norway
Patient Dropouts - psychology
Personality Assessment
Personality Disorders - diagnosis - psychology - therapy
Professional-Patient Relations
Psychoanalytic Therapy - methods
Psychotherapy, Brief - methods
Psychotherapy, Group - methods
Abstract
OBJECTIVE: To investigate and compare the treatment effects of psychodynamic group therapy (PGT) and body awareness group therapy (BAGT) as outpatient treatment following day treatment for personality disorders. MATERIALS AND METHODS: Twenty-one female patients given PGT were compared with 29 female patients receiving BAGT. The average length of outpatient therapy was 24 and 25 months, respectively. The patients were assessed trough the quality assurance system of the Norwegian Network of Psychotherapeutic Day Hospitals, including the Mini International Neuropsychiatric Interview (M.I.N.I.) and Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) for diagnostic purposes. Outcome was assessed using the Global Assessment of Functioning (GAF), Symptom Check List 90-R sum score (Global Severity Index, GSI), Circumplex of Interpersonal Problems (CIP), at admission and at discharge from day treatment, and at the end of outpatient group therapy. RESULTS: Patients undertaking BAGT improved significantly on GAF, GSI and CIP, and reported high ratings of satisfaction with therapy and group climate at the end of outpatient treatment. The magnitude of change on GAF and CIP was significantly higher in the BAGT group compared with the PGT patients who displayed only minor changes after outpatient treatment. CONCLUSIONS: BAGT is possibly an effective outpatient continuation therapy for women with severe personality disorders, but because of limitations of this study, these results warrant a larger randomized study.
Notes
RefSource: Nord J Psychiatry. 2010 Apr;64(2):75-7
PubMed ID
20392134 View in PubMed
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The relative influence of childhood sexual abuse and other family background risk factors on adult adversities in female outpatients treated for anxiety disorders and depression.

https://arctichealth.org/en/permalink/ahliterature30447
Source
Child Abuse Negl. 2004 Jan;28(1):61-76
Publication Type
Article
Date
Jan-2004
Author
Dawn E Peleikis
Arnstein Mykletun
Alv A Dahl
Author Affiliation
Department of Psychiatry, Aker University Hospital, University of Oslo, Sognsvannsveien 21, 0320 Oslo, Norway.
Source
Child Abuse Negl. 2004 Jan;28(1):61-76
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Adult
Anxiety Disorders - therapy
Child
Child Abuse, Sexual - psychology
Depression - therapy
Family Characteristics
Female
Humans
Middle Aged
Psychotherapy
Research Support, Non-U.S. Gov't
Risk factors
Abstract
OBJECTIVE: This study from Norway examines the relative influence of child sexual abuse (CSA) and family background risk factors (FBRF) on the risk for current mental disorders and the quality of current intimate relationships in women with CSA treated for anxiety disorders and/or depression. Women with these disorders frequently seek treatment, and the place of CSA in therapy is still under debate. METHOD: 112 women, who were treated with outpatient psychotherapy by female therapists for anxiety disorders and/or depression were included. CSA had been admitted at the start of treatment start in 56 women, while no CSA was admitted among the 56 women of the comparison group. Systematic and detailed retrospective information about childhood as well as data on current functioning and current mental disorders were collected by questionnaires and structured interviews done by an independent female psychiatrist. RESULTS: The women of the CSA group reported significantly more FBRF than the comparisons. CSA increased the risk for posttraumatic stress disorder (PTSD), non-suicidal self-inflicted harm, and rape after 16 years. Major depression, dysthymia, and their comorbidity were not associated with CSA. The five indicators of quality of current intimate relationship were not associated with CSA. CONCLUSIONS: Women with CSA who have been treated for anxiety disorders and/or depression, also frequently have been exposed to FBRF. Increased risk for PTSD, self-inflicted harm before therapy, and rape after 16 years of age was influenced by CSA, while mood disorders and the quality of current attachment are not associated with CSA, but with FBRF or other factors not examined in this study.
PubMed ID
15019439 View in PubMed
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From general day hospital treatment to specialized treatment programmes.

