Effectiveness of Dialectical Behavior Therapy (DBT) in an outpatient clinic for borderline personality disorders - impact of medication use and treatment costs]

Zusammenfassung Anliegen: Nachweis der Effektivitat tagesklinischer Therapie bei Borderline-Personlichkeitsstorungen (BPS). Methode: Naturalistische, offene Beobachtungsstudie einer 12-wochigen zertifizierten tagesklinischen DBT. Erhebung von Symptom-Checkliste (SCL-90), Beck-Depressions-Inventar (BDI) und Borderline-Symptomliste 95 (BSL-95) in der 1. und 11. Woche sowie Dokumentation der Pharmakotherapie. Ergebnisse: Einschluss von 31 Fallen. Verbesserung im BDI um 50,8% (p<0,001), in der SCL-90 um 42,9% (p<0,01) und der BSL-95 um 48,4% (p<0,001) (Power=0,99). Es fand sich kein Zusammenhang zwischen Medikationsanderung und Symptomreduzierung. Schlussfolgerungen: Erstmals wurde die Effektivitat einer teilstationaren DBT belegt. Abstract Objective: Investigation of the clinical effectiveness of dialectical behavioral therapy in a day clinic setting (DBT-DC) for borderline personality disorders (BPD), and impact of medication and daily costs. Methods: In a prospective, naturalistic, open and uncontrolled design BPD patients were enclosed in a 12-week DBT-DC. This DBT-program was certified by the German network of DBT. We collected data from the Symptom Checklist (SCL-90), the Beck Depression Inventory (BDI) and the Borderline Symptom List 95 (BSL-95) in the first and at the end of the 11(th) week. The concomitant medication and its changes were described. Results: 31 cases were included (9 drop-outs: 29%). The average age was 33.3 years (18-52, SD=10.6). 21 females and one male completed the program. There was no relationship between changes of BDI, SCL-90 and BSL-95 scores (p<0.001) and medication (and its alteration). The BDI scores improved by 50.8% (p<0.001), the SCL-90 by 42.9% (p<0.01) and the BSL-95 by 48.4% (p<0.001). The power was 0.99 (=0.05), the effect size was 1.41. In our setting the daily costs showed a reduction of about 6500Euro per case compared to an inpatient DBT. Medications played no significant role for improvement. Conclusions: For the first time a partial remission for BPD patients after 12 weeks has been shown to be achieved in a DBT-DC setting. DBT-DC reduces the primary costs of BPD compared to a specific inpatient therapy.