Title: Development of a Clinical Decision Support System for treatment selection of patients with a persona
1Development of aClinical Decision Support
Systemfor treatment selection of patients with a
personality disorderJanine van Manen1, Anne
Eland-Goossensen2, Roel Verheul1,3 1Viersprong
Institute for Studies on Personality Disorders
(VISPD), 2Erasmus Medical Centre , 3University of
AmsterdamJanine van Manen, P.O. box 7, 4660 AA,
Halsteren, the Netherlands, janine.van.manen_at_devie
rsprong.nl
Background Accumulating evidence indicates that
the treatment of choice for patients with a
personality disorder is psychotherapy. However,
the dosage of psychotherapeutic treatments varies
widely across settings and modalities.
Furthermore, evidence-based knowledge and
agreement between clinicians about treatment
selection rules is limited. Objective To develop
a Clinical Decision Support System (CDSS,
decision tree) based upon the combination of
clinical and empirical evidence and experiences
of patients, to support treatment selection of
patients with a personality disorder. Method The
development of the clinical decision support
system will be a multi-method two-phase
process 1 Modelling best clinical practice
semi-structured interviews with clinicians,
literature review 2 Validating and optimizing the
model retrospective and prospective analyses,
empirically testing matching hypothesis, and
testing model consistent and model inconsistent
cases. This process is governed by a steering
committee consisting of clinical experts and
researchers. Patients can give their opinion in
an advisory board.
Preliminary results
- Conclusions
- Intakers allocate patients with cluster C
personality disorder significantly different as
compared to patients with a cluster B or B and C
personality disorder (p lt .001). - The main reasons that patients do not start a
psychotherapeutic treatment for personality
pathology are - 1. (temporary) objections in psychological
functioning of the patient - 2. withdrawal of the patient
- 3. practical reasons.
- In combination with literature and the
intaker-questionnaire, we decide that
ego-strength, motivation for change,
psychological mindedness, capacity for
therapeutic relation and quality of defense
mechanisms are important variables in the process
of allocation of treatment for patients with a
personality disorder.