https://arctichealth.org/en/permalink/ahliterature164617
Source
Int Rev Psychiatry. 2007 Feb;19(1):39-49
Publication Type
Article
Date
Feb-2007
Author
Sigmund Karterud
Theresa Wilberg
Author Affiliation
Department for Personality Psychiatry, Psychiatric Division, Ullevål University Hospital, Oslo, Norway. sigmund.karterud@psykiatri.uio
Source
Int Rev Psychiatry. 2007 Feb;19(1):39-49
Date
Feb-2007
Language
English
Publication Type
Article
Keywords
Borderline Personality Disorder - epidemiology - psychology - therapy
Cross-Sectional Studies
Day Care
Humans
Norway
Outcome and Process Assessment (Health Care)
Personality Disorders - epidemiology - psychology - therapy
Prognosis
Psychotherapy
Specialization
Abstract
Approximately one third of day hospitals in Europe can be designated as predominantly psychotherapeutic. They address mainly patients with personality disorders (PD), but also eating disorders and chronic mood and anxiety disorders without PD. As day treatment programmes tend to become associated with mental health centers, their treatment intensity also tends to become reduced. Available data suggest that approximately 10 hours of treatment a week is sufficient. Is such treatment more effective than specialized outpatient treatment? This research question will probably set the agenda in the years to come. In response to this challenge, day treatment should become more specialized. Data from the Norwegian Network of Psychotherapeutic Day Hospitals (n = 2.205) demonstrate that the majority of day treatment patients suffer from borderline and avoidant PD. Programmes for patients with borderline PD are well developed. The authors call for programme development for patients with avoidant PD.
PubMed ID
17365157 View in PubMed
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Interviews of female patients with borderline personality disorder who dropped out of group psychotherapy.

https://arctichealth.org/en/permalink/ahliterature165383
Source
Int J Group Psychother. 2007 Jan;57(1):67-91
Publication Type
Article
Date
Jan-2007
Author
Benjamin Hummelen
Theresa Wilberg
Sigmund Karterud
Author Affiliation
Department for Research and Education, Psychiatric Division, Ullevål University Hospital, 0407 Oslo, Norway. benjamin.hummelen@medisin.uio.no
Source
Int J Group Psychother. 2007 Jan;57(1):67-91
Date
Jan-2007
Language
English
Publication Type
Article
Keywords
Affect
Ambulatory Care
Borderline Personality Disorder - psychology - therapy
Day Care
Emotions
Female
Group Processes
Humans
Interview, Psychological
Motivation
Norway
Patient Care Planning
Patient Dropouts - psychology
Psychotherapy, Group
Risk factors
Abstract
Premature termination from group psychotherapy continues to be a serious problem in the treatment of patients with borderline personality disorder (BPD). Qualitative research is regarded as an important means to shed light upon the complex dynamics leading to dropout. We conducted an interview study with patients having a diagnosis of BPD (n = 8) who dropped out from long-term group psychotherapy as a continuation therapy following intensive day treatment. The group therapists for these patients were interviewed as well (n = 12). The findings suggest the operation of many processes that contribute to dropout. Most significant appeared to be experiences of separation and loss of the day hospital that were not worked through and a failure of the group to regulate and contain the patients' affects. To integrate patients at risk of premature termination it seems necessary to pay attention to the strong negative emotions that they experience in the group. A higher treatment intensity than weekly group sessions may help to promote more beneficial group processes.
PubMed ID
17266430 View in PubMed
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The quality of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dependent personality disorder prototype.

