scholarly journals Iatrogenic Complications of Compulsory Treatment in a Patient Presenting with an Emotionally Unstable Personality Disorder and Self-Harm

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Charlotte Burrin ◽  
Natasha Faye Daniels ◽  
Rudolf N. Cardinal ◽  
Catherine Hayhurst ◽  
David Christmas ◽  
...  
Keyword(s):  
Emergency Department ◽  
Suicidal Ideation ◽  
Personality Disorder ◽  
Ethical Dilemma ◽  
Attempted Suicide ◽  
Compulsory Treatment ◽  
Multiple Factors ◽  
Iatrogenic Complications ◽  
Self Harm ◽  
Emotionally Unstable Personality Disorder

Attempted suicide and deliberate self-harm are common and challenging presentations in the emergency department. A proportion of these patients refuse interventions and this presents the clinical, legal, and ethical dilemma as to whether treatment should be provided against their will. Multiple factors influence this decision. It is difficult to foresee the multitude and magnitude of complications that can arise once it has been decided to treat individuals who do not consent. This case illustrates a particularly complex chain of events that occurred after treating someone against their will who presented with self-harm and suicidal ideation. These consequences are contrasted with those of not intervening when similar situations arose with the same patient.

scholarly journals Patients with first versus multiple episodes of self-harm: how do their profiles differ?

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Philippe Golay ◽  
Louise Ostertag ◽  
Alessandra Costanza ◽  
Bénédicte Van der Vaeren ◽  
Yves Dorogi ◽  
...  
Keyword(s):  
Emergency Department ◽  
Personality Disorder ◽  
Suicide Attempt ◽  
Professional Activity ◽  
Suicidal Risk ◽  
Factors Influencing ◽  
Several Variables ◽  
French Speaking ◽  
Self Harm ◽  
Multiple Episodes

Abstract Background Self-harm (SH) is among the strongest predictors of further episodes of SH, suicide attempt, and death by suicide. People who repeteadly harm themselves are at even higher risk for suicide. Factors influencing the repetition are important to identify when assessing suicidal risk and thereafter to offer specific interventions. Therefore, this study aimed to compare first versus multiple episodes characteristics in a large sample of patients in french-speaking Switzerland. Method We used the database from the French-speaking Swiss program for monitoring SH. Data of the psychiatric assessment of all adults admitted for SH were collected in the emergency department of four Swiss city hospitals between December 2016 and October 2019. Results 1730 episodes of SH were included. Several variables were significantly associated with multiple episodes, including diagnosis (over representation of personality disorders and under representation of anxiety disorders), professional activity (Invalidity insurance more frequent) and prior psychiatry care. Conclusions Patients suffering from a personality disorder and those with invalidity insurance are at risk for multiple episodes of SH and should be targeted with specific interventions.

scholarly journals Off-licence use of clozapine in patients with emotionally unstable personality disorder: a case series analysis

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S116-S116
Author(s):  
Declan Hyland ◽  
Alex Walmsley ◽  
Victoria Simpson
Keyword(s):  
Side Effects ◽  
Personality Disorder ◽  
Suicide Attempts ◽  
Symptom Control ◽  
Case Series ◽  
Community Support ◽  
Retrospective Case ◽  
Psychotherapeutic Treatment ◽  
Self Harm ◽  
Emotionally Unstable Personality Disorder

