structured admission to prevent crisis admission in borderline personality diosrder n.
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STRUCTURED ADMISSION TO PREVENT CRISIS ADMISSION IN BORDERLINE PERSONALITY DIOSRDER . VALSA MANNALI JOHN PRENTICE EMMA MACRAE CAROL SPRATT NEW CRAIGS HOSPITAL NHS HIGHLAND. BORDERLINE PERSONALITY DISORDER. Known for excessive use of psychiatric services

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STRUCTURED ADMISSION TO PREVENT CRISIS ADMISSION IN BORDERLINE PERSONALITY DIOSRDER


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structured admission to prevent crisis admission in borderline personality diosrder
STRUCTURED ADMISSIONTO PREVENTCRISIS ADMISSION IN BORDERLINE PERSONALITY DIOSRDER

VALSA MANNALI

JOHN PRENTICE

EMMA MACRAE

CAROL SPRATT

NEW CRAIGS HOSPITAL

NHS HIGHLAND

borderline personality disorder
BORDERLINE PERSONALITY DISORDER
  • Known for excessive use of psychiatric services
  • Crisis, chaotic, lengthy & repeated admissions
  • Benefit of admission doubtful
inverness experience
INVERNESS EXPERIENCE

Crisis admission pattern

  • Suicidal/ parasuicidal
  • Crisis – A & E, police, Day centre
  • Const. obs.- trying to leave
  • MHA assessment - detention
  • Copy cat agitation
  • Chaotic - closed wards
  • Discharge problem - revolving door
prearranged structured admissions
Prearranged structured admissions
  • Eclectic therapy
  • Team effort
  • Psychosocial management
  • No medical review
  • Behavioural contract
  • Positive reinforcement
  • Further admission on the merit of previous admission
slide5
AIMS

To explore the possibility of undertaking and implementing planned, structured admissions to prevent chaotic, crisis and repeated admissions in BPD.

To demarcate possible prognostic indicators.

hypotheses
HYPOTHESES

Planned, structured admission can prevent crisis admission in BPD

Study outcome will help in identifying prognostic indicators.

cohort
COHORT

Subjects of the study will be recruited from OP/IP at New Craigs Hospital over a span of 12- 18 months.

Consecutive BPD patients who present in crisis will be assessed for suitability for the study.

inclusion criteria
INCLUSION CRITERIA

Both genders

Age between 18-60

DSM-IV diagnosis of BPD

At least one crisis presentation at New Craigs Hospital.

exclusion crtiteria
EXCLUSION CRTITERIA

Axis I diagnosis

Organic brain syndrome

Psychotic dis

Factitious dis.

Primary diagnosis of alcohol/drug use

Axis II diagnosis

Learning disability

Antisocial personality dis.

Axis III diagnosis

Epilepsy

Inability to understand English

control group
CONTROL GROUP

Age-matched controls with DSM IV diagnosis of BPD

Exclusion criteria

Organic brain syndrome

Epilepsy

Psychotic disorder

Factitious disorder

Learning disability

Antisocial personality disorder

Primary diagnosis of alcohol/drug abuse

Inability to understand English

clinical assessment
CLINICAL ASSESSMENT

Detailed history

Physical examination

Investigations, drug screen

DSM IV criteria for BPD

Rating scales for BPD Sx at the start, and at the end of 1 yr

Depression rating scale at recruitment.

structured admissions
STRUCTURED ADMISSIONS

MDT assessment of needs & agenda

Behavioural contract- defining “borders”

Depending on needs, 2-4 admissions/year

Admission for 5 days

No medication review

Psychosocial management with CBT overlay

General strategies

Tailor made for the patient

Other interventions

Occupational therapy

Physiotherapy

Dietetics

others
OTHERS

Informed consent

Ethics

Appropriate statistical analysis

expectations from outcome
EXPECTATIONS FROM OUTCOME

Benefit in planning services for BPD population

Off shoot questions to be addressed in future research

Eg: Childhood precursors

Cluster of personality traits &

gender difference