scholarly journals Mental health presentations to acute psychiatric services: 3-year study of prevalence and readmission risk for personality disorders compared with psychotic, affective, substance or other disorders

BJPsych Open ◽  
2018 ◽  
Vol 5 (1) ◽  
Author(s):  
Kate L. Lewis ◽  
Mahnaz Fanaian ◽  
Beth Kotze ◽  
Brin F. S. Grenyer
Keyword(s):  
Mental Health ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Affective Disorders ◽  
Psychotic Disorders ◽  
Cox Regression ◽  
Mixed Effects ◽  
Naturalistic Study ◽  
Hospital Patients ◽  
Readmission Risk

BackgroundThe relative burden and risk of readmission for people with personality disorders in hospital settings is unknown.AimsTo compare hospital use of people with personality disorder with that of people with other mental health diagnoses, such as psychoses and affective disorders.MethodNaturalistic study of hospital presentations for mental health in a large community catchment. Mixed-effects Cox regression and survival curves were generated to examine risk of readmission for each group.ResultsOf 2894 people presenting to hospital, patients with personality disorder represented 20.5% of emergency and 26.6% of in-patients. Patients with personality disorder or psychoses were 2.3 times (95% CI 1.79–2.99) more likely than others to re-present within 28 days. Personality disorder diagnosis increases rate of readmission by a factor of 8.7 (s.e. = 0.31), marginally lower than psychotic disorders (10.02, s.e. = 0.31).ConclusionsPersonality disorders place significant demands on in-patient and emergency departments, similar to that of psychoses in terms of presentation and risk of readmission.Declaration of interestNone.

Mental health in paris: The homeless issue

2011 ◽  
Vol 26 (S2) ◽  
pp. 2119-2119
Author(s):  
F. Petitjean
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Severe Mental Illness ◽  
Personality Disorders ◽  
Affective Disorders ◽  
Psychotic Disorders ◽  
Homeless Population ◽  
Psychoactive Substances ◽  
The City

The Paris population covered, in 2007 2.181.000 inhabitants. This covers the city itself. When adding the surrounding towns, the total figure reaches 6.507.000, more than half the total Ile de France region.A recent study (LAPORTE, 2010) gives an estimate of 21.000 persons being homeless in the Paris megapole. A third of these individuals suffer from severe mental illness, with a prevalence of 13, 2% for psychotic disorders, 6,7% for affective disorders, 12,2% for anxiety and 21% for personality disorders.Psychoactive substances are to of concern for 29% of the homeless population.The author will present data from a two consecutive studies carried out in the Paris megapole concerning the homeless population. (KOVESS, 2001; LAPORTE, 2010).The author will present data from a two consecutive studies carried out in the Paris megapole concerning the homeless population. (KOVESS, 2001; LAPORTE, 2010).

scholarly journals Specialist personality disorder services in England: a case for managed clinical networks?

2005 ◽  
Vol 29 (10) ◽  
pp. 365-368 ◽  
Author(s):  
Kingsley Norton ◽  
Julian Lousada ◽  
Kevin Healy
Keyword(s):  
Mental Health ◽  
National Health Service ◽  
Personality Disorder ◽  
Health Service ◽  
Personality Disorders ◽  
National Health ◽  
Clinical Networks ◽  
Department Of Health ◽  
Specialist Services

Following the publication by the National Institute for Mental Health in England (NIMHE) of Personality Disorder: No Longer A Diagnosis of Exclusion (National Institute for Mental Health in England, 2003), it is perhaps surprising that so soon after there have been threats to the survival of some of the small number of existing specialist personality disorder services to which it refers. Indeed, one of the few in-patient units specialising in such disorders (Webb House in Crewe) closed in July 2004. Such closures or threats argue for closer collaboration in planning between the relevant secondary and tertiary services and also between the Department of Health, the NIMHE and local National Health Service commissioners. Not safeguarding existing tertiary specialist services, at a time of increasing awareness of the needs of patients with personality disorders, may be short-sighted.

scholarly journals Experience of Occupations among People Living with a Personality Disorder