https://arctichealth.org/en/permalink/ahliterature166865
Source
Compr Psychiatry. 2006 Nov-Dec;47(6):456-62
Publication Type
Article
Author
Tore Gude
Sigmund Karterud
Geir Pedersen
Erik Falkum
Author Affiliation
Modum Bad, Research Institute, N-3370 Vikersund, Norway. tore.gude@medisin.uio.no
Source
Compr Psychiatry. 2006 Nov-Dec;47(6):456-62
Language
English
Publication Type
Article
Keywords
Adult
Day Care
Dependent Personality Disorder - classification - diagnosis - psychology - therapy
Diagnosis, Differential
Diagnostic and Statistical Manual of Mental Disorders
Female
Humans
Male
Norway
Personality Disorders - classification - diagnosis - psychology - therapy
Psychometrics - statistics & numerical data
Psychotherapy
Sensitivity and specificity
Abstract
The aim of this study was to investigate the quality of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition dependent personality disorder (DPD) prototype with special reference to possible bidimensionality.
The sample included 1078 patients, 81% (n = 875) had 1 or more personality disorders. The proportion of patients with DPD was 11.3% (n = 122). Frequency distribution, chi2, correlations, reliability statistics, exploratory and confirmatory factor analyses were performed.
Of the DPD criteria, criterion 3 showed a higher correlation with avoidant personality disorder than with DPD itself, whereas criterion 5 was weakly correlated with DPD, findings being confirmed by an exploratory factor analysis and a low internal consistency of all DPD criteria. An a priori hypothesized 2-factor model was confirmed by the confirmatory factor analysis.
These results indicate a moderate to low quality of the DPD construct. The main objection is that DPD is based too heavily on a bidimensional model of perceived incompetence and dysfunctional attachment. Items should be revised, in particular, items 3 and 5.
PubMed ID
17067868 View in PubMed
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Current mental health in women with childhood sexual abuse who had outpatient psychotherapy.

https://arctichealth.org/en/permalink/ahliterature29677
Source
Eur Psychiatry. 2005 May;20(3):260-7
Publication Type
Article
Date
May-2005
Author
Dawn E Peleikis
Arnstein Mykletun
Alv A Dahl
Author Affiliation
Department of Psychiatry, Aker University Hospital, Sognsvannsveien 21, 0320, University of Oslo, Oslo, Norway. pel@online.no
Source
Eur Psychiatry. 2005 May;20(3):260-7
Date
May-2005
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Ambulatory Care
Anxiety Disorders - etiology - psychology - therapy
Catchment Area (Health)
Child
Child Abuse, Sexual - ethnology - psychology - statistics & numerical data
Depressive Disorder, Major - etiology - psychology - therapy
Female
Humans
Incest - statistics & numerical data
Middle Aged
Norway
Prevalence
Psychotherapy - methods
Questionnaires
Abstract
PURPOSE: This study from Norway examines mental health status of women with child sexual abuse (CSA) who formerly had outpatient psychotherapy for anxiety disorders and/or depression. The relative contributions of CSA and other family background risk factors (FBRF) to aspects of mental health status are also explored. SUBJECTS: At a mean of 5.1 years after outpatient psychotherapy, 56 female outpatients with CSA and 56 without CSA were personally examined by an independent female psychiatrist. Systematic information about current mental health and functioning was collected by structured interview and questionnaires. RESULTS: Among women with CSA 95% had a mental disorder, 50% had PTSD, and mean global assessment of functioning (GAF) score was 61.8+/-10.6. In contrast, 70% of women without CSA had a mental disorder, 14% had PTSD, and mean GAF 71.2 + 8.5. GAF and trauma scale scores were mainly determined by CSA, while FBRF mainly influenced the global psychopathology and dissociation scores. DISCUSSION: We have little knowledge on the mental health status at long-term in women with CSA who had psychotherapy. This study found their mental status to be rather poor, and worse than that of women without CSA who had psychotherapy for the same disorders. From the broad spectrum of mental disorders associated with CSA, this study concerns only women treated as outpatients for anxiety disorders and/or non-psychotic depressions. CONCLUSION: Women with CSA showed poor mental health at long-term follow-up after treatment. The fitness of the psychodynamic individual psychotherapy given, or to what extent treatment can remedy the consequences of such childhood adversities, is discussed.
PubMed ID
15935426 View in PubMed
Less detail

