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Biomedical subjects

S Karterud

Publications and source records attributed to S Karterud.

At least 19 recordsLinked to original sources

Outcomes of poorly functioning patients with personality disorders in a day treatment program.

OBJECTIVE: Rates of completion, complications, and outcome were examined in a sample of poorly functioning patients who participated in a group-oriented day treatment program for patients with personality disorders. METHODS: The study was a naturalistic prospective study of 183 patients admitted to a day treatment program in Oslo, Norway. The program consists of a combination of group analytically oriented groups and cognitive-behavioral groups. The Global Severity Index (GSI) of the Symptom Check List, the circumplex version of the Inventory of Interpersonal Problems (IIP-C), and the Global Assessment of Functioning (GAF) were administered at admission and discharge. RESULTS: A total of 138 [corrected] patients (77 percent) completed the day treatment program. Few patients experienced treatment complications. Effect sizes for GAF, GSI, and IIP-C scores for treatment completers were in the medium-to-high range, indicating a fair level of improvement. Patients' rating of benefit was positive. CONCLUSIONS: The results are promising as a first step toward development of a cost-efficient comprehensive long-term treatment program for patients with severe personality disorders.

Adult

Block training in group analysis: the Norwegian program.

Block training in group psychotherapy makes it possible to train professionals living far apart and to import conductors to an area or country lacking sufficient expertise. This article reports experience with such a training program in Norway. Training is given in blocks of 5 weekends a year, each weekend containing small group therapy, supervision, theory courses, lectures, and large group experiences. The participants were questioned about their personal and professional gains from the training. These findings and the effect of the program in relation to stated goals are discussed.

Adult

The longitudinal pattern of suicidal behaviour in borderline personality disorder: a prospective follow-up study.

The aim was to study the longitudinal course of suicidal behaviour and ideation in patients with borderline personality disorder (BPD) compared with patients with other diagnoses. Ninety-seven patients (41 BPD, 33 other personality disorders, 23 no personality disorder) consecutively admitted to a day unit were given a prospective personal interview follow-up with evaluations at admission, discharge and at follow-up after 2-5 years. Even when controlled for Axis I disorders, BPD patients showed significantly more often a lifetime history of suicide attempts. BPD patients with a history of suicide attempts were more suicidal at index admission, continued to be so over the follow-up period and differed systematically in an unfavourable direction from other BPD patients on the major outcome measures. BPD patients without suicidal behaviour had an outcome nearly as good as non-BPD patients, and only 41% of them retained the BPD diagnosis at follow-up. Suicidal behaviour and ideation are highly prevalent in BPD. These suicidal expressions are of an enduring nature and seem as a diagnostic criterion to enhance the predictive capacity of the BPD diagnosis.

Adult

Day hospital therapeutic community treatment for patients with personality disorders. An empirical evaluation of the containment function.

Does a day hospital format represent an adequate level of treatment for decompensated patients with personality disorders? The study concerns 97 consecutive patients, 50 of whom belonged to cluster A and B personality disorders. The patients were referred partly from an acute admission ward and partly from outpatient departments. The mean treatment time was approximately 6 months. The dropout rate for schizotypal and borderline patients was 38%. No patient committed suicide. Two patients made suicidal attempts during treatment. The level of medication was moderate, and 58% of the patients were drug-free at discharge. Treatment results at discharge, measured by SCL-90 and Health Sickness Rating Scale, were very good for patients with axis I disorders only, good for cluster C personality disorders, modest for borderline patients, and very modest for schizotypal patients. In general, the results indicate that the containing capacity of a day hospital therapeutic community is substantial and that it may reduce the need for long-term inpatient treatment.

Adult

Personality disorders 2-5 years after treatment: a prospective follow-up study.

Ninety-seven patients consecutively admitted to a day unit specializing in the treatment of personality disorders were included in a prospective follow-up study. At follow-up an average of 3 years after index admission, patients with borderline personality disorder (BPD) displayed a moderate symptom reduction and a fair global outcome. Patients with schizotypal personality disorder (STP) showed a similar reduction in symptoms but retained relatively poor global functioning. Individuals with cluster C personality disorders, in contrast, showed both a good global outcome and a marked symptom reduction. STP individuals were the least socially adjusted, employed and self-supporting of all diagnostic subgroups. STP and BPD individuals had far more inpatient treatment in the follow-up period than other groups. The overall suicide rate was low compared with most similar studies.

Adult

A comparative study of six different inpatient groups with respect to their basic assumption functioning.

Seventy-five group therapy sessions of six different inpatient team groups in one short-term, one intermediate term, and one long-term psychiatric ward were studied with Group Focal Conflict Analysis and the Group Emotionality Rating System. The majority of the group sessions (41) functioned as fight-flight groups, twenty-four sessions functioned at a "pseudogroup" level, and ten sessions were dependency groups. The differences between the fight-flight groups and the dependency group on the variables aggression and dependency were highly significant statistically. A mixture of fight-flight groups and pseudogroups were found in the short-term ward with emergency obligations. The author discusses the assets and shortcomings of fight-flight and dependency cultures within psychiatric wards.

Conflict, Psychological

What are the prerequisites and indications of the therapeutic community proper? A comparative study.

Is the therapeutic community model appropriate for short term psychiatric wards with catchment area responsibility and emergency obligations? A comparative study of group dynamics, measured by Group Emotionality Rating System and Group Focal Conflict Analysis within three different therapeutic community wards, revealed that the short term ward contained extreme fight/flight groups and pseudo-groups unable to deal with the delegated responsibility presupposed by the therapeutic community model. The intermediate ward functioned fairly well, while the long term ward for psychotherapy of schizophrenia and personality disorders also functioned badly from a therapeutic community proper point of view. The author discusses these findings in light of previous literature and concludes that the therapeutic community proper is predominantly a treatment model relevant for personality disorders and severe neuroses, and not adequate for the multiplicity of emergency tasks facing a short term psychiatric ward.

Group Processes

The valence theory of Bion and the significance of (DSM-III) diagnoses for inpatient group behavior.

The aim of this study was to investigate the validity of Bion's hypothesis of valence and the significance of (DSM-III) diagnoses for inpatient group behavior. All verbal statements (approximately 17,000) from 91 patients in 75 small group therapy sessions were assessed according to Group Emotionality Rating System, which contains the (Bion) categories of dependency, fight, flight and pairing. The results confirmed the valence theory, since diagnoses explained 7-20% of the variance in emotional group behavior, while sex and age only explained 1-2% of the variance. The personality disorders of the schizoid/paranoid spectrum had the strongest valence for fight(/flight). The major depressions and the dependent personality disorders had the strongest valence for dependency. Neuroses and personality disorders had a significantly higher (P less than 0.05) valence for pairing than psychoses. Tables demonstrating the valence strength for 9 diagnostic categories are presented. The group culture seemed to modify behavior differently according to the diagnoses.

Alcoholism