Somatic comorbidity in personality disorder inpatients - Effect on treatment outcome in a 3-year follow-up study

Few studies have been published on the effects of physical comorbidity on the course or outcome of psychiatric inpatient treatment. In a psychiatric ward specializing in the psychotherapeutic treatment of borderline disorders, changes in symptoms and social management of 42 patients were monitored during an average hospitalization period of 91 days (range, 21-296 days) and a 3-year follow-up period. Physical health status was estimated during a follow-up interview on the basis of the medical records of the general hospital in question. Ages of the patients Varied between 20 and 59 years (median, 41 years). Only 21% had no diagnosed physical illness. The others had mild or temporary (62%) or serious (17%) physical illnesses. During the entire study period, relief of symptoms as assessed on the basis of the Hamilton Depression Rating Scale (HDRS) or the Beck Depression Inventory (BDI) was most marked in patients without physical illness. Depression and anxiety continued to decrease after the end of inpatient treatment. In patients with mild physical symptoms the degree of depression on admission was similar to that in otherwise healthy patients. Their depression decreased during inpatient treatment. During follow-up, symptoms remained at the levels observed at the end of inpatient treatment. Patients with serious illness had the mildest depression and anxiety at the beginning of the treatment, but symptoms increased during the treatment. These differences in treatment outcome were interpreted as consequences of different levels of psychic energy available for psychic work in the groups compared.