2019 ◽  
Vol 2019 ◽  
pp. 1-11
Author(s):  
Olivier Potvin ◽  
Catherine Vallée ◽  
Nadine Larivière
Keyword(s):  
Mental Health ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Exploratory Study ◽  
Life Experiences ◽  
Occupational Therapists ◽  
Sense Of Control ◽  
Semistructured Interview ◽  
Occupational Engagement ◽  
Interview Guide

Introduction. Personality disorders are common mental health disorders, with an estimated lifetime prevalence of 4 to 15%. People living with personality disorders are extensively seeking mental health services, yet few papers focus on their unique occupational needs or effective rehabilitation interventions that may alleviate the occupational issues they face. Occupational therapists are encouraged to support engagement in socially valued occupations, while preventing engagement in damaging ones, despite a lack of evidence on the meaning and the lived experiences of people. Objectives. This paper describes the meaning attributed by people living with personality disorders to their main occupations and the underlying needs they strive to fulfill through occupational engagement, whether or not these occupations are sanctioned. Methods. This exploratory study rests on a descriptive interpretative methodology. The participants were ten men and women, aged between 18 and 35 years old and living with a Cluster B personality disorder. A semistructured interview guide allowed participants to build narratives on occupations that are important to them and discuss how these occupations shape their identity. A thematic content analysis fostered the development of a coding structure that reflected a first-account perspective. Results. The narratives provided by the participants depict a variety of meaningful occupations, many of which are socially disapproved. Many of these occupations serve as a coping strategy to deal with distressing situations, to connect with others who share similar life experiences, or to reestablish a fragile sense of control. Other occupations are socially disapproved due to the overinvestment of the participants’ commitment. While participants described how this overinvestment allowed them to control destructive impulses, significant others perceived it as counterproductive and unnecessary. Participants perceived self-care occupations as painful and tedious chores or meaningless occupations. Engaging in productive occupations allowed some participants to gain recognition or to identify their competencies, but also confirmed their differences, creating some form of alienation or marginalisation. Conclusion. This exploratory study invites clinicians and researchers to develop a more responsive understanding of occupational engagement for this population. The results highlight the importance of situating occupations in their context, while endorsing a first-account perspective, to better understand the forces that shape occupational engagement. Ultimately, occupational therapists should critically appraise their assumptions around healthy and unsanctioned occupations, in order to respond with sensitivity to the needs and experience of their clients, without perpetuating the marginalisation and discrimination they face.

scholarly journals Parenting and personality disorder: clinical and child protection implications

2015 ◽  
Vol 21 (1) ◽  
pp. 15-22 ◽  
Author(s):  
Gwen Adshead
Keyword(s):  
Mental Health ◽  
Personality Disorder ◽  
Child Development ◽  
Personality Disorders ◽  
Child Protection ◽  
Psychiatric Morbidity ◽  
Healthcare Providers ◽  
Mental Healthcare ◽  
Parental Mental Health ◽  
Psychological Burden

SummaryI review some of the evidence that parental personality disorder represents a risk to child development, in terms of both transmission of genetic vulnerability and the environmental stress of living with a parent who has a personality disorder that negatively affects their parenting capacities. I argue that there are two compelling reasons to impose a duty on mental healthcare providers to offer services for adults with personality disorders that specifically focus on their parenting identity: first, because effective therapies for personality disorder are now available; and second, because there is a strong utilitarian and economic argument for improving parental mental health so as to reduce the economic and psychological burden of their offsprings' future psychiatric morbidity.

scholarly journals Lessons from an Australian community dialectical behaviour therapy programme for borderline personality disorder

2008 ◽  
Vol 5 (1) ◽  
pp. 15-16
Author(s):  
Catherine Thompson
Keyword(s):  
Mental Health ◽  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Personality Disorders ◽  
Evidence Base ◽  
Borderline Personality ◽  
Behaviour Therapy ◽  
Dialectical Behaviour Therapy ◽  
Australian Community ◽  
The Uk

