scholarly journals An audit to look at the prescribing of psychotropic medication in the general adult inpatient setting in patients with emotionally unstable personality disorder

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S31-S31
Author(s):  
Declan Hyland ◽  
Charlie Daniels ◽  
Iulian Ionescu ◽  
Christina Houghton ◽  
Katie Goodier ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Psychotropic Medication ◽  
Psychotropic Medications ◽  
Inpatient Setting ◽  
Mood Stabiliser ◽  
Supportive Psychotherapy ◽  
Psychiatric Comorbidities ◽  
Prescribing Practice ◽  
Medication Prescribing ◽  
Emotionally Unstable Personality Disorder

AimsTo assess the frequency of prescription of psychotropic medication in patients with a primary diagnosis of emotionally unstable personality disorder (EUPD) following admission to Clock View Hospital, an inpatient unit in Mersey Care NHS Foundation Trust.MethodA retrospective analysis of the electronic (RiO) record of 50 patients discharged from Clock View Hospital between 1 January 2020 and 1 November 2020 was performed to assess prescribing practice.Twenty-five patients with a diagnosis of EUPD and no associated psychiatric comorbidities were included in the sample, as well as 25 patients with a diagnosis of EUPD and associated psychiatric comorbidities.Result80% of the 25 patients with EUPD and associated psychiatric comorbidities were prescribed psychotropic medication prior to admission to hospital (56% an antidepressant, 24% a mood stabiliser, 60% an antipsychotic and 8% a benzodiazepine). 64% of patients were prescribed two or more psychotropic medications. 28% were initiated on new psychotropic medications following admission. For four of the seven prescriptions commenced on psychotropic medication, prescribing practice was as advised in Mersey Care's EUPD guidelines.Of the 25 patients with EUPD and no associated psychiatric comorbidities, 96% of the patients were prescribed psychotropic medication prior to admission to hospital (56% an antidepressant, 20% a mood stabiliser, 72% an antipsychotic and 12% a benzodiazepine). 68% of patients were prescribed two or more psychotropic medications. Following admission, 28% of patients were initiated on new regular psychotropic medications. For five of the eight prescriptions for new psychotropic medication, prescribing practice was as advised in Mersey Care's EUPD guidelines.78% of the 50 patients were prescribed as required (PRN) psychotropic medication. In 21 patients, PRN medication was prescribed for longer than one week.ConclusionThere is a higher rate of prescribing of antipsychotic prescription in those EUPD patients with no psychiatric comorbidities compared to associated psychiatric comorbidities (72% vs 60%). Surprisingly, there was a lower rate of psychotropic polypharmacy in those with psychiatric comorbidities.Use of PRN psychotropic medication for longer than a week was higher in those patients with psychiatric comorbidities compared to those without psychiatric comorbidities (58% vs 50%). Benzodiazepines were overwhelmingly the most consistently prescribed PRN medication for patients with EUPD.One action to consider would be highlighting the importance of trialling psychologically-minded interventions and supportive psychotherapy prior to initiation of psychotropic medication. There also needs to be consideration to use of the sedative antihistamine promethazine as a first-line PRN medication for acute agitation.

PRN Medication for Psychiatric Inpatients

1987 ◽  
Vol 32 (3) ◽  
pp. 199-203 ◽  
Author(s):  
John L. Craven ◽  
Peter M. Voore ◽  
George Voineskos
Keyword(s):  
Personality Disorder ◽  
Drug Use ◽  
Psychotropic Drug ◽  
Teaching Hospital ◽  
Psychotropic Medication ◽  
Psychotropic Drugs ◽  
Psychiatric Inpatient ◽  
Psychiatric Inpatients ◽  
Psychotropic Medications ◽  
Inpatient Units

Little is known about the extent of the use of prn psychotropic medication in psychiatric inpatient units. A survey of the prn prescription and administration of psychotropic drugs in a psychiatric teaching hospital revealed that a large number of inpatients were prescribed and administered such drugs on a prn basis. Although 50% of the prescriptions were never administered, only 25% were actively discontinued by physicians. A diagnosis of personality disorder was the factor most frequently associated with the rate of prn prescriptions and of administrations. A large number of prn prescriptions had no instructions for indications, minimum time spacing between doses or maximum daily dosage. It is suggested that hospitals monitor the prn use of psychotropic medications in their inpatient units, and explore the reasons for such use. Psychotropic drug use on a prn basis should preferably be reserved for emergencies, and the instructions of prn prescriptions should be clear and detailed.

