scholarly journals Clinical characteristics and care pathways of patients with personality disorder who died by suicide

BJPsych Open ◽  
2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Sandra Flynn ◽  
Jane Graney ◽  
Thabiso Nyathi ◽  
Jessica Raphael ◽  
Seri Abraham ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Clinical Care ◽  
Case Series ◽  
Drug Misuse ◽  
Care Pathways ◽  
Short Term ◽  
Psychological Therapies ◽  
Patient Admissions ◽  
History Of ◽  
The Uk

Background It is estimated that 1 in 10 people have a personality disorder. People with emotionally unstable personality disorder are at high risk of suicide. Despite being frequent users of mental health services, there is often no clear pathway for patients to access effective treatments. Aims To describe the characteristics of patients with personality disorder who died by suicide, examine clinical care pathways and explore whether the care adhered to National Institute for Health and Care Excellence guidance. Method National consecutive case series (1 January 2013 to 31 December 2013). The study examined the health records and serious incident reports of patients with personality disorder who died by suicide in the UK. Results The majority had a diagnosis of borderline/emotionally unstable or antisocial personality disorder. A high proportion of patients had a history of self-harm (n = 146, 95%) and alcohol (n = 101, 66%) or drug misuse (n = 79, 52%). We found an extensive pattern of service contact in the year before death, with no clear pathway for patients. Care was inconsistent and there were gaps in service provision. In 99 (70%) of the 141 patients with data, the last episode of care followed a crisis. Access to specialised psychological therapies was limited; short-term in-patient admissions was adhered to; however, guidance on short-term prescribing for comorbid conditions was not followed for two-thirds of patients. Conclusions Continuity and stability of care is required to prevent, rather than respond to individuals in crisis. A comprehensive audit of services for people with personality disorder across the UK is recommended to assess the quality of care provided.

Adolescent Psychiatry Services

1995 ◽  
Vol 166 (3) ◽  
pp. 306-310 ◽  
Author(s):  
Tony Jaffa
Keyword(s):  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Adolescent Psychiatry ◽  
Clinical Care ◽  
Psychiatric Services ◽  
High Quality ◽  
History Of ◽  
The Uk ◽  
The Way

BackgroundThe way in which psychiatric services for adolescents in the UK are developing will be affected by recent changes in the organisation of the National Health Service.MethodThe history of these services, and the different opportunities for development are reviewed.ResultsWays in which high-quality clinical care can still be provided are indicated.ConclusionAdolescent psychiatric services should be judged on their ability to provide such care, not merely on their ability to survive.

scholarly journals Sympathetic Ophthalmia Two Weeks After 23-Gauge Vitrectomy

2020 ◽  
Author(s):  
Bahaeddin El Khatib ◽  
Alexander Hacopian ◽  
Menka S. Patel ◽  
Monica Dalal ◽  
H. Nida Sen ◽  
...  
Keyword(s):  
Rare Disease ◽  
Pars Plana Vitrectomy ◽  
Silicone Oil ◽  
Case Series ◽  
Sympathetic Ophthalmia ◽  
Ocular Injury ◽  
History Of ◽  
Pars Plana ◽  
23 Gauge ◽  
The Uk

Abstract Sympathetic Ophthalmia (SO) is a rare disease that presents as a bilateral, diffuse, granulomatous panuveitis. Sympathetic Ophthalmia is a clinical diagnosis with history of penetrating ocular injury in the inciting eye and presence of panuveitis in the sympathizing eye. Though early enucleation is believed to minimize the risk, there have been reports of SO even after enucleation of inciting eyes. The possible association between vitrectomy and SO has been initially proposed by Gass [9] and later studied extensively in a large cohort in the UK with an estimated SO risk of 1 in 799 vitrectomies [11]. There have been several case series and reports of SO following vitrectomy, however only three documented cases of SO following vitrectomy without use of silicone oil. These cases demonstrated an onset of SO ranging between 4 weeks to 2 months. We present a patient with SO in the sympathizing eye presenting 16 days after an uncomplicated 23-gauge (23G) sutureless pars plana vitrectomy (PPV) without the use of silicone oil.

scholarly journals Enhancing the Impact of Genomics Research in Autism through Integration of Research Results into Routine Care Pathways—A Case Series

