Original Title: Abordajes de los trastornos de la personalidad en la red de Salud Mental del País Vasco

Authors' objectives: • To know the health assistance demand directly related to Personality Disorders (PD) at the Basque Country Mental Health System. • Analysis of organisational schemes and techniques applied to PD in our system and in other national and international systems. • Elaboration of proposals on treatment of PD which will be eventually developed in the Basque Country to improve the current situation, considering the quality of evidences supporting our proposal and its applicability in our specific conditions, costs included.

Authors' results and conclusions: PD are often found in our units. Many times they are not recognized by planners due to «underdiagnosis» and «under-registration». Clinicians consider them difficult to treat and give them a sombre prognosis, in contradiction with current data on outcome and course of PD. We are lacking well structured clinical protocols to treat these patients in our units. Information is needed on the nature of the disorders and possible clinical approaches. Units of reference, be they at a national or international level, share some specific characteristics: a solid structure, a multicomponent approach with interventions integrated with predominance of dynamic and cognitive-behavioral techniques, applied in individual or group settings in intensive outpatient or partial hospitalization models. Evidences in the literature are scarce and difficult to interpret due to the methodological complexity that goes with psytchotehrapy resaerch added to the specific difficulties following PD research. A wide consensus considers psychotherapy the central element in PD treatment, combined with pharmacological intervention addressed to concrete symptoms clusters. Cognitivebehavioral and dynamic techniques are the more used PT interventions. Antidepressants and ISRS in particular have shown the higher potential in PD treatment. Treatment duration is always longer than a year. Outpatient intensive care and partial hospitalization are the preferred settings in published clinical trials.

Authors' recommendations: Five levels of improvement in the treatment of PD are proponed. Thay have an increasing complexity and can be implemented all at the same time or step by step in the Basque Country Mental Health Network. 1. Training program in PD for the MH Network 2. Training and research Unit 3. Pilot Treatment Unit. Emphasising group interventions. Preferent use of dynamic interventions.Training in cognitive-behavioral techniques. Exhaustive evaluation of clinical outcomes 4. Creation of treatment units throughout all the Basque Country 5. Inpatient Unit. Residencial ProgramWe specifically recommend to start this plan from level 3, creating a Pilot Treatment Unit that also takes charge of developing levels 1 and 2.

Authors' methods: • Analysis of case registers available in the Basque Country Mental Health System, complemented by a detailed examination of data in each of the mental health units where members of the research team work. • Information recollection on actual clinical care devoted to patients with PD in our community through high quality sources. • Information recollection on treatment programs in this field at a national level and also studying prestigious international programs. • Systematic review of scientific literature on specific treatment interventions and programs of treatment of PD. • Data analysis, discussion among team members and elaboration of a document with specific recommendations.

Project Status: Completed

Year Published: 2008

URL for published report: https://www.euskadi.eus/contenidos/informacion/2008_osteba_publicacion/es_def/adjuntos/D_08_01_trastor_persona.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment (OSTEBA)</p>