scholarly journals Comparing psychotropic medication prescribing in personality disorder between general mental health and psychological services: retrospective cohort study

BJPsych Open ◽  
2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Giouliana Kadra-Scalzo ◽  
Jacqueline Garland ◽  
Stephen Miller ◽  
Chin-Kuo Chang ◽  
Marcella Fok ◽  
...  
Keyword(s):  
Personality Disorder ◽  
Psychotropic Medication ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Service Use ◽  
Mental Healthcare ◽  
Psychological Services ◽  
Sensitivity Analyses ◽  
Healthcare Database ◽  
Medication Prescribing

Background Although no drugs are licensed for the treatment of personality disorder, pharmacological treatment in clinical practice remains common. Aims This study aimed to estimate the prevalence of psychotropic drug use and associations with psychological service use among people with personality disorder. Method Using data from a large, anonymised mental healthcare database, we identified all adult patients with a diagnosis of personality disorder and ascertained psychotropic medication use between 1 August 2015 and 1 February 2016. Multivariable logistic regression models were constructed, adjusting for sociodemographic, clinical and service use factors, to examine the association between psychological services use and psychotropic medication prescribing. Results Of 3366 identified patients, 2029 (60.3%) were prescribed some form of psychotropic medication. Patients using psychological services were significantly less likely to be prescribed psychotropic medication (adjusted odds ratio 0.48, 95% CI 0.39–0.59, P<0.001) such as antipsychotics, benzodiazepines and antidepressants. This effect was maintained following several sensitivity analyses. We found no difference in the risk for mood stabiliser (adjusted odds ratio 0.79, 95% CI 0.57–1.10, P = 0.169) and multi-class psychotropic use (adjusted odds ratio 0.80, 95% CI 0.60–1.07, P = 0.133) between patients who did and did not use psychological services. Conclusions Psychotropic medication prescribing is common in patients with personality disorder, but significantly less likely in those who have used psychological services. This does not appear to be explained by differences in demographic, clinical and service use characteristics. There is a need to develop clear prescribing guidelines and conduct research in clinical settings to examine medication effectiveness for this population.

scholarly journals Three clinical pearls in the treatment of patients with seizures and comorbid psychiatric disorders

2017 ◽  
Vol 7 (6) ◽  
pp. 235-245 ◽  
Author(s):  
Kimberly Tallian
Keyword(s):  
Quality Of Life ◽  
Psychiatric Disorders ◽  
Psychotropic Medication ◽  
Strong Association ◽  
Psychotropic Medications ◽  
Seizure Threshold ◽  
Hypersensitivity Reactions ◽  
Psychiatric Comorbidities ◽  
The Impact

Abstract A strong association exists between epilepsy and psychiatric comorbidities, especially depression, anxiety, attention deficit disorders, and psychosis. The impact of psychotropic medications in lowering seizure threshold both directly and indirectly, hypersensitivity reactions to antiepileptic and other psychotropic medications, and how antiepileptic drugs affect psychiatric disorders are explored through three patient cases. Ultimately, in selecting an appropriate psychotropic medication for an individual with epilepsy and psychiatric comorbidities, it is important to consider the clinical and quality-of-life impacts that a particular medication will have on that individual.

scholarly journals Management of emotionally unstable personality disorder in an urban Irish setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S324-S325
Author(s):  
Calvin Har Siu Yee
Keyword(s):  
Mental Health ◽  
Personality Disorder ◽  
Community Mental Health ◽  
Psychotropic Medication ◽  
Psychiatric Care ◽  
Significant Proportion ◽  
Emotional Dysregulation ◽  
Urban Setting ◽  
Service Users ◽  
Emotionally Unstable Personality Disorder