2021 ◽  
Vol 11 (8) ◽  
pp. 755
Author(s):  
Iskra Peltekova ◽  
Daniela Buhas ◽  
Lara Stern ◽  
Emily Kirby ◽  
Afiqah Yusuf ◽  
...  
Keyword(s):  
Clinical Care ◽  
Genetic Research ◽  
Case Series ◽  
Routine Care ◽  
Autism Spectrum ◽  
Care Pathways ◽  
Research Results ◽  
Individualized Care ◽  
The Impact ◽  
Genetic Results

The return of genetic results (RoR) to participants, enrolled as children, in autism research remains a complex process. Existing recommendations offer limited guidance on the use of genetic research results for clinical care. We highlight current challenges with RoR and illustrate how the use of a guiding framework drawn from existing literature facilitates RoR and the clinical integration of genetic research results. We report a case series (n = 16) involving the return of genetic results to participants in large genomics studies in Autism Spectrum Disorders (ASD). We outline the framework that guided RoR and facilitated integration into clinical care pathways. We highlight specific cases to illustrate challenges that were, or could have been, resolved through this framework. The case series demonstrates the ethical, clinical and practical difficulties of RoR in ASD genomic studies for participants enrolled as children. Challenges were resolved using pre-established framework to guide RoR and incorporate research genetic results into clinical care. We suggest that optimal use of genetic research results relies on their integration into individualized care pathways for participants. We offer a framework that attempts to bridge the gap between research and healthcare in ASD.

scholarly journals Children and young people who die by suicide: childhood-related antecedents, gender differences and service contact

BJPsych Open ◽  
2020 ◽  
Vol 6 (3) ◽  
Author(s):  
Cathryn Rodway ◽  
Su-Gwan Tham ◽  
Saied Ibrahim ◽  
Pauline Turnbull ◽  
Nav Kapur ◽  
...  
Keyword(s):  
Young People ◽  
Case Series ◽  
Third Sector ◽  
Drug Misuse ◽  
Mortality Data ◽  
Suicide Rates ◽  
National Mortality ◽  
Self Harm ◽  
The Uk ◽  
Witnessing Domestic Violence

Background Worldwide suicide is commonest in young people and in many countries, including the UK, suicide rates in young people are rising. Aims To investigate the stresses young people face before they take their lives, their contact with services that could be preventative and whether these differ in girls and boys. Method We identified a 3-year UK national consecutive case series of deaths by suicide in people aged 10–19, based on national mortality data. We extracted information on the antecedents of suicide from official investigations, primarily inquests. Results Between 2014 and 2016, there were 595 suicides by young people, almost 200 per year; 71% were male (n = 425). Suicide rates increased from the mid-teens, most deaths occurred in those aged 17–19 (443, 74%). We obtained data about the antecedents of suicide for 544 (91%). A number of previous and recent stresses were reported including witnessing domestic violence, bullying, self-harm, bereavement (including by suicide) and academic pressures. These experiences were generally more common in girls than boys, whereas drug misuse (odds ratio (OR) = 0.54, 95% CI 0.35–0.83, P = 0.006) and workplace problems (OR 0.52, 95% CI 0.28–0.96, P = 0.04) were less common in girls. A total of 329 (60%) had been in contact with specialist children's services, and this was more common in girls (OR 1.86, 95% CI 1.19–2.94, P = 0.007). Conclusions There are several antecedents to suicide in young people, particularly girls, which are important in a multiagency approach to prevention incorporating education, social care, health services and the third sector. Some of these may also have contributed to the recent rise.

scholarly journals Ethical perspectives on suicide and suicide prevention

2011 ◽  
Vol 17 (3) ◽  
pp. 214-219 ◽  
Author(s):  
Chris Kelly ◽  
Eric Dale
Keyword(s):  
Mental Illness ◽  
Suicide Attempt ◽  
Suicide Prevention ◽  
Legal Practice ◽  
Short Term ◽  
Cry For Help ◽  
History Of ◽  
The Individual ◽  
The Uk ◽  
Ethical Perspectives

SummaryPhilosophy both influences and is influenced by clinical and legal practice relating to suicide. This article begins with a brief history of attitudes in the UK and Europe towards those who attempt suicide. It describes the main philosophical positions regarding suicide, including the principle of respect for life, the utilitarian position, the theological principle, and the principles of autonomy and duty to others. It concludes that short-term interventions are justified in most cases, for example when the suicide attempt is a ‘cry for help’ and/or the individual is ambivalent in their attempt or likely to have a mental illness.

scholarly journals How can transference-focused psychotherapy (TFP) help general psychiatrists working with patients with borderline personality disorder?