Psychotherapy for personality disorders: 18 months' follow-up of the ullevÄl personality project.

https://arctichealth.org/en/permalink/ahliterature99399
Source
J Pers Disord. 2010 Apr;24(2):188-203
Publication Type
Article
Date
Apr-2010
Author
Espen Arnevik
Theresa Wilberg
Øyvind Urnes
Merete Johansen
Jon T Monsen
Sigmund Karterud
Author Affiliation
Department for Research and Education, Ulleval University Hospital, 0407 Oslo, Norway. espen.arnevik@aus.no
Source
J Pers Disord. 2010 Apr;24(2):188-203
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adult
Ambulatory Care - statistics & numerical data
Combined Modality Therapy
Commitment of Mentally Ill - statistics & numerical data
Female
Follow-Up Studies
Humans
Interpersonal Relations
Male
Middle Aged
Norway
Personality Disorders - epidemiology - therapy
Physician-Patient Relations
Psychotherapy - methods - statistics & numerical data
Severity of Illness Index
Treatment Outcome
Young Adult
Abstract
The Ullevål Personality Project is a randomized controlled trial (N = 114) initiated as a response to the limited evidence justifying provision of day hospital treatment for patients with personality disorders (PDs). A step-down model (CP) consisting of initial short-term day hospital treatment followed by conjoint group and individual outpatient treatment was compared with outpatient individual psychotherapy (OIP). The patients were evaluated at baseline, 8 months, and 18 months on a wide range of clinical measures assessing symptoms, interpersonal problems, psychosocial functioning, and personality pathology. This study indicates that eclectic psychotherapy provided by private practitioners has at least as good an effect upon personality-disordered patients as a more comprehensive day hospital and outpatient follow-up treatment. However, this study has to be supplemented with a cost-benefit analysis before any consideration of implications for health care planning.
PubMed ID
20420475 View in PubMed
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Nineteen-month stability of Revised NEO Personality Inventory domain and facet scores in patients with personality disorders.

https://arctichealth.org/en/permalink/ahliterature152089
Source
J Nerv Ment Dis. 2009 Mar;197(3):187-95
Publication Type
Article
Date
Mar-2009
Author
Theresa Wilberg
Sigmund Karterud
Geir Pedersen
Øyvind Urnes
Paul T Costa
Author Affiliation
Department for Research and Education, Psychiatric Division, Ullevål University Hospital, Oslo, Norway. theresa.wilberg@medisin.uio.no
Source
J Nerv Ment Dis. 2009 Mar;197(3):187-95
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Cognitive Therapy
Day Care
Extraversion (Psychology)
Female
Follow-Up Studies
Humans
Internal-External Control
Male
Middle Aged
Neurotic Disorders - diagnosis - psychology
Norway
Personality Disorders - diagnosis - psychology - therapy
Personality Inventory - statistics & numerical data
Psychoanalytic Therapy
Psychometrics - statistics & numerical data
Psychotherapy, Group
Reproducibility of Results
Abstract
We lack knowledge of the temporal stability of major personality dimensions in patients with personality disorders (PDs). The Revised NEO Personality Inventory (NEO-PI-R) is a self-report instrument that operationalizes the Five-Factor Model of personality. This study investigated the relative stability, mean level stability, and individual level stability of the NEO-PI-R scores in patients with PDs (n = 393) and patients with symptom disorders only (n = 131). The NEO-PI-R was administered at admission to short-term day treatment and after an average of 19 months. The results showed a moderate to high degree of stability of NEO-PI-R scale scores with no substantial difference in stability between patients with and without PD. Changes in NEO-PI-R scores were associated with changes in symptom distress. Neuroticism was the least stable domain. The study indicates that the Five-Factor Model of personality dimensions and traits are fairly stable in patients with PDs. The lower stability of Neuroticism may partly be explained by its inherent state aspects.
PubMed ID
19282686 View in PubMed
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12 records – page 1 of 2.