In 2003, the National Institute for Mental Health in England (NIMHE) published guidelines for the development of services for people with personality disorders (NIMHE, 2003), prompting community mental health teams (CMHTs) to reassess their service provision for this patient group. The guidelines did not recommend any particular treatment approach, but CMHTs were encouraged to develop specialist programmes. For many CMHTs the focus has been on borderline personality disorder, as it is one of the most prevalent personality disorders seen in adult mental health services and has high costs for both the patient and the service (Moran, 2002). The evidence base for which treatment may be most effective within the community remains small, however, and this has left many CMHTs unclear regarding a suitable programme. Here I will outline a CMHT-based dialectical behaviour therapy (DBT) programme operating in Western Australia and reflect on why I feel it is an option that CMHTs in the UK looking to develop their service should consider.

scholarly journals Professional training and case-load mix within a community mental health team

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S226-S226
Author(s):  
Richard Walsh ◽  
Rebecca Fahy ◽  
Ala Abdelgadir ◽  
Elizabeth Walsh ◽  
Sonn Patel
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Personality Disorders ◽  
Professional Training ◽  
Psychotic Disorders ◽  
Case Mix ◽  
Cross Sectional ◽  
Team Members ◽  
Case Load ◽  
The Past

AimsCommunity Mental Health Teams (CMHTS) are now the cornerstone of modern mental health care and play a central role in assessment, diagnosis and care coordination. CMHTs vary widely in their service provision and composition. Within teams there is latitude for variation of professional roles but the extent to which different disciplines undertake generic and profession-specific work is poorly defined. This cross-sectional study aims to establish how professional training influences the distribution of case-load mix within a general adult CMHTMethodThe GR1 CMHT provides care to a mixed urban/rural population of 25,000 in Galway city and Connemara. A review was conducted of multi-disciplinary case notes for all patients actively registered with the team for a period of one year. Name, age, gender, whether referred or admitted in the past year, medication and day hospital attendance were recorded. Clinical diagnoses were recorded but, where missing, verified with a relevant team member. The team consultant reviewed and verified the 1CD-10 primary clinical diagnosis for all patients. Evidence of clinical input by multidisciplinary team members was recorded from clinical files with the final electronic database being checked by each professional for accuracy. We examined any input over the past year rather thanfrequency of input. Patient characteristics and diagnosis by professional discipline were examined using descriptive statistics.ResultOf a total of 246 patients registered to the team, 37.8% (N = 93) saw one, 34.6% (N = 85) saw two and 24.4% (N = 60) saw 3 or more team members. Of those who saw three or more team members, psychotic disorders represented the majority diagnoses (40%, N = 24) followed by personality disorders (25%, N = 15) and affective disorders (15%, N = 9). Patients were most commonly seen by a doctor (91.5%, N = 225) followed by community mental health nurses (CMHNs) (52.8%, N = 130). Doctors saw 85% or more of all patients grouped by ICD-10 diagnoses. The majority of social work and occupational therapy case-mix comprised psychotic disorders (SW = 44.2%, OT = 34.2%) followed by personality disorders (SW = 25.6%, OT = 23.7%). Of psychology case-mix, the highest was personalitydisorders at 41.6% (N = 13) followed by anxiety and related disorders at 25% (N = 8). CMHN case-mix was highest for psychotic disorders at 44.6% (N = 58) followed by 21.5% mood disorders (N = 28).ConclusionThis cross sectional survey informs how we currently target our specialist resources. We will now develop this to include frequency of contact to inform resource allocation and skill mix.

scholarly journals Factors in psychiatric admissions: before and during the COVID-19 pandemic

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S40-S40
Author(s):  
Robyn McCarron ◽  
Peter Swann ◽  
Fiona Thompson ◽  
Graham Murray
Keyword(s):  
Mental Health ◽  
Affective Disorders ◽  
Psychotic Disorders ◽  
The Elderly ◽  
Community Treatment ◽  
Mixed Methods Design ◽  
Retrospective Case ◽  
Social Stressors ◽  
Psychiatric Admissions ◽  
Case Note Review