2019 ◽  
Vol 25 (4) ◽  
pp. 237-239
Author(s):  
William Burbridge-James
Keyword(s):  
Borderline Personality Disorder ◽  
Personality Disorder ◽  
Advisory Committee ◽  
Clinical Care ◽  
Psychotherapy Training ◽  
Borderline Personality ◽  
The Uk ◽  
Transference Focused Psychotherapy ◽  
Medical Psychotherapy

SUMMARYTransference-focused psychotherapy concepts and techniques have much to offer experienced psychiatrists and psychiatrists in training in their work with patients with borderline personality disorder and, as a consequence, help address the stigmatisation of this group of patients and improve their clinical care.DECLARATION OF INTERESTW.B.-J. is chair of the Specialty Advisory Committee of the Faculty of Medical Psychotherapy, RCPsych, with governance for the content and delivery of the curriculum for psychotherapy training of trainee psychiatrists in the UK.

Prevalence of Jones Fracture Repair and Impact on Short-Term NFL Participation

2017 ◽  
Vol 39 (1) ◽  
pp. 6-10 ◽  
Author(s):  
Leigh-Anne Tu ◽  
Derrick M. Knapik ◽  
Joseph Sheehan ◽  
Michael J. Salata ◽  
James E. Voos
Keyword(s):  
Significant Risk ◽  
Case Series ◽  
Fracture Repair ◽  
American Football ◽  
Return To Play ◽  
Short Term ◽  
Jones Fracture ◽  
Early Return ◽  
History Of ◽  
The Impact

Background: Elite American football athletes are at high risk for Jones fractures. Fixation is recommended to minimize nonunion and allow early return to play. The purpose of this investigation was to evaluate the prevalence of Jones fracture repair in athletes invited to the National Football League (NFL) Combine and the impact of fracture repair on short-term NFL participation compared to athletes with no history of repair. Methods: A total of 1311 athletes participating in the Combine from 2012 to 2015 were evaluated. Athletes with history of Jones fracture repair were identified. Athlete demographic information was collected while physical examination findings were recorded. Radiographs were evaluated to determine fixation type and the presence of nonunion. Future participation in the NFL was evaluated based on draft status, games played, and games started in the athlete’s first season following the Combine. Results: Fixation was performed for 41 Jones fractures in 40 athletes (3.1%). The highest prevalence was in defensive linemen (n = 10 athletes), with the greatest rate in tight ends (5.1%, n = 4 of 79 athletes). Intramedullary screw fixation was used for all fractures. Incomplete bony union was present in 3 (8%) fractures. Athletes with a history of repair were not at significant risk for going undrafted ( P = .61), playing ( P = .23), or starting ( P = .76) fewer NFL games compared to athletes with no history of repair during athletes’ first NFL season. Conclusion: Athletes with a history of Jones fracture repair were not at significant risk of going undrafted or for diminished participation during their first season in the NFL. Level of Evidence: Level IV, case series.

scholarly journals Sympathetic Ophthalmia Two Weeks After 23-Gauge Vitrectomy

2020 ◽  
Author(s):  
Bahaeddin El Khatib ◽  
Menka S. Patel ◽  
Alexander Hacopian ◽  
Monica Dalal ◽  
H. Nida Sen ◽  
...  
Keyword(s):  
Rare Disease ◽  
Pars Plana Vitrectomy ◽  
Silicone Oil ◽  
Case Series ◽  
Sympathetic Ophthalmia ◽  
Ocular Injury ◽  
History Of ◽  
Pars Plana ◽  
23 Gauge ◽  
The Uk