AimsTo determine the prevalence of emotionally unstable personality disorder (EUPD) attending a community mental health team (CMHT) in a major Irish cityTo describe the current psychiatric care afforded to this cohort of service userMethodClinical chart review of all 328 patients attending a CMHT outpatient in an urban setting was carried out. Patients diagnosed with EUPD or displayed features of EUPD were identified. Data on the various interventions offered to this cohort of service users were collected and compared against current guidelines.ResultOut of the 328 patients actively attending the service, almost 17% (n = 55) were diagnosed with EUPD and further 6% (n = 19) were found to display features of EUPD such as emotional dysregulation, self-harming behaviour and cognitive distortions. Comorbid psychiatric disorder such as mood or anxiety spectrum disorder was diagnosed in 23% (n = 17) of this cohort. Meanwhile, 8% (n = 6) was diagnosed with addiction disorders and 5% (n = 4) was diagnosed with a comorbid personality disorder. A significant proportion of 77% (n = 57) were prescribed psychotropic medication with 51% (n = 29) being on more than one psychotropic medication. Antidepressants, antipsychotics and hypnotics were the three most common medications prescribed at the rate of 89% (n = 51), 30% (n = 17) and 28% (n = 16) respectively. A majority of 66% (n = 49) were offered intervention from a multi-disciplinary team (MDT) member with 47% (n = 23) being offered more than one type of intervention. Referrals to community mental health nurses and psychology service were the two most common interventions offered with a referral rate of 59% (n = 29) and 55% (n = 27) respectively. 28% (n = 21) of service users with EUPD or EUPD traits has had at least one hospital admission while attending the CMHT and 46% (n = 34) have been admitted to the day hospital at least once.ConclusionThe prevalence of EUPD in our outpatient sample corresponds with findings in previous studies. Standard psychiatric care is the most common option available to the majority of general adult patients with EUPD in Ireland due to the lack of any national treatment programme and scarce availability of specialised therapeutic approaches such as dialectical behavioural therapy within community mental health teams. Our CMHT will attempt to integrate mentalization-based treatment into our outpatient management of EUPD patients taking into account current clinical guidelines for management of EUPD and resources needed for training and delivering the intervention.

scholarly journals Treatment of Severe Emotionally Unstable Personality Disorder with Comorbid Ehlers-Danlos Syndrome and Functional Neurological Disorder in an Inpatient Setting: A Case for Specialist Units without Restrictive Interventions

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Jessica Henry ◽  
Eddie Collins ◽  
Amanda Griffin ◽  
Jorge Zimbron
Keyword(s):  
Personality Disorder ◽  
Childhood Abuse ◽  
Neurological Disorder ◽  
Suicide Attempts ◽  
Inpatient Setting ◽  
Ehlers Danlos Syndrome ◽  
Nonepileptic Seizures ◽  
Emotionally Unstable Personality Disorder ◽  
Danlos Syndrome ◽  
Functional Neurological Disorder

We present the case of a young woman with an Emotionally Unstable Personality Disorder (EUPD) diagnosis suffering from high-risk self-injurious behaviour. She was also diagnosed with Ehlers-Danlos Syndrome and Functional Neurological Disorder, manifesting as nonepileptic seizures and immobility. Our patient, “A,” endured traumatic childhood abuse and became highly dependent on services in her late teens. Recurrent suicide attempts resulted in twenty to thirty acute psychiatric admissions, Intensive Care Unit stays, and multiple failed trials of psychological therapy. Nonepileptic seizures and wheelchair dependency made her “too complex” for many specialist services. She was eventually admitted to Springbank ward in Fulbourn Hospital, Cambridge. The EUPD specialist unit prides itself on evidence-based treatments, shared values, and a least restrictive approach. At discharge, our patient was self-harm free and able to walk unaided and no longer met EUPD diagnostic criteria. We include “A’s” personal views on her illness and how Springbank ward facilitated her recovery, together with results from structured clinical outcome measures.

scholarly journals An evaluation of the incorporation of psychological interventions into the care of patients with a diagnosis of emotionally unstable personality disorder following admission to the general adult inpatient setting

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S327-S327
Author(s):  
Declan Hyland ◽  
Charlie Daniels ◽  
Iulian Ionescu ◽  
Katie Goodier ◽  
Simon Graham
Keyword(s):  
Risk Management ◽  
Personality Disorder ◽  
Psychological Intervention ◽  
Psychological Treatment ◽  
Management Plan ◽  
Risk Management Plan ◽  
Care Plan ◽  
Inpatient Setting ◽  
Psychiatric Comorbidities ◽  
Extended Care

