Patients with dual diagnosis, major depressive disorders and cluster B personality disorders, must be carefully monitored because of the refractory cases high incidence to either psychotherapeutic or pharmacologic therapy, when applied alone. In histrionic patients the the emphasis during psychotherapy must be on the collaborative therapeutic relationship and on the goals operationalizing process.

We prospectively evaluated 12 patients, female, mean age 35.5 years, diagnosed with major depressive disorder and histrionic personality disorder (according to DSM IV TR criteria) treated with antidepressants (fluoxetine 30 mg/day, n=5, paroxetine 30 mg/day, n=4, mirtazapine 45 mg/day, n=3) and weekly sessions of cognitive-behavioural therapy, for 6 months. We used Beck Depression Inventory (BDI)- 21 items form initially and every two weeks until the endpoint. The Global Assessment of Functioning (GAF) was used also, with the same frequency. The specific schemas of histrionic personality disorder had been addressed simultaneously with depressive specific dysfunctional beliefs.

There were 4 cases of discontinuation after a mean duration of 10.6 weeks. These patients presented at 6 months a higher score on BDI (+6.5) and a lower degree of social and professional level of functioning (-15 on GAF); a follow-up evaluation (after one year from baseline) observed more residual symptoms or recurrence of depression than patients that participated in all study sessions (mean BDI score 15.6vs.9.5, GAF 78vs.89, 2vs.0.5 depression episodes incidence).

Adressing dysfunctional schemas of histrionic personality disorder improves the long term prognosis in depressed patients with dual diagnosis.