Defining severity of personality disorder using electronic health records: short report.

Severity of personality disorder is an important determinant of future health. However, this key prognostic variable is not captured in routine clinical practice. Using a large clinical data-set, we explored the predictive validity of items from the Health of Nation Outcome Scales (HoNOS) as potential indicators of personality disorder severity.

Categorical and dimensional approaches in the evaluation of the relationship between attachment and personality disorders: an empirical study.

Although several studies have highlighted the relationship between attachment states of mind and personality disorders, their findings have not been consistent, possibly due to the application of the traditional taxonomic classification model of attachment. A more recently developed dimensional classification of attachment representations, including more specific aspects of trauma-related representations, may have advantages. In this study, we compare specific associations and predictive power of the categorical attachment and dimensional models applied to 230 Adult Attachment Interview transcripts obtained from personality disordered and nonpsychiatric subjects.

Reflective function as a mediator between childhood adversity, personality disorder and symptom distress.

A growing body of literature has indicated the central role of childhood adversity for the development in later life of personality disorder (PD) and psychiatric distress. In this investigation, we examine the role of reflective function (RF) as a mediator between childhood adversity, subsequent development of PD and psychiatric morbidity. We tested the hypothesis that adversity leads to decreased RF, which in turn is associated with PD, and both increase the likelihood of psychiatric distress.

Clinical associations of deliberate self-injury and its impact on the outcome of community-based and long-term inpatient treatment for personality disorder.

Background: Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). There are gaps in our knowledge of DSI as an indicator of severity of psychopathology, as moderator of outcome and with regard to its response to different treatment programs and settings.

Methods: We compare 2 samples of PD with (n = 59) and without (n = 64) DSI in terms of clinical presentation, response to psychosocial treatment and relative outcome when treated with specialist long-term residential and community-based programs.

Psychiatric morbidity and treatment pathway outcomes of patients presenting to specialist NHS psychodynamic psychotherapy services: results from a multi-centre study.

Objective: Little is known about socio-demographic, diagnostic, and clinical characteristics of patients referred for assessment to psychodynamic psychotherapy services. The aim of this study was to remedy this by prospectively collecting comprehensive and systematic demographic and clinical information on a large number of patients referred to NHS psychodynamic psychotherapy services.

Design: Fourteen psychotherapy services operating within a National Health Service joined the study and contributed data for 1,136 patients referred from primary and secondary care clinics.

Prediction of medium-term outcome in cluster B personality disorder following residential and outpatient psychosocial treatment.

Background: There is a paucity of research concerning the identification of individual characteristics predictive of outcome in the treatment of personality disorders (PDs).

Methods: In this study, we carried out a predictor analysis of a sample of 73 hospitalized patients with a primary diagnosis of cluster B PD admitted to two different psychosocial programs for PD: (a) long-term inpatient treatment, and (b) a step-down program.

Results: Younger age, higher Global Assessment Scale intake scores, longer length of treatment, absence of self-mutilation and avoidant PDs were a significant predictor of outcome at 24-month follow-up.

Psychosocial treatment for severe personality disorder. 36-month follow-up.

Background: In a previous report a step-down psychosocial programme for severe personality disorders was found to be more effective at expected termination of treatment than a longer in-patient treatment with no planned after-care.

Aims: To evaluate the clinical effectiveness of these two psychosocial specialist programmes over a 3-year follow-up period.

Method: Two samples allocated to the in-patient treatment and to the step-down programme were compared prospectively on symptom severity, social adjustment, global assessment of mental health and other clinical indicators at 6, 12, 24 and 36 months after intake.

When less is more: An exploration of psychoanalytically oriented hospital-based treatment for severe personality disorder.

This paper discusses the main findings of a prospective study based at the Cassel Hospital, a centre dedicated to the psychoanalytically informed residential treatment of severe personality disorders. The results--showing that significantly greater improvements on a number of outcome indicators were found in patients exposed to the psychoanalytically informed treatment programmes compared to a general psychiatric approach based on management and pharmacotherapy alone--underscores the importance and the centrality of the psychoanalytic input in the treatment of severe personality disorders. However, the results of the study also suggested that some features of long-term hospital treatment might carry the risk of iatrogenic and anti-therapeutic effects for a sub-group of patients with severe borderline core pathology.

Patients' characteristics, outcome and cost-benefit of hospital-based treatment for patients with personality disorder: a comparison of three different programmes.