Abstract Sympathetic Ophthalmia (SO) is a rare disease that presents as a bilateral, diffuse, granulomatous panuveitis. Sympathetic Ophthalmia is a clinical diagnosis with history of penetrating ocular injury in the inciting eye and presence of panuveitis in the sympathizing eye. Though early enucleation is believed to minimize the risk, there have been reports of SO even after enucleation of inciting eyes. The possible association between vitrectomy and SO has been initially proposed by Gass [9] and later studied extensively in a large cohort in the UK with an estimated SO risk of 1 in 799 vitrectomies [11]. There have been several case series and reports of SO following vitrectomy, however only three documented cases of SO following vitrectomy without use of silicone oil. These cases demonstrated an onset of SO ranging between 4 weeks to 2 months. We present a patient with SO in the sympathizing eye presenting 16 days after an uncomplicated 23-gauge (23G) sutureless pars plana vitrectomy (PPV) without the use of silicone oil.

Test-Retest Reliability of a Self-Report Questionnaire for DSM-IV and ICD-10 Personality Disorders

2000 ◽  
Vol 16 (1) ◽  
pp. 53-58 ◽  
Author(s):  
Hans Ottosson ◽  
Martin Grann ◽  
Gunnar Kullgren
Keyword(s):  
Personality Disorder ◽  
Anxiety Disorders ◽  
Personality Disorders ◽  
Clinical Sample ◽  
Self Report ◽  
Anxiety State ◽  
Short Term ◽  
Retest Reliability ◽  
Axis I ◽  
Test Retest Reliability

Summary: Short-term stability or test-retest reliability of self-reported personality traits is likely to be biased if the respondent is affected by a depressive or anxiety state. However, in some studies, DSM-oriented self-reported instruments have proved to be reasonably stable in the short term, regardless of co-occurring depressive or anxiety disorders. In the present study, we examined the short-term test-retest reliability of a new self-report questionnaire for personality disorder diagnosis (DIP-Q) on a clinical sample of 30 individuals, having either a depressive, an anxiety, or no axis-I disorder. Test-retest scorings from subjects with depressive disorders were mostly unstable, with a significant change in fulfilled criteria between entry and retest for three out of ten personality disorders: borderline, avoidant and obsessive-compulsive personality disorder. Scorings from subjects with anxiety disorders were unstable only for cluster C and dependent personality disorder items. In the absence of co-morbid depressive or anxiety disorders, mean dimensional scores of DIP-Q showed no significant differences between entry and retest. Overall, the effect from state on trait scorings was moderate, and it is concluded that test-retest reliability for DIP-Q is acceptable.

External Validity of SCORS-G Ratings of Thematic Apperception Test Narratives in a Sample of Outpatients and Inpatients

2015 ◽  
Vol 36 (1) ◽  
pp. 58-81 ◽  
Author(s):  
Michelle B. Stein ◽  
Jenelle Slavin-Mulford ◽  
Caleb J. Siefert ◽  
Samuel Justin Sinclair ◽  
Michaela Smith ◽  
...  
Keyword(s):  
Life Events ◽  
Psychiatric Hospitalization ◽  
Clinical Care ◽  
Thematic Apperception Test ◽  
Clinical Samples ◽  
Cross Sectional ◽  
Conduct Disordered ◽  
Global Ratings ◽  
Thematic Apperception ◽  
History Of

Abstract. The Social Cognition and Object Relations Scale-Global Ratings Method (SCORS-G; Stein, Hilsenroth, Slavin-Mulford, & Pinsker-Aspen, 2011 ) is a reliable system for coding narrative data, such as Thematic Apperception Test (TAT) stories. This study employs a cross-sectional, correlational design to examine associations between SCORS-G dimensions and life events in two clinical samples. Samples were composed of 177 outpatients and 57 inpatients who completed TAT protocols as part of routine clinical care. Two experienced raters coded narratives with the SCORS-G. Data on the following clinically relevant life events were collected: history of psychiatric hospitalization, suicidality, self-harming behavior, drug/alcohol abuse, conduct-disordered behavior, trauma, and education level. As expected, the clinical life event variable associated with the largest number of SCORS-G dimensions was Suicidality. Identity and Coherence of Self was related to self-harm history across samples. Emotional Investment in Relationships and Complexity of Representations were also associated with several life events. Clinical applications, limitations of the study, and future directions are reviewed.

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