Search results for ‘Subject term:"personality disorders"’ Sort:
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Borderline personality disorder and hospitalization
- Author:
- FRIEDMAN Freda B.
- Journal article citation:
- Social Work in Mental Health, 6(1/2), 2008, pp.67-84.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
The potential for suicide is higher among those with borderline personality disorder than any other group with mental health problems. Rates of admission to hospital as the result of suicidal ideation or suicide attempts are high, but hospitalisation remains controversial. It can mask or sometimes exacerbate symptoms, and may be chosen more for its benefit to the therapist or the family than the patient. This paper summarises existing guidelines for the use of brief hospital admission for BPD patients, and examines what happens during such admissions in terms of treatment approaches, and the challenging and perplexing nature of the behaviour of BPD patients that may be heightened by transference and counter-transference in the hospital setting. Staff may become distressed, angry and frustrated as a result, and these problems may be exacerbated by the additional stresses imposed by family involvement. Enhanced hospital care for BPD patients should be based on an attempt to elicit the patient’s perceptions of his or her problems. Effective training and supervision of staff, as well as involvement of the patient in decision making about care, may help, as will a clear understanding on all sides that progress is likely to be of the ‘two steps forward, one step back’ variety. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
A two-model integrated personality disorder service: effect on bed use
- Authors:
- JONES Barry, JUETT Georgia, HILL Nathan
- Journal article citation:
- Psychiatrist (The), 36(8), August 2012, pp.293-298.
- Publisher:
- Royal College of Psychiatrists
A study assessed the impact on psychiatric inpatient bed use of a new personality disorder service in South London using 2 psychoanalytical models: mentalisation-based treatment and the provision of service user network groups (using therapeutic community principles with coping process and psychoanalytical theories). The number of psychiatric bed days used by patients attending the open-access service user groups or 2 or 3 day mentalisation-based treatment programmes was collated using the electronic patient record system, and bed use in the 6 months and 12 months before starting treatment was compared with bed use in the same periods after starting treatment. Statistical analysis showed bed use to be significantly reduced by treatment, with the reduction maintained at 12 months. There was no significant difference in bed use between patients attending the mentalisation-based treatment and those attending the service user network project at 6 months. The authors present detailed findings and discuss their implications.
Admission patterns of patients with personality disorder
- Authors:
- DASGUPTA Pritha, BARBER Joan
- Journal article citation:
- Psychiatric Bulletin, 28(9), September 2004, pp.321-323.
- Publisher:
- Royal College of Psychiatrists
The aim was to examine the prevalence and admission patterns of patients with personality disorder admitted to a Scottish general adult psychiatry service. We carried out a retrospective case-note study of patients identified from the computerised patient administration system. A subgroup of patients was identified as having a longer in-patient stay. Their admission pattern over the preceding 4 years was studied further. Sixty-two of 844 patients admitted had personality disorder. Thirty-nine had a primary diagnosis of personality disorder, 19 had an additional diagnosis of psychiatric disorder and 12 of alcohol or substance misuse. Within the subgroup admitted for longer in 2001, patterns of few/brief and numerous/often lengthy admissions were noted in earlier years. Personality disorder occurs in approximately 7% of admissions to general adult psychiatry beds. Many have additional diagnoses of psychiatric disorder, or substance or alcohol misuse further complicating their treatment.
And here's one we audited earlier
- Authors:
- GAW Caron, REDRUP Lauren
- Journal article citation:
- Health Service Journal, 10.2.11, 2011, pp.24-25.
- Publisher:
- Emap Healthcare
An audit was undertaken to improve patients' care pathway in Croydon's mental health services, with the aim of preventing unnecessary hospital admission and returning patients to the community as soon as possible. The first audit supported the development of an outpatient personality disorder service. The findings from the second audit suggested this had resulted in a reduction in unnecessary hospital stays for people with personality disorder as planned.
An evidence-based approach to managing suicidal behavior in patients with BPD
- Author:
- PARIS Joel
- Journal article citation:
- Social Work in Mental Health, 6(1/2), 2008, pp.99-108.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Mental health professionals are taught how to prevent suicide but there is little or no evidence that is possible to prevent events that cannot be predicted. Chronic suicidality is characteristic of people with borderline personality disorder and the preventive approach is particularly inappropriate with this group, leading to multiple hospital admissions that interfere with therapy. Long term studies of people with BPD suggest that completed suicides tend to occur not when patients are at their most suicidal (generally in their twenties) but later, after a series of unsuccessful treatments. This raises the question of whether hospital admission or other preventive action does more harm than good by compromising the patient’s quality of life to a personally intolerable level. A therapeutic approach is advocated that focuses less on responding to threats of suicide and more on understanding the distress that lies behind them. Specific evidence-based techniques that have proved effective are dialectical behaviour therapy and mentalisation-based treatment delivered in outpatient settings. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
The value of community member involvement in the admission day process
- Authors:
- PRIOR Graham, HULME Claire
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 28(4), Winter 2007, pp.393- 406.
- Publisher:
- Emerald
The process by which residents are admitted to a therapeutic community is significant in enabling a sense of connection in the community. This paper reports on a study that explored the value added by including residents in the admissions day process of a therapeutic community. Focus groups elicited the perceptions of the key groups involved, the management, residents and rota staff. The study found engagement of new residents was hampered by task-oriented structure. Conversely, lack of structure and clear delineation of staff, residents and their roles meant both new and current residents felt uncomfortable. While those managing the service believed involving residents would be worthwhile, staff had mixed views. Conflict between residents and new arrivals arose as a result of the perceived special treatment received by the new arrivals which could lead to alienation form their peers. Residents had an empathy with new arrivals but felt involvement in the process to be a chore.
