STRUCTURED ADMISSION TO PREVENT CRISIS ADMISSION IN BORDERLINE PERSONALITY DIOSRDER

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STRUCTURED ADMISSIONTO PREVENTCRISIS ADMISSION
IN BORDERLINE PERSONALITY DIOSRDER

• VALSA MANNALI
• JOHN PRENTICE
• EMMA MACRAE
• CAROL SPRATT
• NEW CRAIGS HOSPITAL
• NHS HIGHLAND

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BORDERLINE PERSONALITY DISORDER

• Known for excessive use of psychiatric services
• Crisis, chaotic, lengthy repeated admissions
• Benefit of admission doubtful

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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

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Prearranged structured admissions

• Eclectic therapy
• Team effort
• Psychosocial management
• No medical review
• Behavioural contract
• Positive reinforcement
• Further admission on the merit of previous
  admission

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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.

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HYPOTHESES

• Planned, structured admission can prevent crisis
  admission in BPD
• Study outcome will help in identifying prognostic
  indicators.

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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.

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INCLUSION CRITERIA

• Both genders
• Age between 18-60
• DSM-IV diagnosis of BPD
• At least one crisis presentation at New Craigs
  Hospital.

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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

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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

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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.

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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

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OTHERS

• Informed consent
• Ethics
• Appropriate statistical analysis

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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

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THANK YOU