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BORDERLINE PERSONALITY DISORDER. Known for excessive use of psychiatric servicesCrisis, chaotic, lengthy
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1. STRUCTURED ADMISSIONTO PREVENTCRISIS ADMISSION IN BORDERLINE PERSONALITY DIOSRDER VALSA MANNALI
JOHN PRENTICE
EMMA MACRAE
CAROL SPRATT
NEW CRAIGS HOSPITAL
NHS HIGHLAND
2. BORDERLINE PERSONALITY DISORDER Known for excessive use of psychiatric services
Crisis, chaotic, lengthy & repeated admissions
Benefit of admission doubtful
3. 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
4. Prearranged structured admissions Eclectic therapy
Team effort
Psychosocial management
No medical review
Behavioural contract
Positive reinforcement
Further admission on the merit of previous admission
5. 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.
6. HYPOTHESES Planned, structured admission can prevent crisis admission in BPD
Study outcome will help in identifying prognostic indicators.
7. 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.
8. INCLUSION CRITERIA Both genders
Age between 18-60
DSM-IV diagnosis of BPD
At least one crisis presentation at New Craigs Hospital.
9. 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
10. 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
11. 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.
12. 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
13. OTHERS Informed consent
Ethics
Appropriate statistical analysis
14. 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
15. THANK YOU