پیش بینی ترک تحصیل زود هنگام ناشی از مراقبت های سرپایی روانپزشکی برای اختلال شخصیت مرزی با عوامل مربوط به بیمار

Despite obvious clinical need, factors underlying early treatment discontinuation among ‘real world’ borderline personality disorder (BPD) patients are still unknown. This study investigates individual characteristics that can predict early (<three months) dropout among BPD outpatients at a general psychiatric service. Out of a sample of 1437 consecutively treatment-seeking psychiatric outpatients, 162 BPD subjects have been identified by means of the Structured Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) Personality. Sociodemographic, clinical and personality variables potentially relevant for dropout were assessed for all participants at baseline. Early dropouts (n=54) were compared to continuers (n=108) on all measures. Logistic regression was then used to identify independent predictors of early dropout. A history of suicide attempts predicted early discontinuation, whereas the presence of an eating disorder and of avoidant personality features protected from early dropout. If confirmed, these findings may help clinicians operating in general psychiatric settings with estimating the risk of premature treatment discontinuation, and stress the need to specifically address suicidal behaviours in order to improve treatment retention among borderline outpatients. In this regard, implementing general psychiatric care with specialised, evidence-based psychotherapeutic interventions may be deemed necessary.

Patients with borderline personality disorder (BPD) are notoriously hard to engage in treatment. Satisfactory treatment compliance is difficult to achieve, and high dropout rates (15–77%) have been reported in all treatment settings, including hospital-based treatments (Gunderson et al., 1989 and Skodol et al., 1983), community treatment by experts (Doering et al., 2010 and Linehan et al., 2006), structured general psychiatric management for BPD (Bateman and Fonagy, 2009 and McMain et al., 2009), treatment as usual conditions (Davidson et al., 2006, Verheul et al., 2003 and Farrell et al., 2009) and in research settings (Kelly et al., 1992 and Links et al., 1990). Most strikingly, dropout rates are not ideal even in specialised, empirically supported, effective psychotherapies for BPD, with a high degree of heterogeneity in completion rates between studies and an overall dropout rate of 25% for interventions of <12 months' duration, and 29% for longer interventions (Barnicot et al., 2011).