Clinical course, outcome and follow-up of inpatients with borderline level disorders

Abstract

Patients suffering from borderline personality disorders (BPD), or related disorders, are recognized to belong to a group for which specific inpatient treatment approaches are needed. In this prospective study, in the Kuopio University Hospital Department of Psychiatry, changes in symptoms and social management - were monitored in 62 borderline patients admitted in 1989 to an open ward, specializing in the psychotherapeutic treatment of borderline level disorders. The duration of hospitalization was 91 days, on average (range 21 - 296 days). The average follow-up period was 3.4 years. Patients were evaluated using various rating scales, including the Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS), at the beginning, middle and end of their stay in hospital and after the follow-up period. Forty-two patients (70%) participated in the follow-up evaluation. Most patients suffered from overt anxiety and depressive symptoms at the beginning of hospitalization. These symptoms declined significantly during hospital treatment. An active, positive attitude towards symptom alleviation and treatment predicted a good outcome, a passive, projective attitude predicted a poor outcome. Standard background variables and medical diagnosis did not differentiate between outcomes. It was concluded that in crisis situations patients with borderline level disorders and relatively mild symptoms benefit from treatment lasting longer than immediate symptom alleviation necessitates. Further treatment, on an outpatient basis, was recommended for all discharged patients. Three years later a regular contact had been established by about one third. Depressive and anxiety symptoms were at the same level as on discharge, as assessed by the BDI and HDRS. Although better affect regulation was attained on average, some patients suffered continually from serious problems, of which suicidal behaviour was the most marked sign. During follow-up the sample clearly differentiated into two groups: those continually capable of work and those chronically incapable of work, the latter a group at risk of social marginalization. Patients with concomitant physical illness benefited less from inpatient treatment than other patients. This was attributed to intolerance of psychic conflict.