Development of a Clinical Decision Support System for treatment selection of patients with a persona

1
Development 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.