AimsTo assess incorporation of and access to psychological therapies for patients with a diagnosis of emotionally unstable personality (EUPD) who were discharged from the inpatient wards at Clock View Hospital, an inpatient unit in Mersey Care NHS Foundation Trust.MethodA retrospective analysis of the electronic record of 50 patients discharged from Clock View Hospital between 1st of January 2020 and 1st of November 2020 was performed to assess whether patients were engaged with psychotherapy and whether they had an extended care plan in place.25 patients with EUPD and no associated psychiatric comorbidities were included in the sample, as well as 25 patients with EUPD and associated psychiatric comorbidities.ResultThose EUPD patients with no psychiatric comorbidities were more likely to be under the care of the Liverpool Personality Disorder (PD) Hub compared to those with psychiatric comorbidities (12 vs seven patients). Of the 19 patients under the PD Hub, 11 had a Case Manager, four were engaged with the PD Hub's day services / safe service and one with a PD Hub readiness group. Six of the 50 patients had a documented refusal to engage with the PD Hub.Only 27 of the patients had either received psychological intervention, were on a waiting list, or had a referral in place. 16% of patients refused a psychotherapy referral. Of the 20 patients who received psychological treatment, eight completed a form of psychotherapy (cognitive analytic therapy, dialectical behaviour therapy, cognitive behavioural therapy, eye movement desensitisation and reprocessing) and 12 psychological intervention (either structured case management, psychoeducation or emotional coping skills).Only 28 of 50 patients had an extended care plan and 28 had a collaborative risk management plan in place.ConclusionThere was no obvious correlation between previous completion of psychological therapy and degree of polypharmacy. Median admission time was reduced for patients under the PD Hub (six vs 14 days). This was also reduced for patients who accessed psychotherapy or psychotherapeutic interventions (nine vs 10 days).This audit coincided with the COVID-19 pandemic and subsequent reduced access to the PD Hub and psychotherapy service. There is a need to consider barriers to EUPD patients receiving psychotherapy.EUPD patients may have numerous hospital admissions and frequently present in crisis. Given the iatrogenic harm from prolonged hospital admission, there is a need to consider incorporating a collaborative extended care plan and risk management plan as part of discharge planning, following admission to hospital.

scholarly journals Implementing an Interdisciplinary Committee to Reduce Psychotropic Drug and Increase Behavioral Intervention Use

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 306-306
Author(s):  
Lauren Hess Conrad ◽  
David Portman
Keyword(s):  
Psychotropic Drug ◽  
Behavioral Intervention ◽  
Psychotropic Medication ◽  
Behavioral Interventions ◽  
Psychotropic Medications ◽  
Interdisciplinary Treatment ◽  
Fiscal Year ◽  
Term Care ◽  
Care Plans ◽  
And Behavior

Abstract In Fiscal Year (FY) 2018, the Butler VA Health Care System’s Psychotropic Medication and Behavior Management Committee was identified as a Veterans Integrated Service Network 4 Best Practice. The goal of this committee is to reduce unnecessary psychotropic medication use and polypharmacy and to increase behavioral intervention implementation among Community Living Center (CLC) Veterans. This committee meets quarterly to review Psychotropic Drug Safety Initiative data, behaviors and behavior care plans, and all psychotropic medications prescribed to Veterans. Psychiatric diagnoses, changes to psychotropic medications, and appropriate behavioral interventions are discussed. Committee members take responsibility for action items in accordance with their discipline; documentation of recommendations are made in quarterly behavioral health assessments in CPRS; and follow-up on action items is completed at twice weekly interdisciplinary treatment team meetings, weekly behavior rounds, and/or as needed. From the first quarter (Q1) of FY16 to Q1 FY20, the Butler VA CLC has seen decreased prescriptions of 2 or more anticholinergics (6.6% to 0.80%), antihistamines (12.5% to 5.9%), benzodiazepines (24.7% to 11.0%), and benzodiazepines or sedative hypnotics (23.2% to 9.0%). While prescription of antipsychotic use has increased (Q1 FY20 = 23.8%), the committee will follow Long Term Care Institute guidelines for gradual dose reductions, behavioral interventions, and as needed psychotropic medication PRN use. This committee provides an interdisciplinary forum to discuss and implement beneficial changes to pharmacological and non-pharmacological interventions among all CLC Veterans. The committee is a valuable process for monitoring and reinforcing best practices that may be easily replicated across VA CLCs nationwide.

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