Ismay Kremers

Out-patient psychotherapy for borderline personality disorder: cost-effectiveness of schema-focused therapy v. transference-focused psychotherapy

BACKGROUND Schema-focused therapy (SFT) and transference-focused psychotherapy (TFP) for borderline personality disorder were recently compared in a randomised multicentre trial. AIMS To assess the societal cost-effectiveness of SFT v. TFP in treating borderline personality disorder. METHOD Costs were assessed by interview. Health-related quality of life was measured using EQ-5D. Outcomes were costs per recovered patient (recovery assessed with the Borderline Personality Disorder Severity Index) and costs per quality-adjusted life-year (QALY). RESULTS Mean 4-year bootstrapped costs were euro37 826 for SFT and euro46 795 for TFP (95% uncertainty interval for difference -21 775 to 3546); QALYs were 2.15 for SFT and 2.27 for TFP (95% UI -0.51 to 0.28). The percentages of patients who recovered were 52% and 29% respectively. The SFT intervention was less costly and more effective than TFP (dominant), for recovery; it saved euro90 457 for one QALY loss. CONCLUSIONS Despite the initial slight disadvantage in QALYs, there is a high probability that compared with TFP, SFT is a cost-effective treatment for borderline personality disorder.

The endorsement of dysfunctional attitudes is associated with an impaired retrieval of specific autobiographical memories in response to matching cues

Two studies investigated a hypothesis of Dalgleish et al. (2003) that overgeneral memory may arise from matching between task cues and dysfunctional attitudes or schemas. In the first study, 111 euthymic patients with at least two previous major depressive episodes completed the Dysfunctional Attitude Scale: Form A (DAS-A) and the Autobiographical Memory Test (AMT). In the second study, 82 patients with a borderline personality disorder completed the Young Schema Questionnaire (YSQ) and the same version of the AMT. In both studies, patients retrieved less specific autobiographical memories in response to cue words that matched highly endorsed attitudes or schemas. These results suggest that an impaired retrieval of specific memories may be the result of certain cues activating generic, higher-order mental representations.

The Role of Cognitive Coping in Female Victims of Stalking

The aim of the study is to examine the role of cognitive coping in a sample of 47 female victims of stalking. Stalking victims who blamed themselves more for the stalking report significantly higher symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). Respondents who ruminated more about the stalking experience, or respondents who explicitly emphasized the terror of the stalking to a higher extent, also report significantly higher symptom levels. Finally, respondents who thought more about what steps to take and how to handle the stalking report significantly higher symptom levels of depression, anxiety, and PTSD. This conclusion holds also after controlling for the severity of stalking. If the findings of the present study can be confirmed, this could possibly contribute to the help provided to victims of stalking.

Autobiographical memory in depressed and nondepressed patients with borderline personality disorder after long‐term psychotherapy

The present study investigated whether scores on the Autobiographical Memory Test (AMT) in 55 patients with borderline personality disorder (BPD) were modified after long‐term psychotherapy and whether the pretreatment AMT scores would predict improvement in depression severity or BPD symptom severity at the end of treatment. In addition, it was analysed whether changes in ratings of mood, thought suppression, dissociation, and BPD symptom severity following treatment were associated with changes in AMT scores. Only patients with BPD and a comorbid diagnosis of depression at time 1, generated significantly more specific memories and fewer categoric memories after 15 months of therapy. Moreover, these changes were unrelated to type of therapy and changes in depression severity, borderline symptom severity, dissociation, or thought suppression. The AMT scores at initial assessment did not predict depression severity at 15 months. The percentage of negative specific memories tended to predict BPD symptom severity.

Life Events Over the Life Cycle and Depression in Late Life

Depression in late life is a severe problem. Depressive symptoms constitute a major risk factor for suicidal behavior for the elderly. Researchers have focused primarily on the effects of negative life events on adult depression, finding that loss-experiences (e.g., physical, social and psychological losses) and abuse are important risk factors for depression (Allers, Benjack, & Allers, 1992; Anderson, Yasenik, & Ross, 1993; Bifulco, Brown, & Adler, 1991; Moeller, Bachmann, & Moeller, 1993; Paykel, 1994; Weismann-Wind, & Silvern, 1994). However, looking at the available literature, elderly depression has received little attention. In order to be able to prevent elderly depression and (attempted) suicide and to make effective prevention and intervention programs, it is important to identify risk factors for elderly depression. Studies concerning elderly depression primarily investigated the association between recent life events and depression in late life. Recent negative life events (e.g., bereavement, chronic social difficulties, personal physical illness and moving during the past year) appear to be correlated with depression in late life (for a review, see Katona, 1993). The influence of early negative life events and how they may pervade in old age has not yet been extensively studied. The aim of the present study was to examine which life events occurring at different stages in life are related to depression in late life. This study is a pilot-study in preparation of a larger study. Therefore, the results presented here are to be considered preliminary.