Suicides associated with admission to an inpatient therapeutic community
- Authors:
- HEALY Kevin, CHAMBERLAIN Janet
- Journal article citation:
- Therapeutic Communities: the International Journal of Therapeutic Communities, 26(2), Summer 2005, pp.206-224.
- Publisher:
- Emerald
The authors present findings from an audit on suicides associated with intensive inpatient treatment at the Cassel Hospital in Surrey. They identify the characteristics of patients likely to be most at risk of suicide during treatment. Two examples are given to illustrate the interplay between intra-psychic, interpersonal, and institutional factors that ordinarily keep these suicidal dynamic factors that can lessen the psychological containment available from staff for patients struggling with suicidal impulses. Active involvement of staff in the relationships formed in treatment, and attention to individual and institutional dynamics, alongside anticipation of the impact of any gaps in staffing levels are recommended to lessen the likelihood of suicide during treatment.
Admitting offenders with antisocial personality disorder to a medium secure unit: a qualitative examination of multidisciplinary team decision-making
- Author:
- McRAE Leon
- Journal article citation:
- Journal of Forensic Psychiatry and Psychology (The), 24(2), 2013, pp.215-232.
- Publisher:
- Taylor and Francis
This paper reports on the results of a qualitative study funded by the Economic and Social Research Council (ESRC) looking at multidisciplinary team decisions to admit sentenced offenders with antisocial personality disorder to a medium secure unit located in an English Healthcare NHS Trust. It examines admission decision-making from a multidisciplinary perspective explores the interprofessional dynamics and contextual pressures informing those decisions. The primary method of data collection was 12 semi-structured interviews with a convenience sample of various multidisciplinary staff involved in pre-admission assessment and post-assessment decision-making (psychiatrists, nurses, psychologists, and occupational therapists. Data was then coded according to the dialectic of competitive and cooperative goal seeking within groups. The findings suggest that, whilst both forms of goal seeking inform admission decisions, the presence of significant resource pressures will lead to decisional solidarity among the multidisciplinary team. When minor professional disagreements arise, they are resolved by the group leader, the Responsible Clinician, in order to maximise group productivity. It is argued that the discursive-limiting effect of resource pressures on group decision-making may weaken the morale of certain front line staff, if not undermine institutional purpose. (Edited publisher abstract)
Cost-effectiveness of psychotherapy for cluster B personality disorders
- Authors:
- SOETEMAN Djora I., et al
- Journal article citation:
- British Journal of Psychiatry, 196(5), May 2010, pp.396-403.
- Publisher:
- Cambridge University Press
An economic evaluation of three modalities of psychotherapy for patients with cluster B personality disorders is reported. Clinical and economic patient-level data from the SCEPTRE trial was incorporated in a probabilistic decision-analytic model to assess the cost-effectiveness of out-patient, day hospital and in-patient psychotherapy over 5 years in terms of cost per recovered patient-year and cost per quality adjusted life-year (QALY). Analyses were conducted from both societal and payer perspectives. The trial included 241 subjects, aged 18 to 70 years, who were recruited from mental health institutes in the Netherlands from March 2003 to March 2006. In the out-patient strategy individuals were offered up to two sessions per week. In the day hospital strategy individuals were offered psychotherapy combined with sociotherapy and/or non-verbal therapies for 1-5 days per week. The in-patient strategy offered the same but individuals lived in the treatment centres 5-7 days per week. From the societal perspective, the most cost-effective choice switched from out-patient to day hospital psychotherapy at a threshold of 12,274 euro per recovered patient-year; and from day hospital to in-patient psychotherapy at 113,298 euro. In terms of cost per QALY, the optimal strategy changed at 56,325 and 286,493 euro per QALY respectively. From the payer perspective the switch points were 9,895 and 155,797 euro per recovered patient-year, and 43,427 and 561,188 euro per QALY. The authors conclude that out-patient psychotherapy and day hospital psychotherapy are the optimal treatments for patients with cluster B personality disorders in terms of cost per recovered patient-year and cost per QALY.
Mental health: the new law
- Author:
- FENNELL Phil
- Publisher:
- Jordans
- Publication year:
- 2007
- Pagination:
- 646p.
- Place of publication:
- Bristol
The Mental Health Act 2007 is the most significant amendment of mental health legislation since the Mental Health Act 1983, introducing new definition of mental disorder, new criteria for compulsion, radical changes to professional roles under the Act, and new procedures for Supervised Community Treatment. The 2007 Act not only amends the 1983 Act, it also introduces new procedures into the Mental Capacity Act 2005 to authorise deprivation of liberty where necessary in the best interests of someone who lacks mental capacity to consent to in-patient care. The Domestic Violence Crime and Victims Act 2004 is also amended by the 2007 Act to extend the rights of victims of crimes committed by mentally disordered offenders. This book provides a comprehensive, authoritative and practical guide to the changes introduced in the 2007 Act and their implications for service users, carers, psychiatrists, psychologists, social workers, nurses, other mental health professionals, hospital managers, members of Mental Health Review Tribunals, and Independent Mental Health Advocates. The effects of the 2007 Act are placed in the context of the European Convention on Human Rights, and other human rights instruments. The interface between the Mental Health Act 1983 (as amended) and the Mental Capacity Act 2005 is clearly and comprehensively explained.