ObjectiveThis retrospective case series followed emotionally unstable personality disorder (EUPD) patients following initiation of clozapine on an off-licence basis, aiming to examine tolerance by determining side effect prevalence and treatment cessation frequency, as well as examining efficacy, by investigating number of hospital re-admissions and symptom control.Case reportThis case series captured the experiences of 11 EUPD patients under the care of Mersey Care NHS Foundation Trust, all of whom had, at some time in the past five years, been initiated on clozapine. All patients were white British females, with a median age of 31. The median daily dose of clozapine was 300 mg. Most patients had significant psychiatric comorbidities, as well as illicit substance and / or alcohol misuse.Whilst prescribed clozapine, patients were only admitted to hospital once on average and this was commonly for clozapine re-titration. Whilst in hospital, rates of self-harm were low, but ligaturing and suicide attempts showed higher prevalence. Patients still demonstrated self-harming behaviour out of hospital leading to A and E presentations. In the community, contacts with the police were minimal, with only two patients undergoing Section 136 assessments or arrests.All patients reported side effects from clozapine - usually hypersalivation, over-sedation and constipation. All 11 patients experienced sinus tachycardia. Eight patients temporarily ceased taking clozapine at some point. In three patients, discontinuation of clozapine was as a result of intolerable side effects. Three patients experienced neutropenia, which subsequently resolved. Only two patients had a body mass index within healthy range.DiscussionDespite patients reporting clozapine to provide symptomatic benefit for their EUPD, and improved their engagement with mental health services, prevalence of self-harm and of A and E presentations remained high, indicating the importance of community support and concomitant psychotherapeutic treatment. Patients with more robust community support showed greater adherence to clozapine.High prevalence of side effects and obesity in these patients, in addition to risk of developing neutropenia, highlights the importance of rigorous monitoring after initiating clozapine. It is reassuring that, despite development of neutropenia in some patients, this recovered quickly, and clozapine treatment could resume.ConclusionClozapine may be an effective pharmacological treatment for enabling EUPD patients to engage more therapeutically with services. Clozapine may be of greater benefit to those with more stable, less chaotic lives. Although diminished, patients still show self-harming behaviour and need for A and E admissions and re-hospitalisation. Side effects of clozapine are common and regular monitoring is required.

scholarly journals 485: ATTEMPTED SUICIDE, SUICIDAL IDEATION, AND SELF-HARM IN PEDIATRIC PATIENTS WITH GENDER DYSPHORIA

2021 ◽  
Vol 50 (1) ◽  
pp. 233-233
Author(s):  
Hannah Mitchell ◽  
Danielle Apple ◽  
Elle Lett ◽  
Nadia Dowshen ◽  
Nadir Yehya
Keyword(s):  
Suicidal Ideation ◽  
Gender Dysphoria ◽  
Attempted Suicide ◽  
Pediatric Patients ◽  
Self Harm

scholarly journals Effects of ketamine treatment on suicidal ideation: a qualitative study of patients’ accounts following treatment for depression in a UK ketamine clinic

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e029108 ◽  
Author(s):  
Karen Lascelles ◽  
Lisa Marzano ◽  
Fiona Brand ◽  
Hayley Trueman ◽  
Rupert McShane ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Qualitative Study ◽  
Structured Interviews ◽  
History Of ◽  
Bipolar Type ◽  
Self Harm ◽  
And Function ◽  
Emotionally Unstable Personality Disorder ◽  
The Impact

ObjectiveIt is recognised that ketamine treatment can reduce suicidal ideation (SI) in people with depression, at least in the short term. However, information is lacking on patients’ perspectives on such effects. Studying these can contribute to greater understanding of the mechanisms underlying impact of ketamine treatment on SI. The aim of this study was to investigate patients’ reports of the impact of treatment on their SI, the duration of effects and possible mechanisms.Design and settingThis qualitative study consisted of semi-structured interviews with patients who had received ketamine treatment for depression. Interview data were analysed thematically.ParticipantsFourteen patients (8 females, 6 males, aged 24–64 years) who had received treatment with ketamine for treatment-resistant depression, and had SI at the initiation of treatment. Two participants also had a diagnosis of bipolar type 1 and two of emotionally unstable personality disorder. Eight had a history of self-harm.ResultsSI reduced following ketamine treatment in 12 out of 14 participants for periods of a few hours following a single treatment to up to three years with ongoing treatment. Reduction of SI was variable in terms of extent and duration, and re-emergence of suicidal thoughts often occurred when treatment ceased. Participants’ accounts indicated that reduced SI was associated with improved mood and reduced anxiety, as were clarity of thought, focus and concentration, and ability to function. Participants reported experiencing some or all of these effects in various orders of occurrence.ConclusionGenerally, ketamine treatment was experienced as effective in reducing SI, although duration of effects varied considerably. Patients’ perspectives indicated similarities in the mechanisms of reduction in SI, but some differences in their manifestation, particularly in relation to chronology. Experiences of this cohort suggest that reduced anxiety and improvement in ability to think and function were important mechanisms alongside, or in some cases independently of, improvement in mood. Further studies of patients’ experiences are required to gain enhanced understanding of the variability of effects of ketamine on SI and functionality.

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