Biomedical subjects

Roy Krawitz

Publications and source records attributed to Roy Krawitz.

4 recordsLinked to original sources

PubMed2006

Australasian dialectical behaviour therapy pilot outcome study: effectiveness, utility and feasibility.

OBJECTIVES: This paper aims to describe the outcome of 10 patients treated in a New Zealand pilot study of dialectical behaviour therapy (DBT) for people with borderline personality disorder (BPD), and to ascertain the clinical utility and feasibility of implementing DBT into a standard New Zealand public mental health service. METHOD: Patients had a clinical and an International Personality Disorder Examination diagnosis of BPD and received 6 months of standard DBT treatment. Rating scales used were the Millon Clinical Muliaxial Inventory, 3rd edition (MCMI-III) and the Symptom Checklist 90-Revised (SCL-90-R), which were completed pre treatment and post treatment. Pre-post treatment data were completed on inpatient resource usage. Qualitative patient interviews were conducted post treatment. RESULTS: There were statistically significant improvements in functioning on 10 of the 24 MCMI-III subscales (p < 0.03 to p < 0.0008), including notably the borderline personality subscale (p < 0.01) and the anxiety (p < 0.05) and depression (p < 0.001) subscales. There was a statistically significant improvement on the Global Severity Index of the SCL-90-R (p < 0.001) and on 10 of the 12 SCL-90-R scales (p < 0.05 to p < 0.001). The hospital bed days used decreased from 0.57 days per patient per month to 0.2 days per patient per month. CONCLUSIONS: These preliminary results document the clinical effectiveness of DBT. Dialectical behaviour therapy has practical and clinical utility of relevance to Australasian public mental health services. A DBT service can be successfully implemented within existing public mental health services.

Adult↗

PubMed2006

Borderline personality disorder: a pilot survey about clinician views on defensive practice.

OBJECTIVE: To conduct a pilot survey about clinician views on defensive practice when working with adults with borderline personality disorder. METHOD: All mental health clinicians from adult community, crisis and inpatient services of a district public mental health service who attended a routine team meeting completed a survey questionnaire (n = 29). RESULTS: Defensive practice was common, with 85% of clinicians having practised in the previous year in a manner that they believed was not in the best interests of their patients. CONCLUSIONS: The findings support clinical impressions of a significant gap between clinician views on best practice and actual practice. The potential importance of the findings warrants a comprehensive multicentred study.

Adult↗

PubMed2004

Professionally indicated short-term risk-taking in the treatment of borderline personality disorder.

OBJECTIVE: To define and explore the rationale for professionally indicated short-term risk-taking in treating adults with borderline personality disorder, and discuss prerequisites for the approach, clinical implementation and medicolegal contexts. CONCLUSION: When prerequisites are met and clinical and medicolegal practice is sound and thorough, taking short-term risk, as part of a comprehensive treatment, is a legitimate professional consideration in working with some adults with borderline personality disorder.

Adaptation, Psychological↗

PubMed2004

Borderline personality disorder: attitudinal change following training.

OBJECTIVE: To assess the effect of a two-day training workshop on clinician attitudes to working with people with borderline personality disorder (BPD). The main goal of the workshop was to achieve positive change in the attitude of clinicians treating people with BPD in a public setting. The hypothesis underlying the intervention was that informing clinicians about current concepts of the diagnosis, aetiology, prognosis and treatment of BPD, combined with detailed discussion of the principles of treatment in the public setting, would result in positive attitude change. METHOD: Changes in attitudes (optimism, enthusiasm, confidence and willingness to work with people with BPD) and self-perceptions of knowledge and skills among staff working with BPD patients were assessed for 418 participants from public mental health and substance abuse services who attended the workshops over an 18-month period. A survey questionnaire was administered pre- and post-workshop and at 6 month follow-up (time 1, time 2, time 3, respectively). One-way repeated measures analysis of variance (anova) were carried out to compare scores on attitudes and perceptions of knowledge and skills at time 1, time 2 and time 3. RESULTS: The results from repeated measures anova show that there was a statistically significant effect for time for all six items. Analyses of within-subject contrasts indicated that, for all six variables, the time 2 and the time 3 scores were statistically significantly different from time 1 scores (p < 0.01). These findings confirm that there were statistically significant changes at the post-workshop assessment, which were either maintained or showed a non-significant decrease at 6-month follow-up. CONCLUSIONS: The brief training workshop described was effective in achieving positive attitude change in clinicians working with patients with BPD. This research shows that it is possible through brief training to assist clinician positivity and to effect clinician attitude change. Implications of this research could include the influencing of future training of clinicians in public mental health and substance abuse fields.

Adult↗