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STRUCTURED ADMISSION TO PREVENT CRISIS ADMISSION IN BORDERLINE PERSONALITY DIOSRDER VALSA MANNALI JOHN PRENTICE EMMA MACRAE CAROL SPRATT NEW CRAIGS HOSPITAL NHS HIGHLAND BORDERLINE PERSONALITY DISORDER Known for excessive use of psychiatric services Crisis, chaotic, lengthy & repeated admissions Benefit of admission doubtful 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 Prearranged structured admissions Eclectic therapy Team effort Psychosocial management No medical review Behavioural contract Positive reinforcement Further admission on the merit of previous admission AIMS 1. 2. 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. HYPOTHESES 1. 2. Planned, structured admission can prevent crisis admission in BPD Study outcome will help in identifying prognostic indicators. 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. INCLUSION CRITERIA Both genders Age between 18-60 DSM-IV diagnosis of BPD At least one crisis presentation at New Craigs Hospital. 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 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 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. 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 OTHERS Informed consent Ethics Appropriate statistical analysis 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 THANK YOU