In this study we aimed (a) to ascertain whether a relationship exists between different treatment programmes and settings for personality disorder and patient characteristics; (b) to give an indication of treatment effects in three personality disordered populations admitted to different treatment contexts; and (c) to compare costs in relation to outcomes. We collected and compared three samples from one in-patient site (Cassel in England) and two day hospitals (Halliwick in England and Ulleval in Norway) on a number of demographic, diagnostic and other key clinical variables. Outcome in the areas of symptom severity (Symptom Checklist-90-R) and social adaptation (Social Adjustment Scale) was evaluated by comparing admission with discharge scores.

Health service use costs by personality disorder following specialist and nonspecialist treatment: a comparative study.

The impact of specialist psychosocial treatment on health service use costs by patients with personality disorder is not yet sufficiently documented. In this prospective study we compare patterns of health service costs by three groups of people with personality disorder treated in a hospital-based program (IPP), a step down program (SDP), and a general psychiatric program (GPP). Total service use costs at follow up, compared with intake costs, showed that significantly higher savings were achieved by SDP and IIP compared with GPP.

Early termination of treatment in personality disorder treated in a psychotherapy hospital. Quantitative and qualitative study.

Background: Factors underlying premature discontinuation of psychosocial in-patient treatment are still unclear.

Aims: Investigation of early discontinuation of specialised in-patient psychosocial treatment in a sample of people with personality disorder.

Method: Out of 134 consecutive admissions to the Cassel Hospital, 42 early drop-outs and 92 patients who remained were compared on demographic and clinical variables.

Cassel Personality Disorder Study. Methodology and treatment effects.

Background: The effectiveness of hospital-based treatment models for personality disorder is still uncertain.

Aims: To compare effectiveness of two models of psychosocial intervention for personality disorder.

Method: Two samples of people with personality disorder allocated to a one-stage treatment model (in-patient treatment with no after care) and to a two-stage model (shorter in-patient admission followed by outreach therapy) are prospectively compared.

Hospital adjustment in personality disorder patients admitted to a therapeutic community milieu.

This study investigated aspects of adjustment to the therapeutic community milieu in a group of personality disorder patients. Eighty-one patients consecutively admitted to the Cassel Hospital for medium/long-term residential treatment between April 1994 and October 1997 comprised the sample. The adjustment to the milieu was rated on the Hospital Adjustment Scale, while outcome was evaluated at 6-monthly intervals using a battery of self-rated and rater-based instruments.

A model of psychosocial care for severe personality disorder.

This paper describes the development of a preliminary model of psychosocial outreach nursing for patients with severe personality disorder. Through a grounded theory approach the outreach nurse evaluates their role and spheres of psychosocial intervention. Psychodynamic theory enhances an understanding of the nurse-patient relationship and the nature of the patient's difficulties, facilitating appropriate nursing interventions.

The use of leisure activities in a therapeutic community.

This paper is concerned with the use of social and leisure activities as part of nursing work in a therapeutic community. It describes this element in the therapeutic programme of the Cassel Hospital. There is a brief introduction to the general principles of the therapeutic community and then to the nurses' role at the Cassel Hospital.

When loyalties are divided between teachers and patients.

Three situations are described where a junior doctor is required by his consultant to do something that he thinks is not in the patient's best interests. The dilemma is explored from the perspective of patients' interests being the doctor's first concern; of the importance of respect for medical teachers, and of the implications of an apprenticeship model of postgraduate medical training.

A comparative study of psychotherapy referrals.

This retrospective study examines the effects of a change in policy in the method of offering appointments for assessment to patients referred to an out-patient psychotherapy service. It was anticipated that the new system would reduce the frequency of non-attendance (DNAs) at assessment interviews, increase the proportion of attenders judged suitable for psychotherapy and reduce the proportion of early dropouts amongst those commencing therapy. Results confirmed a reduction in DNAs, but suitability for therapy was not enhanced, nor did the rate of early dropouts diminish.

Child physical abuse observed. Comparison of families with and without history of child abuse treated in an in-patient family unit.

Twenty-seven families, 14 with a history of child physical abuse and 13 with no such history, were studied over the course of intensive in-patient treatment. The families in the former group differed significantly from those in the latter group in terms of current circumstances and background histories. Families where abuse was admitted benefited significantly more from treatment than families where abuse was suspected but not admitted.

Chronically ill psychiatric patients in a district general hospital unit. A survey and two-year follow-up in an inner-London health district.

A survey was undertaken at the end of 1984 of all patients occupying psychiatric beds for more than six months in an inner-London health district. Excluding those with senile dementia, 30 patients were identified. Two years later, a follow-up survey traced the original cohort and the accumulation of additional patients on the wards.