IPRI indicates Interpersonal Relationships Inventory; FPI, Functional Performance Inventory. Error bars indicate 95% confidence intervals. Mean data are adjusted for baseline 24-item HAM-D (Hamilton Depression Rating Scale) score, fitting main effects of interpersonal psychotherapy/clinical management, citalopram/placebo, and baseline social support or functional performance scores, plus all 2-way interactions by intention-to-treat, last-observation-carried-forward analysis. From lowest to highest, quartiles (means) were defined as 13 to 27 (30.48), 38 to 45 (42.03), 46 to 50 (48.21), and 51 to 63 (53.91) for the IPRI and as 0.53 to 1.59 (1.23), 1.63 to 2.00 (1.82), 2.03 to 2.38 (2.21), and 2.41 to 3.00 (2.61) for the FPI. P = .03 for interaction between continuous IPRI score and interpersonal psychotherapy/clinical management; P = .003 for interaction between continuous FPI score and interpersonal psychotherapy/clinical management.

Overall outcome was assessed by averaging the effect sizes of target problems, general psychiatric symptoms, and personality and social functioning. Effect sizes are Hedges d (ie, within-group effect sizes), measured at the beginning and end of therapy. Error bars represent 95% confidence intervals (CIs). Studies are stratified into randomized controlled trials (RCTs) vs observational studies (with or without control groups).

HAM-D indicates 24-item Hamilton Depression Rating Scale; CAD, coronary artery disease; CCS, Canadian Cardiovascular Society angina class; CREATE, Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy; IPT, interpersonal psychotherapy; SAE, serious adverse event.
*Patients who stopped 1 of the 2 treatments to which they had been allocated were encouraged to continue the remaining treatment.
"Medication only" indicates that patients stopped citalopram or placebo but continued IPT or clinical management alone as allocated.
"IPT only" indicates that patients stopped IPT but continued citalopram or placebo as allocated.

For each type of borderline personality disorder, a combination of psychotherapy and pharmacotherapy is indicated. Reliance on pharmacotherapy will be greater, particularly early in the course of treatment, for types 1-3 until affect regulation and impulse control have stabilized. Adapted with permission from American Psychiatric Publishing Inc.⁷

Based on patient response to selected treatment, patients may continue with the original treatment (eg, medication, psychotherapy, none), switch treatments, add additional treatments, or be referred for specialty consultation or care. After randomization, when the quality improvement intervention began, primary care clinicians were informed that the quality improvement patient was in the study. CBT indicates cognitive-behavior therapy.