Download mwhite assignment 1

Psychological therapies for people
with borderline personality disorder
(Review)
Authors:
Publication status:
Binks, C., Fenton, M., McCarthy, L., Lee, T., Adams, C., Duggan, C
Edited (no change to conclusions), published in Issue 1, 2009.
Review content assessed as up-to-date: August 2005.
Melinda White
SW 7113
Study Objectives
Background: Borderline personality disorder (BPD) is a relatively common
personality disorder with a major impact on health services as those
affected often present in crisis, often self-harming behavior
20% of inpatient population comprised of BPD
1.6 - 2% of the population
75% female
Objective: To evaluate the effects of psychological interventions for
people with borderline personality disorder
Plain language summary present, no protocol
Study Inclusion
Criteria
Clarity of purpose and anticipated gains
Defined rationale for participant inclusion
Detailed description of the intervention process
Randomized control trials with/out blinding
Attrition less than 50%
BPD diagnosis requirements: formal dx or informal dx weighted
Excluded quasi-randomized trials, for example, allocation taken on
surname
Data Collection
Data sources: 26 specialist and general bibliographic databases and
relevant reference lists, grey literature databases, author contacts
Date range: 1962 to Jan. 2003
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Search string:
(de=((antisocial personality disorder) OR (avoidant personality disorders) OR (borderline
personality disorder) OR (dependent personality) OR (depressive personality disorders) OR
(gender identity disorder) OR (histrionic personality disorder) OR (multi-impulsive personality
disorder) OR (multiple personality disorder) OR (narcissistic personality disorder) OR (passiveaggressive personality disorder) OR (sadistic personality disorder) OR (schizotypal personality
disorders) OR (self defeating personality disorder) OR (antisocial behaviour))) OR (((parano*
NEAR person*) OR ((asocial* OR antisocial* OR dissocial* OR psychopath* OR sadist* OR
sociopath*) NEAR person*)or (psychopath OR sociopath OR (moral NEAR insanity) OR
dissocial)) OR (diagnostic within 2 statistical manual iii) OR (diagnostic within 2 statistical
manual iv) OR (diagnostic within 2 statistical manual ii)) and (ab=(random*) OR ti=(random*)
OR de=(randomi?ed controlled trials) OR ab=(double* blind*)or ti=(double* blind*)or
de=(double blind studies) OR (single* NEAR blind*))
Study Inclusion
Flow diagram not reported
Final studies selected
Bateman (1999) 18 mo
Koons (2001)
6 mo
Linehan, (1991, 1999, 2002) 1 yr
Turner (2000) 1 yr
van den Bosch (2002) 1 yr
BPD Dx either by DSM IV or other
standard measure & 3 criteria
Defining the question
Participants
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N = 262, age 18+, male:16 female: 246
Interventions
Behavioral
Cognitive-behavioral
Psychodynamic
Group treatment
Miscellaneous treatment
Standard Care (TAU, wait list)
Comparisons -There were 5 in the 7 studies.
•
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Outcome measures
Too numerous to name. Recidivism, depression, anxiety, parasuicidal behavior,
self harm, incarceration, anger
Study level, timeline, context
Context not limited. Timelines too short. No longitudinal data
Data Analysis
Data extraction by 3 independent researchers
Summary measures: risk ratio reported with 95% CI
Utilized random effects model to handle heterogeneity. I 2 statistic
utilized with inspection of graphs, if i 2 within 75%, data considered
statistically heterogeneous
Included continuous data from rating scales only if they had been
previously described in peer reviewed journal
Documented risk of bias in individual studies. Areas vulnerable:
randomization (not always reported), blinding, (not mentioned by 2),
blinded independent rater evaluations used but no followup to verify
rates of allocation, 1 used raters blinded to the study, but not blinded
to the conditions.
Limitations
7 small studies of moderate quality
Data were lost due to unclear reporting (CONSORT guidelines, Moher,
2001)
Little data could be synthesized
Overall reporting of methods in all 7 studies was not good and leaves
all results at risk for bias. This is highlighted by the fact that Linehan
and Bateman (leaders in the field) oversaw 4 of the 7 studies
The synthesis is not current
Time frames too short. For example, Koons’ study was 6 months
Some studies could have been categorized in more than one way
Cannot be reproduced: sources unreliable
Tie breakers resolution: study inclusion, quality rating, data extraction
Implications
Policy implications: None because review is not conclusive. If it were,
perhaps one could say that policy could support the specific
treatments found to be effective. Insurance supports evidence
informed practices
Research implications: more research needed after review is updated