AimsThe COVID-19 pandemic has impacted community mental health, but the effect on psychiatric admissions is unknown. We investigated factors contributing to acute psychiatric admissions, and whether this changed during the first UK lockdown.MethodA retrospective case-note review study with an exploratory mixed-methods design was used to examine factors in psychiatric admissions following the first UK 2020 lockdown compared to the same time periods in 2019 and 2018.ResultThemes of psychopathology, risk, social stressors, community treatment issues, and physical health concerns were generated. The mean number of codes per case was 6⋅19 (s.d. = 2⋅43), with a mean number of categories per case of 3⋅73, (s.d. = 0⋅98). Changes in routines and isolation were common factors in the study year; accommodation and substance abuse were more prominent in the control year. Relationship stressors featured strongly in both groups. There were significantly more women (χ2(1, N = 98) = 20⋅80, p < 0⋅00001) and older adults (χ2(1, N = 98) = 8⋅61, p = 0⋅0033) in the study group than the control. Single people, compared to those in a relationship (χ2(1, N = 45) = 4.46, p = 0⋅035), and people with affective disorders compared to psychotic disorders ((χ2(1, N = 28) = 5.19, p = 0⋅023), were more likely to have a COVID-19 related admission factor.ConclusionThe COVID-19 pandemic amplified pre-existing psychosocial vulnerabilities with a disproportionate psychiatric admissions impact on the mental health of women, the elderly and those with affective disorders.

scholarly journals Assessment of personality disorder

2009 ◽  
Vol 15 (5) ◽  
pp. 389-397 ◽  
Author(s):  
Penny J. M. Banerjee ◽  
Simon Gibbon ◽  
Nick Huband
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Personality Disorder ◽  
Mental Health Services ◽  
Health Services ◽  
Severe Mental Illness ◽  
Personality Disorders ◽  
Assessment Instruments ◽  
Department Of Health

SummaryIn 2003 the Department of Health, in conjunction with the National Institute for Mental Health in England, outlined the government's plan for the provision of mental health services for people with a diagnosis of personality disorder. This emphasised the need for practitioners to have skills in identifying, assessing and treating these disorders. It is important that personality disorders are properly assessed as they are common conditions that have a significant impact on an individual's functioning in all areas of life. Individuals with personality disorder are more vulnerable to other psychiatric disorders, and personality disorders can complicate recovery from severe mental illness. This article reviews the classification of personality disorder and some common assessment instruments. It also offers a structure for the assessment of personality disorder.

A study on mental health in elder long term unemployed persons

2011 ◽  
Vol 26 (S2) ◽  
pp. 557-557 ◽  
Author(s):  
B. Meiler ◽  
C. Steil ◽  
I. Wiesten ◽  
J. Wiltfang ◽  
B. Kis
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Personality Disorders ◽  
Psychotic Disorders ◽  
Psychiatric Examination ◽  
Clinical Interviews ◽  
High Incidence ◽  
Icd 10 ◽  
And Gender

IntroductionThere are complex associations between work and mental health. Self-efficacy, experience of own abilities and appropriate challenges are important prerequisites of mental health. Availability of these factors is specifically decreased in the elder long term unemployed and results in higher vulnerability for mental impairment.ObjectivesInvestigation on mental health of elder long term unemployed personsAimsTo examine incidence of mental disorders in elder long term unemployed personsMethodsSenior long term unemployed participants in a vocational reintegration program were examined. Clients were allocated by choice to the study by their placement officers. An extensive psychiatric examination including structured clinical interviews (SKID) and clinical and personality questionnaires (BDI, STAI, MSWS, SCL 90-R, SF36, AUDIT, FTNA) was performed with each subject.Results90 subjects were included into the study so far and 42 completed the psychiatric examination. The mean age was 54.7 years and gender ratio was balanced. 94% were diagnosed with a psychiatric disorder and 80% were diagnosed with more than one disorder according to ICD-10. In particular, 78.6% of the subjects had depression, 40.5% anxiety disorders, 35.7% combined personality disorders, 26.2% posttraumatic disorders, 21.4% addiction disorders, 16.7% single personality disorders and 7.1% psychotic disorders.ConclusionA large proportion of the long term unemployed persons examined is affected by mental disorders. Along with the high incidence of depressive, anxiety and addiction disorders there was a considerable number of personality and specifically trauma-related disorders. Accordingly, personality disorders may be a risk factor for unemployment in elder people too.

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