Inpatient management of borderline personality disorder at Helen Joseph Hospital, Johannesburg.

Laila Paruk,Albert B.R Janse Van Rensburg

doi:10.4102/sajpsychiatry.v22i1.678

Abstract

ObjectiveThe aim of this report was to establish a profile of patients with borderline personality disorder (BPD) admitted to the acute inpatient psychiatric assessment unit at the Helen Joseph Hospital, in Johannesburg, over the course of 1 year.MethodsA retrospective record review was conducted to investigate the prevalence, demographics, reasons for admission, treatment, length of stay and follow-up of a group of inpatients during 2010 with a diagnosis of BPD, based on DSM-IV-TR diagnostic criteria, allocated on discharge.ResultsConsidering evidence retrospectively, the quality of the BPD diagnosis allocated appeared adequate. Statistical analysis revealed findings mainly in keeping with other reports, for example, that patients with BPD are above-average users of resources who make significantly more use of emergency services and that they generally do not adhere well to their scheduled outpatient follow-up arrangements. The longer average length of inpatient stay of this group with BPD, however, exceeded the typically brief period generally recommended for acute inpatient containment and emergency intervention.ConclusionImplementation of targeted prevention and early intervention strategies, based on systematised programmes such as dialectical behavioural therapy and mentalisation based therapy, may be useful in addressing these problems experienced with integrating the in- and outpatient management of BPD.

Highlights

According to Davison:. . . the management of patients with personality disorder is one of the most challenging and sometimes controversial areas of psychiatry.[1]They have many diverse needs, and often present repeatedly to psychiatric services
The DSM IV-TR characterises borderline personality disorder (BPD) as: A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts.[2]
To assess the quality of the diagnoses of BPD documented for these inpatients, the patients who have been allocated a diagnosis of BPD or borderline traits by doctors on discharge and those for whom evidence was retrospectively found in the clinical file to fulfil the diagnostic criteria were compared using a chi-square test to determine significance, which was set at p = 0.05

Summary

Introduction

The management of patients with personality disorder is one of the most challenging and sometimes controversial areas of psychiatry.[1]. They have many diverse needs, and often present repeatedly to psychiatric services. A pervasive pattern of instability of interpersonal relationships, self-image and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts.[2]. It describes nine criteria, of which five must be fulfilled in order for a diagnosis of BPD to be made. A fifth edition of the DSM (DSM 5) was introduced in May 20133; there have been no significant changes to the description of personality disorders (Appendix 1)

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Results

Discussion

Conclusion