Alesiani Roberta, Boccalon Silvia, Giarolli Laura, Blum Nancee, Fossati Andrea
Clinical Psychology and Psychotherapy Unit, San Raffaele Turro, Scientific Institute H San Raffaele, Milan, Italy.
Clinical Psychology and Psychotherapy Unit, San Raffaele Turro, Scientific Institute H San Raffaele, Milan, Italy.
Compr Psychiatry. 2014 May;55(4):920-7. doi: 10.1016/j.comppsych.2014.01.003. Epub 2014 Jan 17.
In this study we present a clinical application of the STEPPS model in an Italian sample of severely affected patients with borderline personality disorder (BPD) or personality disorder (PD) with prominent borderline features in comorbidity with a mood disorder. The aims of this work are: 1) to confirm our preliminary results in a larger sample and at a 12-month follow-up, and 2) to identify predictors of drop-out vs completion of STEPPS in order to understand which characteristics of patients make them suitable or not for this treatment. The sample is composed of 32 subjects recruited from a population of inpatients of the Mood Disorders Center, Department of Clinical Neurosciences, Hospital San Raffaele-Turro, Milan. To confirm STEPPS efficacy at 12-month follow-up, we selected the following outcome criteria: reduction in the number of hospitalizations related to self-harm acts; reduction in the number of suicidal attempts; reduction of perceived emotional intensity levels; changes in cognitive filter scores; changes in the scores on self-report questionnaires. To identify predictors of drop-out vs completion, we analysed the following variables: demographic features (sex, marital status, school level achieved, and job status); Axis-I diagnosis; Axis-II categorical and dimensional diagnosis; and personality features. Seventeen (53%) subjects completed the treatment successfully. The drop-out rate was 47%. Patients who completed the program show a significant decrease in the number of hospitalizations, both at the end of the treatment and at 12-month follow-up. Friedman ANOVA test shows a significant decrease in suicidal attempts during and after STEPPS, and at 12-month follow-up. Analysis of drop-outs showed no significant differences with regard to sex, marital status, school level and job status between the two groups. Axis-I and Axis-II categorical diagnoses did not discriminate between the two groups. Those patients who dropped differ significantly from completers in histrionic personality traits and magical thinking index, given by the interaction between low scores in Self-Directedness and high scores in Self-Transcendence.
在本研究中,我们展示了STEPPS模型在意大利一组严重受影响患者中的临床应用,这些患者患有边缘型人格障碍(BPD)或具有突出边缘特征且合并情绪障碍的人格障碍(PD)。本研究的目的是:1)在更大样本和12个月随访中确认我们的初步结果,以及2)确定STEPPS治疗退出与完成的预测因素,以便了解患者的哪些特征使其适合或不适合这种治疗。样本由32名受试者组成,他们从米兰圣拉斐尔 - 图罗医院临床神经科学系情绪障碍中心的住院患者群体中招募。为了在12个月随访时确认STEPPS的疗效,我们选择了以下结果标准:与自我伤害行为相关的住院次数减少;自杀未遂次数减少;感知情绪强度水平降低;认知过滤分数变化;自我报告问卷分数变化。为了确定退出与完成的预测因素,我们分析了以下变量:人口统计学特征(性别、婚姻状况、学历和工作状态);轴I诊断;轴II分类和维度诊断;以及人格特征。17名(53%)受试者成功完成了治疗。退出率为47%。完成该项目的患者在治疗结束时和12个月随访时住院次数均显著减少。Friedman方差分析测试显示,在STEPPS治疗期间、治疗后以及12个月随访时,自杀未遂次数显著减少。对退出者的分析表明,两组在性别、婚姻状况、学历和工作状态方面没有显著差异。轴I和轴II分类诊断在两组之间没有区分作用。那些退出治疗的患者在表演型人格特质和神奇思维指数方面与完成治疗的患者有显著差异,这是由自我导向得分低和自我超越得分高之间的相互作用得出的。